St. Francis Hospital: The real cost of having a baby
About the author: I am an award-winning investigative journalist who worked at Greenville, SC’s WYFF News 4 from 1999 to 2005. Everything you read below is objectively true.
Summary: Below is a long and detailed account of paying to have my second child delivered at St. Francis Hospital in Greenville, SC. It is a story of broken promises, misinformation, and billing practices that have been reported to state and federal regulators. It serves as a warning to people seeking to self-pay for the cost of having a baby at St. Francis Hospital. No matter what you may be told, no matter what you may pay in advance, no matter how many receipts showing zero balances you have, you will never know when the hospital billing will stop. St. Francis Hospital can charge you whatever it wants to deliver your baby, and it will charge you much more than it promises in advance. Although the healthcare professionals there are magnificent and are beyond reproach, the billing office should give you pause. Do your homework before choosing St. Francis to deliver your baby. If you have questions about this report, feel free to use the contact box at the top of the page to send me a message.
Market Price
All we wanted to know was, “How much is it going to cost?”
Our second son was on the way and there was no stopping him. The calendar had just flipped and we were going to have a baby in May, no matter what.
Frankly, our question seemed like an easy one. Every item has value and every service has a price. Go to almost any business, and the man behind the counter will gladly tell you how much he is going to charge. We wanted to know, “How much is it going to cost to have a baby at St. Francis Hospital in Greenville, SC?”
And the hospital wouldn’t tell us.
It wasn’t for a lack of asking. I called St. Francis and left several messages. My wife did the same. We searched the web site. We sent e-mails. It seemed like a simple question that should have a ready answer.
Of course, we weren’t expecting an exact price. No birth is the same. The duration of delivery, emergencies, and any number of things can change how much a delivery would cost. However, there are dozens of people who work for that hospital who know the average cost of a birth at St. Francis. We simply wanted a ballpark number. Finding someone who would tell us that estimate was nearly impossible.
The price was important to us. We have private health insurance for which we pay a $934 monthly premium. It would cost more, but we decided five years ago to save several hundred dollars a month in insurance premiums by not carrying maternity coverage. It’s what our insurance agent recommended and seemed to be the most logical course of action. We enjoyed having a plan specific to our needs that wasn’t charging us extra for hospital visits that would never happen. You can get this too if you visit https://thehospitalplansite.co.za/ and get a quote. Instead of giving thousands more dollars per year to an insurance company, we put the money in the bank with the intention of using it to pay for the birth of our second son. All we needed to know was an estimate of how much it would cost.
In a logical business environment, it should be easy to calculate. Hospital rooms cost X per night, nurses cost X per hour, drugs cost X per dose. All we wanted was, if you don’t mind the metaphor, the hospital’s menu. Instead, hospital finance workers routinely presented us with the medical equivalent of steak and lobster served at “Market Price.” That is, the hospital would only tell us the final cost when it was all over. It’s standard practice, we were told. In fact, my wife’s OB-GYN office was in constant search of the same information so it could provide it for its patients. The people there begged my wife to uncover the schedule of charges so they could help other mothers plan for the costs.
Ultimately, my wife marched down to the hospital and pleaded for guidance. How were we supposed to plan for our family if we had no idea how much to save for the birth of our son? She finally found a woman who said she could help. St. Francis, the billing officer said, offered a pre-pay option for people without maternity coverage. We could pay for everything in advance and get a small discount for putting the money up front. No muss, no fuss, no worries about big unexpected bills later.
Of course, we were suspicious. The hospital wouldn’t provide a printed contract. We couldn’t get the menu we wanted. In fact, the best my wife could wrestle from the billing officer was a Post-It note.
The note was white with three tilted apples at the bottom. At the top, the woman scrawled “2 day Vag Del” (two-day vaginal delivery) and the amount we could pre-pay. We were told that was the average amount charged for a routine St. Francis birth. Below that, the woman wrote “Well baby” and the amount it would cost for the hospital to care for our son immediately after he was born. Finally, the woman wrote the phone number for Palmetto Anesthesia, the local provider for the hospital and the company that would provide my wife’s pain management service. We were told we could pre-pay there as well.
We breathed a sigh of relief. Finally, we found someone who could help us plan for the cost of having a baby. We wrote a check for $6,224.77 to St. Francis hospital with the verbal assurance that if nothing went wrong with the birth, we wouldn’t have to pay any more money and may even be due a refund. That same week, we pre-paid $900 to Palmetto Anesthesia and were told we were square with them, too. That was in addition to the check we gave the OB-GYN office for around $2,000. In all we’d submitted more than $9,000 in payments. It was a lot of money, but it was money we’d saved for just that purpose. Even better, we were working on the assurance we wouldn’t have to worry about spending any more of our savings if we had a routine delivery.
We would soon learn a very tough lesson: St. Francis didn’t want to give us a price because every birth costs a different amount. Even routine births that are exactly the same can have different prices. It depends on whether you have insurance, whether you can pay in advance, and, most importantly, however the numbers can be worked such that the hospital makes as much money as possible.
That is a long way of saying, there is no way of knowing how much it will cost to have a baby at St. Francis hospital until the last bill arrives-and you never know when that will be.
Paranoia strikes Dad
In the months leading up our son’s birth, the nervousness rose up in my throat. I found myself awake at night worrying about the typical paternal fears. What if something went wrong? What if the baby was sick? What if something happened to my wife?
I bolted out of bed one night and said, perhaps a little too excitedly, “What happens if you need a C-section?”
