Letters to the Editor<\/a>\u00a0is a periodic feature. We\u00a0 welcome all comments<\/a>\u00a0and will publish a selection. We edit for length and clarity and require full names.<\/em><\/p>\n

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Envy for-profit US healthcare? Check out this MD whose wife is a medical billing expert who spent over a year challenging an egregious billing error. After it all they still paid $1200. These are resourceful knowledgeable people who got taken for a ride. https:\/\/t.co\/fnlUz3KTJb<\/a><\/p>\n
\u2014 Raghu Venugopal MD (@raghu_venugopal) October 26, 2022<\/a><\/p><\/blockquote>\n
\u2014 Dr. Raghu Venugopal, Toronto<\/em><\/p>\n
A Plea for Sane Prices<\/strong><\/p>\n
I just read your story about the emergency room billing for a procedure that was not done (\u201cA Billing Expert Saved Big After Finding an Incorrect Charge in Her Husband\u2019s ER Bill<\/a>,\u201d Oct. 25). We too had a similar experience with an emergency room and a broken arm that was coded at a Level 5, and it was a simple break. No surgery needed, and it took them only 10 minutes to set and wrap the broken arm but charged us over $9,000. I disputed the charges, and it took six months to get them to reduce the bill but they never admitted that they coded a simple break incorrectly to jack up the price of the bill. If it had been a Level 5 issue, we would not have sat in the waiting room for six hours before being seen. It was a horrible experience, and I think ERs all over the nation are doing this to make up for the non-payers they treat every day. It is robbery.<\/p>\n
\u2014 Terrence Campbell, Pocatello, Idaho<\/em><\/p>\n
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It would be great if the vaulted @KHNews<\/a> would clearly distinguish between the ED pro fee billing & hospital charges as it is not entirely clear here w\/ in network svs.\u2014Billing Expert Saved Big After Finding an Incorrect Charge in Her Husband\u2019s ER Bill https:\/\/t.co\/jRFAYb5F0P<\/a><\/p>\n
\u2014 Ed Gaines (@EdGainesIII) October 25, 2022<\/a><\/p><\/blockquote>\n
\u2014 Ed Gaines, Greensboro, North Carolina<\/em><\/p>\n
As you said, CPT codes should always be examined. This case is probably more than \u201cjust an error.\u201d As a retired orthopedic surgeon, chief of surgery, and chief of staff at a North Carolina hospital, I have seen care such as this coded exactly like this with the rationale that, \u201cHey, this was a fractured humerus and it was manipulated and splinted.\u201d 24505 is correct IF that is the definitive treatment, which it was not here. Even code 24500 would indicate definitive treatment without manipulation. This was just temporary care until definitive care could be done later. It should be billed as a visit and a splint. The visit for this, if it was an isolated problem (no other injury or problems), would qualify only as a Level 2 visit. That frequently gets upcoded as well by adding a lot of non-pertinent family, medical, and social history and a complete physical exam (seven systems at least) and a whole lot of non-pertinent \u201cmedical decision making.\u201d All of that should<\/em> be documented in the medical records even if the hospital stonewalls on the CPT codes.<\/p>\n
Look closely at medical records and you will find frequent upcoding, if you are familiar with the requirements for different levels of treatment.<\/p>\n
\u2014 Dr. Charles Beemer, <\/em>Arvada, Colorado<\/em><\/p>\n
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Never attribute to Baumol’s cost disease that which is adequately explained by malice. https:\/\/t.co\/RbKOlBgCmp<\/a><\/p>\n
\u2014 Shashank Bhat (@shashank_ps) October 26, 2022<\/a><\/p><\/blockquote>\n
\u2014 Shashank Bhat, San Francisco<\/em><\/p>\n
A number of years ago, I was billed using a code that described a treatment that was not carried out. In similar fashion, I talked with my insurance company, which basically said it did not care whether the treatment took place or not as all it required was for a valid code to appear. I also contacted the Virginia Bureau of Insurance, which approves the various policies, and it said it had no jurisdiction over claims. I decided to let the hospital sue me for the disputed amount and defended myself in district court. Despite their attorney and four \u201cwitnesses,\u201d the case was thrown out because the hospital was both unwilling and unable to justify the charges to the satisfaction of the judge. They did not want anybody in power to testify because of the questions they would have been asked, so they left it to people who were completely clueless. The takeaways from this were:<\/p>\n
