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Old 02-17-2010, 12:07 PM
 
3 posts, read 4,658 times
Reputation: 10

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I'm not really sure where this post should go...but anyway...

I'm trying to figure out if this is common and if there is some rationale that I just don't see.

The hospital charged my one twin a higher rate for being in the "intermediary" nursery because she was under 6 pounds. The other twin, who slept in the same little cubby, was charged the "regular" nursery rate. Because of the way the charges were coded (and the way the insurance contract was written between the insurance co. and the provider), the Intermediary charges were nearly 3x the amount of the regular charges.

There was nothing wrong with my kids. They stayed in the room with me except for night time and any time they need to run a test or do something they required.

I know that you will pay at least "regular" rates for a child even if they stay in the same room with you. I'm ok with that. However, I'm not ok with charging me (or my insurance company - which is my employer since we are self funded) for services that were not rendered.

The insurance company acted like "the claim processed correctly based on the codes and the contract". The hospital repeatedly has said that they charged based on the weight (they tell me this over the phone) and in writing they basically say "you were charged correctly".

A co-worker of mine said this should be a class-action suit. I kind of agree. However, I'm sure lawyers would look at the big picture and see just how much money they could get out of this. This is not about the extra $1000 that I had to pay. To me, I see this as a systemic problem in the HCA hospital organization. You know that there are plenty of infants less than 6 pounds who are very healthy - maybe healthier than 6+ pound babies...but they are being charged higher rates. The hospital (or corporation in this case) is taking advantage of consumers and insurance companies. Besides "class-action" - are there other good ways to bring this issue to light to make HCA and others take notice? I've had several moms tell me just to "let it go...you'll never win". I'm one of those people who want to speak up and try to make a difference. You don't always succeed in making a change...but it has to start somewhere.
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Old 02-19-2010, 10:35 AM
 
621 posts, read 957,444 times
Reputation: 399
Quote:
Originally Posted by agvball View Post
I'm not really sure where this post should go...but anyway...

I'm trying to figure out if this is common and if there is some rationale that I just don't see.

The hospital charged my one twin a higher rate for being in the "intermediary" nursery because she was under 6 pounds. The other twin, who slept in the same little cubby, was charged the "regular" nursery rate. Because of the way the charges were coded (and the way the insurance contract was written between the insurance co. and the provider), the Intermediary charges were nearly 3x the amount of the regular charges.

There was nothing wrong with my kids. They stayed in the room with me except for night time and any time they need to run a test or do something they required.

I know that you will pay at least "regular" rates for a child even if they stay in the same room with you. I'm ok with that. However, I'm not ok with charging me (or my insurance company - which is my employer since we are self funded) for services that were not rendered.

The insurance company acted like "the claim processed correctly based on the codes and the contract". The hospital repeatedly has said that they charged based on the weight (they tell me this over the phone) and in writing they basically say "you were charged correctly".

A co-worker of mine said this should be a class-action suit. I kind of agree. However, I'm sure lawyers would look at the big picture and see just how much money they could get out of this. This is not about the extra $1000 that I had to pay. To me, I see this as a systemic problem in the HCA hospital organization. You know that there are plenty of infants less than 6 pounds who are very healthy - maybe healthier than 6+ pound babies...but they are being charged higher rates. The hospital (or corporation in this case) is taking advantage of consumers and insurance companies. Besides "class-action" - are there other good ways to bring this issue to light to make HCA and others take notice? I've had several moms tell me just to "let it go...you'll never win". I'm one of those people who want to speak up and try to make a difference. You don't always succeed in making a change...but it has to start somewhere.
Interesting post.

To look at it from their side, they may have created policy based on weight as some sort of "best practice" and are over-generalizing all babies under 6 lbs as a higher risk and in need of more supervised care.

If they do this across the board for all children under 6lbs, it is probably not at all fraudulent and more cautious medical practice having that half pound buffer. There is well - documented risk involved with complications and mortality rates for infants under 5.5lbs and since it takes no time at all for a 6lb baby to become a 5.5 pound baby, the 1/2 pound buffer can be justified.

This cautious approach would be broad since there is a correlation with low birth rate (under 5.5lbs) and infant mortality regardless of Apgar score at birth. When something happens with these infants, it's happening quickly and so they are over-monitoring.

Yes. It's possible that healthy babies never present with problems and in retrospect may be a waste. But, that care and caution will help an infant in distress who also appeared healthy at birth.

I think your mind and heart are in the right place in wanting to monitor Hospital waste and overcharging. In this case, I believe you just found a hospital with high standards of care and preventive policies.

To be sure, schedule a meeting with the Hospital Administrator and allow for time to review their policies and justifications. They'll give you the time and if their explanation is not satisfactory, then you have options.
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Old 02-19-2010, 12:24 PM
 
Location: Arizona
1,034 posts, read 3,972,421 times
Reputation: 1368
I also think your heart is in the right place. I think there is a fine line between what is healthy and what is viewed as unhealthy or sickly. My neice and nephew were considered healthy infants at 2.5 and 3.4 lbs each. They just needed to grow a little more. While they didn't have any challenges with breathing or feeding, they were still monitored around the clock in the NICU. I think 6 lbs may be pushing it a little. I personally think of a 5lb infant as being more fragile. But each hospital is different. Even though your child may have thrived in the hospital, the hospital probably compiled numbers that showed others of a similar weight needed to be observed more closely to ensure good feeding habits and unlabored breathing. I'm sorry to say but I have to agree that it may be a losing battle. That doesn't mean you should give up on what you believe though.
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Old 02-21-2010, 12:02 AM
 
3,191 posts, read 8,418,235 times
Reputation: 2181
Hmm, I guess that they could have charged you the "intermediary" on BOTH, if they did sleep together in the "intermediary" nursery any. I reckon they sorta gave you a discount on one
Good luck, enjoy them.
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Old 02-21-2010, 12:40 AM
Status: "Jungian kind of" (set 1 day ago)
 
Location: Hawaii
1,691 posts, read 3,878,892 times
Reputation: 3087
It's all about liability.
The hospital is acting according to "standards of care" that have been established per potential situation.
If something would have gone wrong with the underweight baby (which there are established wt limits and care procedures per hospital) and the hospital was not documenting accordingly then they would be the liable ones.
It's called defensive medicine and unfortunately adhered to because of all the law suits hospitals endure.
Enjoy your kids and be thankful they are OK.
There is no case.
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Old 02-21-2010, 07:16 AM
 
2,838 posts, read 9,199,998 times
Reputation: 2889
Quote:
Originally Posted by crazyma View Post
Hmm, I guess that they could have charged you the "intermediary" on BOTH, if they did sleep together in the "intermediary" nursery any. I reckon they sorta gave you a discount on one
Good luck, enjoy them.
According to the OP, though, they weren't in the "intermediary" nursery... they were in mom's room.

Very interesting. Just another way to overcharge, with no legal ramifications, I guess.
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Old 02-21-2010, 07:23 AM
 
3,646 posts, read 9,878,730 times
Reputation: 5456
[quote=TouchOfWhimsy;12991032]According to the OP, though, they weren't in the "intermediary" nursery... they were in mom's room. [quote]

According to the OP, they spent their nights in the nursery.
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