Doctor's orders: Spiked bill has him lauding Obamacare

The Supreme Court's surprise ruling to uphold the highly controversial "individual mandate" component of President Obama's Affordable Care Act, a rule practically requiring all Americans to purchase some health insurance, has one local man hailing the decision as a big win for all Americans, particularly after an incident with his own medical bills.

"This is amazing news," says Craig Evans, an energy consultant who works in downtown Charlottesville, on the morning the Supreme Court issued its ruling. "The Affordable Care Act is good news for people like me who self pay."

The turmoil over the ouster of University of Virginia President Teresa Sullivan and the ensuing debate over how UVA should deal with 21st century challenges to the traditional college system wasn't lost on Evans, who has a cautionary tale about his own 21st century experience as an uninsured patient at the UVA Medical Center.

For Evans, the problem started last July, when he went for a routine blood test. He had recently switched doctors, which meant switching from Martha Jefferson to UVA. One thing, however, was not routine: the bill.

Evans who had been paying $91 at Martha Jefferson, found himself facing a $424 bill for the same procedure at UVA. As he began piecing together why he was effectively facing a 450 percent price spike, Evans made some startling discoveries about the small segment of the population who opt to self-pay their medical bills instead of buying in to what Evans sees as an inefficient and often predatory health insurance market.

“The U.S. healthcare budget is bigger than the entire budget of France,” says Evans. “Other countries have totally comparable healthcare at a fraction of our cost.”

Unlike many of America’s 50 million uninsured, who are indigent, careless, or just struggling to pay bills, Evans made his decision to go it alone with deliberation. Not long after deciding to self-insure, in November of 2010, Evans’ wife needed gall bladder surgery, and the bill came to $24,000. Big mistake? Evans says he actually saved about $10,000.

Here's how he figures. Evans had been paying an $1,800 monthly premium with Blue Cross/Blue Shield, on top of which he was responsible for the first $5,000 of any non-routine procedure. Throughout 2010, as healthcare became a hot-button political issue and providers anticipated new laws by raising rates, his premiums were soaring, eventually topping $3,400 a month, which meant his annual cost, including deductible, was heading toward $45,000. Despite paying for his wife's surgery out-of-pocket, Evans finished out 2011 by spending about $34,000— a whopping $10,000 less than what he would have paid an insurer.

As for the unexpected price of his blood test, Evans discovered that UVA's cost structure included multiple charges: a physician fee of $146 and a facilities fee of $191– on top of the fee for the test itself.

When Evans complained, his doctor and the lab technician expressed surprise. Evans’ doctor, Richard Santen, even raised the issue at a monthly meeting of UVA endocrinologists. According to Evans, Santen noted that UVA not only charges more on average than Martha Jefferson but more than the renowned Mayo Clinic.

Evans figures that a double-charge isn’t necessarily unique to UVA, rather that most patients simply don’t notice such additional fees since insurers generally cover the majority of any procedure. As someone who scrutinizes every bill, files every invoice, and triple checks every price list, Evans felt his story should be shared to help others.

In an e-mail to Dr. Santen, one leading UVA endocrinology doctor called the hospital's price structure "mostly meaningless." When confronted with Evans' billing woes, this doctor pointed out that the small group of people who forgo insurance are trapped in an "unfortunate game" played by hospitals and insurance companies. 

A document prepared by the UVA Medical Center in response to a reporter's questions outlines why UVA patients might see higher street prices than at a community hospital like Martha Jefferson. The document points to UVA’s wider range of services— like inpatient psychiatric care and a Level 1 trauma center— and the fact that as an academic medical center it treats a higher volume of uninsured and under-insured patients, many of whom qualify for charity care if deemed unable to pay their medical bills. While the document indicates that UVA aims for the median prices of comparable peer institutions, it concedes that UVA fees are currently above the median. 

A recent study from the non-profit Commonwealth Fund found that over half of the insurance plans sold on the individual market would fail to meet the standards put forth by the Affordable Care Act– the so-called Obamacare which aims to overhaul U.S. healthcare by requiring everyone to purchase some minimum insurance, prohibiting providers from denying patients with pre-existing conditions, and establishing higher standards of care. The legislation has been met with heavy criticism from policy experts who question the seemingly opposed goals of improving and expanding coverage while slashing overall costs.

Though small, the shift away from insurance consumption by people like Evans reflects a U.S. healthcare market in distress. Evans' choice to opt out of health insurance could become illegal– and unnecessary, he hopes– under the Affordable Care Act's "individual mandate." But Evans hails the Act and the Supreme Court's June 28 decision.

"The Affordable Care Act is going to help to eliminate the problem I’ve identified," says Evans. "Hopefully, charges for medical services are going to be made even across the board, and people who don’t have affordable insurance can afford insurance."