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Hospitals make up the numbers and leave them grossly inflated so they can claim that they are giving away care when they give discounts on the made-up numbers.<\/li>\n
Hospitals turn employees into separate billing entities so they can double-charge.<\/li>\n
Hospitals open facilities such as physical therapy in hospital locations because insurance companies will pay higher amounts when treatment is carried out in a hospital environment.<\/li>\n
Insurance companies and state insurance agencies do not act as gatekeepers to protect their clients\/taxpayers.<\/li>\n
The insurance companies and the providers have a shared interest in the highest possible ticket prices and outrageous charges because the providers get to claim how generous they are with \u201cunremunerated care,\u201d and if the prices were affordable then they could not justify the high prices for insurance premiums and the allowed administration\/profit share of 20% would be based on a far smaller amount.<\/li>\n<\/ul>\n
In any other industry, this would have resulted in multiple antitrust suits. U.S. health care is a sad example of government, health care industry, and insurers all coming together against the interests of consumers. After this court case, I wanted to form a nonprofit to systematically challenge every outrageous charge against people who, unlike myself, did not believe or know how to defend themselves. If hospitals and other providers were forced to go to court to justify their charges on a systematic basis, pricing sanity would eventually prevail.<\/p>\n
\u2014 Philip Solomon, Richmond, Virginia<\/em><\/p>\n
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The obvious solution to prosecute the hospital for fraud followed by a civil suit”A hospital charged nearly $7,000 for a procedure that was never performed” https:\/\/t.co\/wPNNZ5cZey<\/a><\/p>\n
\u2014 Barry Ritholtz (@ritholtz) October 31, 2022<\/a><\/p><\/blockquote>\n
\u2014 Barry Ritholtz, New York City<\/em><\/p>\n
Patients as Watchdogs<\/strong><\/p>\n
Thank you for the article on Lupron Depot injections (Bill of the Month<\/a>: \u201c $38,398 for a Single Shot of a Very Old Cancer Drug<\/a>,\u201d Oct. 26). Last year, I was diagnosed with prostate cancer, though my case is not anywhere as severe as that experienced by Mr. Hinds.<\/p>\n
Last month my urologist scheduled an MRI update for me at a facility owned by Northside Hospital Atlanta. At the suggestion of my beloved wife, I called my insurance company, UnitedHealthcare, to make sure the procedure was covered. Fortunately, it was. That being said, the agent from UnitedHealthcare mentioned that Northside Hospital\u2019s fee was \u201cquite a bit higher than the average for your area.\u201d It was. Before insurance, the charge for an MRI at Northside was $6,291. I canceled the appointment at Northside and had the MRI done by a free-standing facility. Their charge, before insurance, was $1,234.<\/p>\n
Every single encounter that I have with the health care system involves constant vigilance against price-gouging. When I have a procedure, I have to make sure that the facility is in-network,. that each physician is in-network, that any attending specialist such as an anesthesiologist or radiologist is in-network (and their base-facility as well). If I have a blood test, I have to double-check if the cost is included in a procedure or if it is separate. If it is a separate fee, I have to ensure that the analysis is also covered, and, if it is not, that it is not done through a hospital-owned facility but instead through a free-standing operation.<\/p>\n
I have several ongoing conditions in addition to my prostate cancer \u2014 Dupuytren\u2019s contracture, a rare bleeding disorder similar to thrombocytopenia, and arthritis. Needless to say, navigating our byzantine, inefficient, and profit-driven health care system is a total nightmare.<\/p>\n
Health care in the United States has become so exceedingly outrageous. I cannot understand why it is not an issue that surfaces during election years or something that Congress is willing to address.<\/p>\n
