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Johnson: Hospitals sock it to those least able to pay

By Bill Johnson, Rocky Mountain News (Contact)

Published February 8, 2006 at midnight

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Way too many people keep asking about my Christmas Day stay in the hospital, and the $14,500.54 bill that came with it.

The maybe-not-too-surprising thing, many of them say, is that even at that price, I got off pretty cheaply.

I could not begin to fully recount here the hospital- bill stories I've heard or read about.

I still remember a woman's tale of how her uninsured husband went into the emergency room for minor shoulder pain and walked out with $21,000 in charges.

Most were tales of heart-related emergencies, both real and false alarms, that resulted in bills ranging from $60,000 to more than $150,000 - sums these uninsured folks now must pay or, they said, face unthinkable consequences.

Come to think of it, maybe I did get off easy. In fact, I did - but only because I have insurance.

The mail arrived the other day, and my wife was nearly doubled over in laughter as she read the "explanation of benefits" letter our insurer sent.

"How much of that $14,500 do you think the insurance company paid?" she asked.

I don't know, I replied - what? - maybe $5,000?

She handed me the statement. Of the $14,500.54 the hospital had submitted, our insurer negotiated a $1,225 settlement, plus another $1,000 or so with the doctors, technicians and labs.

My responsibility in all of it totaled $122.50.

"In determining the amount of a charge that is covered," the letter explained, "we consider other factors, including the prevailing charge in other areas. (Our) determination of the prevailing charge does not suggest your provider's fee is not reasonable and proper."

Whatever. One-hundred, twenty-two bucks certainly will not bankrupt me.

For every story like mine, there are many more like Scott Ferguson's. He is, I think, a man you'd probably never want to tick off.

His story began in December 2003, when he went to the hospital for what doctors initially diagnosed as pneumonia. It turned out that he'd suffered a heart attack.

And today he needs a heart transplant, he said. He is also uninsured.

Yet it isn't his physical condition or the fact he needs a major operation that he cannot afford that has him ticked off. The hospital is demanding payment on its $66,900 bill for treatment.

Scott Ferguson, 53, a retired musician from Wheat Ridge, said he was still in the hospital when he asked to speak with the facility's director of finance.

He knew his bill for the six days there would be gargantuan. He said he requested all of the codes related to his treatment that the hospital would give his insurance company - well, if he had one.

Only months later, after threatening to sue, did he get the codes and the corresponding amounts an insurance company would pay.

Then he did sue.

In a 2004 federal lawsuit against Centura Health Corp., Ferguson contended the hospital would have charged a patient with private insurance about $9,000, and a patient covered by Medicare about $8,000, for the same care he received.

"The bill they give you is totally different from the one they give the insurance companies," he said.

His federal lawsuit was tossed out, Scott Ferguson said.

In the meantime, he has launched a crusade against what he calls hospital "gouging," collecting stories of individuals facing the loss of their homes for the simple reason they got ill when they had no health insurance.

"I've got so many stories, of uninsured people going into the ER with a headache, who come out with $25,000 bills. It is . . . a long, deep horror story."

So he has formed the Colorado Hospital Victims Project.

"It consists of just me. I'm the only one screaming. You have to start somewhere."

But Ferguson has an ally in K.B. Forbes, director of a Los Angeles-based advocacy group, Consejo de Latinos Unidos, who has gained national attention as an advocate for the uninsured.

Forbes has attacked the practice of hospitals billing uninsured patients up to four times as much as they bill HMOs and Medicare for the exact same services, and he has addressed the Colorado Civil Rights Commission on the issue.

Both men are particularly wrathful in talking about church-related, nonprofit hospitals, alleging that they charge the uninsured "full list price," or as much as 200 percent over their costs.

"These are hospitals with Jesus and the saints in their lobbies, and they are creating poor people," Scott Ferguson said.

Last December, he said, he took his concerns to Washington, D.C., to pass out literature at a national Catholic bishop's conference.

"Not one of the bishops would talk to me," he said. "They wouldn't even take a flier."

He doesn't hazard a guess on what will happen with his $66,900 bill.

"But if one week in the hospital wipes out everything you have, tears apart your family, what can you do?"

In his case, a lot.

Bill Johnson's column appears Wednesday, Friday and Saturday. Call him at 303-892-2763 or e-mail him at .