UVA Board of Visitors rector Helen Dragas highlighted the need to strategically plan for a “rapidly changing health care environment” in a letter e-mailed to UVA students and faculty June 22 that offered a list of explanations for her ouster of Teresa Sullivan on June 10. She wrote about the need for a strategic plan and “very ambitious interim steps."

The dual goals of remaining competitive in the private healthcare sector and staying in the median price range of academic medical centers may call for tough decisions, especially when current costs—of healthcare and health insurance—already place heavy burdens on the public.

After relentlessly pressing his case to the higher-ups at the UVA Medical Center, Evans did get his bill reduced, although this “carrot,” as Evans describes it, still left him paying twice as much as he'd grown accustomed to paying at Martha Jefferson. After a subsequent visit to UVA, he did notice that he was no longer getting charged the additional facility fees– a result, he surmises, of someone flagging his account after he so vigorously fought the charges.

He says the lesson to self-payers is clear: when every bill is coming out of your pocket, it pays to crunch the numbers. And it pays even more to make some noise.

“Insurance companies like to play games with the rates,” says Evans, asserting that while healthcare and insurance providers may like puffed-up hospital bills, they can become a big loss for those, such as Evans, who would otherwise be better off self-paying.

“There’s this small population of people," says Evans, "who slip through the cracks."

21 comments

It is like going to a great restaurant with a group of people on someone elses tab. No one really looks at the bill that close...and the hospitals know it.

Interesting article. Thanks.

UVA prices are higher because we have to help pay for the many uninsured patients that come thru their door and they jump on to do unnecessary surgery procedures etc so their residents and medical students can learn. Trust me thats the truth I work there.

UVA overchargin folks - plain and simple.

Lets turn to Thomas Jefferson who so eloquently said "Shake it like a salt shaker"

I totally relate to Mr. Evans. Augusta Health often overcharges and adds fees to its services. Unless you watch the bills like a hawk, you will be ripped off. Unfortunately, their CEO doesn't answer letters or phone calls. The billing staff fights every question and blames the insurance companies for not paying the charges.

UVA should not add charges to cover the services that are often reimbursed by insurance companies. The Heilcopter and the Psych service are covered charges. The State of Virginia reimburses for uncompensated charges from those who are without insurance or the ability to pay. The University took advantage of a Federal program in the 1940's and 1950's called the Hill-Burton Act to build buildings or to purchase expensive equipment. As such, they are required by the Act to provide services to those without the ability to pay. The grants from Hill-Burton were substantial.

These days you really have to shop for health care. I would rank Martha Jefferson first in terms of quality, service and cost. Rockingham in Harrisonburg is a clear second. UVA is a third place finisher, but is uneven across the board. Augusta Health is last place +++for this area. Augusta recently sent a letter to those in the service area stating that they would not join a larger health care organization. Without question, they will be forced to eat that letter and will be forced to join UVA, Sentara or Carillon in the very near future. Their professional staff leadership and their board are not in touch with reality. Cooperation and collaboration are the future of health care. When their professional staff call Augusta "Cornfield General" and express a lack of support for the executive suite, it may be time to put some knowledgable professionals on the Board of Directors. "Nice" people in the community aren't qualified for this important task. Can you say Helen Dragas!

Perhaps with Obamacare, people will stop going into health care to get rich and start going in because they actually care about people. Wouldn't it be nice to be able to trust your doctor and hospital again? To know the tests they order are necessary and not just get-rich-quick schemes.

When the bums on the downtown mall can get free care from the walmart or cvs clinic you will see them lined up to get free vicodin for imaginary back pain. The doctors will do a bunch of tests that won't prove anything so they will make them come back every week for another round of pills and another bill to the taxpayers. The bums will either take or trade the vicodin for booze, get some munchies with their food stamp card and go back to the crash pad they rent with the money they bum and play xbox.

Perhaps a more reasonable approach would have been a catasthophic policy with a 20k deductible for 1000 a month.

This will not turn out well.

Yes, good article. Now, if they could only read it through and stop the voices in their heads.

There's no reason (that I know of) you have to get the bloodwork done at UVA. Get an order from your doctor and go over to one of Martha Jefferson's outpatient labs. They accept orders from my physicians in St. Louis regularly. The results can be sent directly to your UVA doctor's office. Just because your doctor works for one outfit, doesn't mean you can't avail yourself of the facilites available to you. (Unless your doctor refuses...which would be absurd.)

The big game they pay is the old warehouse store "suggested retail price." I recently had a bill for 800 bucks which really was under $100 in what Anthem and I paid in actual cash.

As I understand it the hospital sets the price that high and then negotiates with Anthem so that they can get the $100 they actually need. Then they stick folks like Mr. Evans with the full $800 on the off chance they'll cough it up, although that price bears no real relation to the cost.