Again, thank you for your excellent reporting.<\/p>\n
\u2014 Karl D. Lehman, Atlanta<\/em><\/p>\n
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Why capitalism without guardrails is a pipedream. Own the patent, control the pricing, and this is the result: $38,398 for a Single Shot of a Very Old Cancer Drug https:\/\/t.co\/BLes77QN7F<\/a> via @khnews<\/a><\/p>\n
\u2014 Brian Murphy (@NorwoodCDI) October 26, 2022<\/a><\/p><\/blockquote>\n
\u2014 Brian Murphy, Austin, Texas<\/em><\/p>\n
I was a medical stop-loss underwriter and marketer for over 30 years. Most larger (company plans for 100-plus employees) are self-funded, meaning the carrier \u2014 as in this case, UnitedHealthcare \u2014 is supplying the administrative functions and network access for a fee, while using the employer\u2019s money to pay claims.<\/p>\n
Every administrator out there charges a case management fee, either as a stand-alone charge or buried in their fees. Either way, they all tout how they are looking out for both the employer and the patient.<\/p>\n
Even if this plan was fully insured, wouldn\u2019t it have been in the best interest of all parties when they became aware of the patient\u2019s treatment (maybe after the first payment) to reach out to the patient and let them know there are other alternatives?<\/p>\n
The question in these cases is who is minding the store for both the patient and the employer. The employer, the insurer, and the patient could have all saved a lot of money and pain, if someone from case management had actually questioned the first set of charges.<\/p>\n
\u2014 Fred Burkacki, <\/em>Sarasota, Florida\u00a0<\/em><\/p>\n
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I did a few rounds of Lupron in my 20s for severe #endometriosis<\/a>, and I had to fight my insurance company to get approved. Now, this is how much it costs for some people. https:\/\/t.co\/UlB1TTtW40<\/a> #healthcare<\/a> #prostatecancer<\/a><\/p>\n
\u2014 Amanda Oglesby \ud83c\udf0a (@OglesbyAPP) October 26, 2022<\/a><\/p><\/blockquote>\n
\u2014 Amanda Oglesby, Neptune, New Jersey<\/em><\/p>\n
\u2018Bill of the Month\u2019 Pays Off<\/strong><\/p>\n
I received a $1,075 refund on a colonoscopy bill I paid months earlier after listening to the KHN-NPR \u201cBill of the Month<\/a>\u201d segment \u201c Her First Colonoscopy Cost Her $0. Her Second Cost $2,185. Why?<\/a>\u201d (May 31) and finding out the procedure should be covered under routine health care coverage. Thank you!<\/p>\n
\u2014 Cynthia McBride, University Place,<\/em> Washington<\/em><\/p>\n
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We have to close legal loopholes to make sure that cancer diagnostic procedures have the same insurance coverage as screening. Colonoscopies must be fully covered whether a polyp is found or not #ACA<\/a> #colorectalcancer<\/a> #CancerScreening<\/a> https:\/\/t.co\/slE6p3FvHe<\/a><\/p>\n
\u2014 Erica Warner, ScD (@ewarner_12) May 31, 2022<\/a><\/p><\/blockquote>\n
\u2014 Erica Warner, Boston<\/em><\/p>\n
Removing Barriers to Benefits<\/strong><\/p>\n
In the story \u201cPeople With Long Covid Face Barriers to Government Disability Benefits<\/a>\u201d (Nov. 9), you stated: \u201cMany people with long covid don\u2019t have the financial resources to hire a lawyer.\u201d This is incorrect. When applying for disability, you don\u2019t need<\/em> financial resources. There are law firms that specialize in disability claims and will not charge you until you win your claim. And, according to federal law, those law firms can charge only a certain percentage of the back pay you would get once the claim has been won. Also, if you lose the claim, and the law firm has appealed as many times as possible, you don\u2019t owe anything. Please don\u2019t make it more difficult for those who are disabled with misinformation.<\/p>\n
\u2014 Lorrie Crabtree, Los Angeles<\/em><\/p>\n
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People unable to work due to Long Covid are facing barriers to obtaining government disability benefits.https:\/\/t.co\/zWQfW5CkOS<\/a><\/p>\n
\u2014 Ron Chusid (@RonChusid) November 10, 2022<\/a><\/p><\/blockquote>\n
\u2014 Ron Chusid, Muskegon, Michigan<\/em><\/p>\n
Vaccine Injuries Deserve Attention, Too<\/strong><\/p>\n
I read your long-covid article with interest because many of the barriers and some of the symptoms faced by people with long covid are similar to those experienced by people with vaccine injuries. I\u2019m really concerned about how there is even less attention and support for people who suffered adverse vaccine reactions.<\/p>\n
Long covid and vaccine injuries are both issues of justice, mercy, and human rights as much as they are a range of complex medical conditions.<\/p>\n
It\u2019s nearly 20 months since someone I know sustained a serious adverse reaction, and it is heartbreaking how hard it has been for her to find doctors who will acknowledge what happened and try to help. There\u2019s no medical or financial support from our government, and the Countermeasures Injury Compensation Program is truly a dead end, even as other countries such as Thailand, Australia, and the United Kingdom have begun to acknowledge and financially support people who sustained vaccine injuries.<\/p>\n
I\u2019ve contacted my congressional representatives dozens of times asking for help and sharing research papers about vaccine injuries, but they have declined to respond in meaningful ways. Similarly, my state-level representatives ignore questions about our vaccine mandate, which remains in place for state employees, despite at least one confirmed vaccine-caused fatality in a young mother who fell under the state mandate in order to volunteer at school.<\/p>\n
There have been a few articles, such as \u2026<\/p>\n
\u2026 but no new ones have come to my attention recently, and it is concerning that the media and our political and public health leaders seem OK with leaving people behind as collateral damage.<\/p>\n
Please consider writing a companion piece to highlight this need and the lack of a functional safety net or merciful response. My hope is that if long covid and vaccine injuries were both studied vigorously, new understanding would lead to therapeutics and treatments to help these people.<\/p>\n
\u2014 Kathy Zelenka, Port Angeles, Washington<\/em><\/p>\n
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Given how long it took Congress to eventually approve “Agent Orange” and “Burn Pit” benefits for disabled veterans, it is at least a 15-20 year time frame and they don’t have the backing or societal standing that veterans do. https:\/\/t.co\/idt6tSioHc<\/a><\/p>\n
\u2014 Matthew Guldin (@MRG_1977) November 11, 2022<\/a><\/p><\/blockquote>\n
\u2014 Matthew Guldin, West Chester, Pennsylvania<\/em><\/p>\n
More on Mammograms<\/strong><\/p>\n
The article \u201cDespite Katie Couric\u2019s Advice, Doctors Say Ultrasound Breast Exams May Not Be Needed<\/a>\u201d (Oct. 28) does a disservice to women and can cause harm. An ultrasound is saving my life. I had two mammograms with ultrasounds this year. Although the first mammogram showed one cyst that was diagnosed as \u201cmaybe benign,\u201d I knew it wasn\u2019t. Why? Because I could feel the difference. I insisted on a second, and sure enough a large-enough cyst that\u2019s definitely malignant was found. I had breast surgery on Oct. 31, followed by radiation treatment and, if needed, chemotherapy later. This article will deprive other, less aggressive and experienced women who do not have health care credentials or a radiologist for a husband to be harmed by being lulled into complacency.<\/p>\n
\u2014 Digna Irizarry Cassens, Yucca Valley, California<\/em><\/p>\n
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Why do some women with dense breasts get additional screening while others do not? \u2066 @CNN<\/a>\u2069 explains. \u2066 @IronwoodCancer<\/a>\u2069 https:\/\/t.co\/uFZZKo6RO4<\/a><\/p>\n
\u2014 Patricia Clark (@patriciaclarkmd) October 27, 2022<\/a><\/p><\/blockquote>\n
\u2014 Patricia Clark, Scottsdale, Arizona<\/em><\/p>\n
Your article on breast cancer screening neglected to present the supplemental option of Abbreviated Breast MRI (AB-MRI). The out-of-pocket cost at many clinics ranges from $250 to $500. For a national listing of clinics that offer this supplemental screening option, please go to https:\/\/timetobeseen.org\/self-pay-ab-mri<\/a>. For benefits, just Google \u201cAbbreviated Breast MRI.\u201d<\/p>\n
\u2014 Elsie Spry, Wexford, Pennsylvania<\/em><\/p>\n