Why would Romney or Walker be so against this law?
Insurance exchanges are free market systems that allow customers to select only the plans they want.
Romney is going to look pretty silly in the presidential debates when the subject turns to health care.
Oh wait a minute, it's not about serving the american public, it's about control of power.

I do wish President Obama had used a different choice of words last night. He said "I" did this for the american people.

Not only does UVA charge more than the Mayo clinic for services, but it pays its staff doctors less unless they are administrators and not really taking care of patients.

Actually plenty of people look closely Jimi, the problem is if they ask questions or attempt to shop around, they generally find they can't get staright answers. It's "Well it depends o your insurance company."Ask your insurer? "We can't tell you until we see how they code the bill."

That's part of the fraud that is perpetrated on us. Also the idea that you have 'choice.' You choose to go where your insurance company will pay for it. Have Anthem? Don't go to Augusta ER, because they no longer accept anthem. You'll be out of network.

What a crock.

UVA's top nurse weighs in with an essay on reducing price and improving health with nurse practitioners: http://www.readthehook.com/104409/nurse-practitioners-theyll-save-your-l...

My da lived in another state and just never needed a doctor he thought. A few years back he went into a first med type office for what he thought was an ingrown hair that was infected. Turns out it was an aggresive skin cancer and he was told that he needed surgery to save his life. Well he went into sit down with the billing office to work out the details. The surgery was to be an outpatient surgery. The total cost was over 25gs. He tells them he is going to work out a payment plan ans he also puts 5gs down. The hospital starts dropping the price for each part of the procedure(Dr's fee, OR rental, med equipment, etc.) . They told him tht since he was going to pay by cash they would reduce the cost. Eventually the bill came out to around 11gs. 7 years now and he's alive and well. The question is why the reduced cost for him? Insurance pays for other people and they pick up the entire cost. Seems to me that the Hostpitals and Dr's got for the higher paydays that won't be challenged, just payed along with other patients costs that are submitted. The real reason is the insurance company's double billing are paying for the "charity " cases.

Another example, my uncle went to UVA for a heart attack and had to be admitted. When they checked him into the room there was a small platic tub that was given to him. It was about 16inches x 16inches, covered in saran wrap, and contained a wash cloth, soap, shampoo, a tooth bush, tooth paste, and mouth wash. When he went through the insurance billing the tub was listed as a "wleome tub" or something like that. Insurance was billed $95 for that little item that could put together for about 6-7 bucks from Walmart. Again, more funding for the charity cases.

The are both still alive and well. I'm very thankful for the care they received, but come on be honest. I beleive in helping out my neighbors but don't STEAL from me and my insurance company to pay for charity. Most people get arrested for doing stuff like that.

It is a good article.

Hmm. I keep receiving emails saying there are new comments on this thread, but clearly not. And my comment isn't up either. Glitch?

The hospitals are going broke across the country.

Insurance companies have palaces for headquarters buildings.

Health care companies are paid millions of taxpayer dollars to implement government programs like medicare advantage.

Single heathcare companies have monopolies in some states, and can charge whatever they want.

Why did the republican party offer no alternatives to the affordable health care act???

Simple answer, they like the status quo because health care company lobbyist are filling their coffers.

Still really confused how this fool thinks he'll benefit from obamacare. It's not like everyone who elects not to buy private insurance can all of a sudden get it for free. You have to be needy and below a certain income level, which it sounds like this guy is not. Shows how naive the general public in its knowledge of this program

I happen to be on diability and here is what I have already experienced in Chville: one of my doctors stopped seeing ALL medicare patients, my copays have increased, my cost of supplemental insurance has gone up, my insurance company has FORCED my mail order company to switch my medical supplies by discontinuing to carry the ones I have used for years, doc office visits are now rushed, pay more for lab work which I have do have done on a quarterly basis. Face it folks - healthcare is NOT A RIGHT. Even though public education sucks in this country, we need to do the same in healthcare - what is the minimum we as a society should provide someone - I say vaccinations, pain relief and death with dignity.

Like others, appreciate this good and timely article

Good article. Everyone is discussing the intent of this legislation; however, the reality of its implementation is going be a faulty as every other federal social program that I can think of.

“Other countries have totally comparable healthcare at a fraction of our cost.” Cost to the tax payer or cost to the patient? Under the old plan indigent health care is subsidized and under the new plan indigent care is also subsidized. Under the new plan it is estimated that another 16 million will be added to the federal and state rolls of Medicaid. We will learn to do less with highway and education funding. Does the plan say who's going to pay for the health care of illegal aliens?
Question: under the new plan is every medical illness and procedure covered? If not, who decides which are not?