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Why didn\u2019t more #SeniorCitizens<\/a> leave for safer havens during Hurricane Ian as recommended? \u2066 @judith_graham<\/a>\u2069 rightfully suggests that learning why is critical as the population of older people grows and #NaturalDisasters<\/a> become more frequent. https:\/\/t.co\/7k8bvNQxug<\/a><\/p>\n
\u2014 Donald H. Polite (@DonaldPolite) November 2, 2022<\/a><\/p><\/blockquote>\n
\u2014 Donald H. Polite, Milwaukee<\/em><\/p>\n
Preparation Plans for Seniors: All for One and One for All<\/strong><\/p>\n
At least 120 people died from Hurricane Ian, two-thirds of whom were 60 or older. This is a tragedy among our most vulnerable population that should have been prevented (\u201cHurricane Ian\u2019s Deadly Impact on Florida Seniors Exposes Need for New Preparation Strategies<\/a>,\u201d Nov. 2).<\/p>\n
Yes, coming together and developing preparedness plans is one way to protect seniors and avoid these kinds of tragedies in the future, but since this is not a one-size-fits-all situation, organizations that help seniors across the country must first look internally and be held accountable by making sure their teams always have a plan in place and are prepared to activate them at a moment\u2019s notice.<\/p>\n
During Hurricane Ian, I saw firsthand what can happen when teamwork and effective planning come together successfully to protect and prepare seniors with chronic health conditions like chronic obstructive pulmonary disease who require supplemental oxygen to breathe.<\/p>\n
Home respiratory care providers and home oxygen suppliers worked tirelessly to ensure our patients received plenty of supplies to sustain them throughout the storm, and when some patients faced situations where their oxygen equipment wasn\u2019t working properly inside their homes, staff members were readily available to calmly talk the patient through fixing the problem. After the winds receded, mobile vans were quickly stationed in safe spaces for patients or their family members to access the oxygen tanks and supplies they needed. If patients were unable to make it to these locations, staff members were dispatched to deliver tanks to their homes personally and check in on the patient.<\/p>\n
Patients were also tracked down at shelters, and a team of volunteers was formed around the country to find patients who could not be reached by calling their emergency backup contacts, a friend, or family member. Through these established systems, we were able to remain in contact with all of our patients in Ian\u2019s path to ensure their care was not impeded by the storm.<\/p>\n
Organizations should always be ready and held accountable for the seniors they care for in times of disaster. I know my team will be ready. Will yours?<\/p>\n
\u2014 Crispin Teufel, CEO of Lincare, <\/em>Clearwater, Florida<\/em><\/p>\n
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Understanding the impact of #Climatechange<\/a> on older people is critically important as the population expands and #naturaldisasters<\/a> become more frequent and intense.https:\/\/t.co\/RKB7pA28nr<\/a><\/p>\n
\u2014 Ashley Moore, MS, BSN Health Policy (@MooreRNPolicy) November 2, 2022<\/a><\/p><\/blockquote>\n
\u2014 Ashley Moore, San Francisco<\/em><\/p>\n
The Tall and the Short of BMI<\/strong><\/p>\n
I am amazed that in your article about BMI (\u201cBMI: The Mismeasure of Weight and the Mistreatment of Obesity<\/a>,\u201d Oct. 12) you never mentioned anything about the loss of height. If a person goes from 5-foot-2 to 4-foot-10, the BMI changes significantly.<\/p>\n
\u2014 Sue Robinson, Hanover, Pennsylvania<\/em><\/p>\n
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I’ve been against this since after gastric bypass surgery I got down to 164 pounds but at 5’7″ BMI still considered me overweight. How an overreliance on BMI can stand between patients and treatment https:\/\/t.co\/OawzhO0aOk<\/a><\/p>\n
\u2014 Steve Clark (@blindbites) October 10, 2022<\/a><\/p><\/blockquote>\n
\u2014 Steve Clark, Lee\u2019s Summit, Missouri<\/em><\/p>\n
Caring for Nurses\u2019 Mental Health<\/strong><\/p>\n
During the pandemic, when I read stories about how brave and selfless health care heroes were fighting covid-19, I wondered who was taking care of them and how they were processing those events. They put their own lives on the line treating patients and serving their communities, but how were these experiences affecting them? I am a mother of a nurse who was on the front lines. I constantly worried about her as well as her mental and physical well-being (\u201cEmployers Are Concerned About Covering Workers\u2019 Mental Health Needs, Survey Finds<\/a>,\u201d Oct. 27). I was determined to find a way to honor and support her and her colleagues around the country.<\/p>\n
I created a large collaborative art project called \u201cThe Together While Apart Project\u201d that included the artwork of 18 other artists from around the United States. It originated during the lockdown phase of the pandemic, a time when we were all physically separated yet joined by a collective mission to create one amazing art installation to honor front-line workers, especially nurses. Upon its completion, this collaboration was recognized by the Smithsonian Institute, Channel Kindness (a nonprofit co-founded by Lady Gaga) and NOAH (National Organization of Arts in Medicine). After traveling around the Southeast to various hospitals for the past year on temporary exhibit, the artwork now hangs permanently in the main lobby at the University of Virginia Medical Center in Charlottesville, Virginia.<\/p>\n
I wanted to do something philanthropic with this art project to honor and thank health care heroes for their dedication over the past two years. It was important to find a way to help support them and to ensure they are not being forgotten. Using art project as my platform, I partnered with the American Nurses Association and created a fundraiser. This campaign raises money for the ANA\u2019s Well-Being Initiative programs, which support nurses struggling from burnout and post-traumatic stress disorder and who desperately need mental and physical wellness care. Fighting covid has taken a major toll on too many nurses. Some feel dehumanized and are not receiving the time off or the mental and physical resources needed to sustain them. Many are suffering in silence and have to choose between caring for themselves or their patients. They should not have to make this choice. Nurses are the lifeline in our communities and the backbone of the health care industry. When they suffer, we all suffer. Whether they work in hospitals, doctors\u2019 offices, assisted living facilities, clinics or schools, every nurse has been negatively impacted in some way by the pandemic. They are being asked to do so much more than their jobs require in addition to experiencing greater health risks, less pay, and longer hours. Nurses under 35 and those of color are struggling in larger numbers.<\/p>\n
The American Nurses Foundation offers many forms of wellness care at no charge. They rely heavily on donations to maintain the quality of their offerings as well as the ability to provide services to a growing number of nurses. I am an artist, not a professional fundraiser, and I have never raised money before. But I feel so strongly about ensuring that nurses receive the support and care they deserve, that I am willing to do whatever it takes to advocate and elevate these health care heroes.<\/p>\n
The Together While Apart Project\u2019s \u201cThank You Nurses Campaign\u201d goal is $20,200, an amount chosen to reflect the numbers 2020, the year nurses became daily heroes. So far, I have raised over $15,500 through gifts in all amounts. For example, a $20 donation provides a nurse with a free one-hour call with a mental health specialist. That $20 alone makes a big difference and can change the life of one nurse for the better. The campaign has provided enough funding (year to date) to enable 940 nurses to receive free one-hour wellness calls with mental health specialists.<\/p>\n
The online fundraiser can be found at https:\/\/givetonursing.networkforgood.com\/projects\/159204-together-while-apart-fundraiser<\/a>.<\/p>\n
\u2014 Deane Bowers, Seabrook Island, South Carolina<\/em><\/p>\n
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CEAPs, is it time to offer more #mentalhealth<\/a> services? Nearly 1\/2 of employers (w\/ 200 workers) report a growing share of workers using mental health services. Yet 56% report they lack #behavioralhealth<\/a> providers for employees to access to timely care. https:\/\/t.co\/Vpkkwlq6C6<\/a><\/p>\n
\u2014 EAPA (@EAPA) October 27, 2022<\/a><\/p><\/blockquote>\n
\u2014 Employee Assistance Professionals Association, Arlington, Virginia<\/em><\/p>\n<\/div>\n