It was the one thing we hadn’t considered in the medical billing process. We knew we’d paid for everything related to gestation, labor, and delivery. I didn’t remember, however, how we would be billed if my wife ended up in surgery.
The next day, I calmed myself and sat in front of the phone. I didn’t want to talk to the insurance company again. The calls were almost always adversarial and I always felt like there was a guy standing at my bank ready to withdraw $1,000 just because I’d made the mistake of calling.
When I got somebody on the phone, however, I was uncharacteristically reassured. Unless my wife elected to have a C-section, our insurance would cover it. That is, if it was an emergency procedure, we were covered.
Every base, we believed, was covered. My wife’s doctors had been paid in full. The anesthesia company had been paid in full. The hospital had been paid in full. In the event my wife had to undergo an emergency Caesarean section, the insurance company would cover it. We were prepared as we could be.
With that, we sat back and waited on a baby.
Did you pack our attorney?
Women know.
Instinct takes over and in the blink of an eye they can determine, “This is the day I’m having a baby.”
One nice day in May, the look in my wife’s eye changed. She called her doctor, we went into the office, and they said, “You’re having a baby.” My wife nodded. Another spot-on medical opinion.
Rather than spend more time and money than necessary at the hospital, we went home. Understand, we were doing all we could to make sure we didn’t overshoot the amount of money we already pre-paid. My wife packed newborn diapers for the baby and a bottle of Ibuprofen for herself. We were leaving nothing to chance. Again, we were told that if everything was routine, we would not owe a penny more. Moreover, we hoped for that possible refund.
My wife sat at home for another three or four hours until the pain made it evident that our second son was going to be born soon.
It was a calmer drive than the first time we’d had a baby. We’d done it all before. We knew the way to the hospital. We knew the protocol when we got there. It was, we were sure, going to go smoothly.
“We pre-registered,” my wife said to the lady at the front desk.
In between contractions, my wife was a reasonable and put-together woman. She’d spent months writing checks, signing papers, and making sure we were not going to end up with one of those medical billing horror stories. Now, with those final words to the front desk, she was free to writhe in a pain that only mothers can comprehend.
If the ladies in the St. Francis Hospital billing office are to be believed, this is the moment I should’ve consulted an attorney. This moment in which my wife is doubled over in pain and being led away from me by a stone-faced nurse? This moment in which all I want to do is be beside her and make sure nothing goes wrong?
This is the point in my adult life in which I should pay very close attention to the fine print.
It is of no matter that we began preparing for the logistics and protocol of our son’s delivery when he was still a peanut-sized fetus. It is of no matter that we, in good faith, paid every bill in advance and were assured that only in the event of an extraordinary deviation from the norm would we end up owing more than we’d paid. It was of no matter that my wife’s face was a mask of pain and that we were at our most vulnerable.
No, this was the moment I was apparently supposed to grab the registration documents and run down to my lawyer’s office.
Remember this moment.
This is the moment St. Francis would get paid.
Defining routine
We had every reason to be happy. The labor could not have been much shorter. The delivery almost seemed easy. Within less than four hours of arriving at the hospital, we were alone in our room with our new baby boy. In short, if you needed a definition for “routine birth,” you only needed to look at us.
We felt confident that we would owe no more money. In fact, we even spoke that night about the possibility of getting some of our money back because everything was so quick and easy. My wife felt so good and healthy that she declined drug after drug, and service after service designed to make her more comfortable. If we’d kept going at that rate, St. Francis should’ve been cutting us a nice check.
The doctor, the mother, the baby,and the nurse defining routine birth
The bills started almost immediately upon our arrival home.
Despite our repeated protestations that we had no maternity coverage, and despite notes on our account specifically stating that we had no maternity coverage, St. Francis submitted all the bills to our insurance company anyway.
A reasonable person would ask, “Well, if you had already paid for everything, why would the hospital submit the bills to the insurance company?”
There is no clear or fair answer. The hospital would likely say it was a mistake or that, in a moment of altruism, it was trying to save us money. Someone else might assume the hospital thought it might be able to get paid a little more. There is no way of knowing for sure.
Know this, however: when our insurance company mistakenly paid the hospital thousands of dollars for coverage we didn’t have, St. Francis Hospital neither tried to give that money back to the insurance company, nor did it try to give us back the money we had paid in advance. It was only after Blue Cross/Blue Shield had discovered its error and demanded the money back that St. Francis returned the cash to the insurance company. And then the hospital started billing us again.
It took three months of fighting with the St. Francis billing office and being told that we, in no uncertain terms, owed money to the hospital before we finally snapped. We literally picked up our baby and stormed the hospital. We demanded to speak to someone in person. We were settling it that day.
By some quirk of fate, we ended up across the desk from the lady with the tilted apple Post-It notes. We shoved a thick file folder across a desk, showed her the note with her handwriting on it, and said, “Fix this today.”
She hemmed and hawed. She scrunched up her face and looked deeply into our account. Finally she said, “This is a mistake.”
This woman again appeared to be our savior. After hours of waiting on the phone and fighting with the heavies in the central business office, we’d found the woman who had, in essence, entered into a verbal contract with us seven months before. This was the woman who had promised us that, if everything went smoothly, we’d never have to worry about paying another bill.
She called her supervisor, Angie Pittman, into the office. Pittman looked across the desk at us and shook her head like we were the two most pitiful people in the world. It must have been a sight. My wife and I are educated people. We have no debt except our home mortgage. I have been in debt before but I read some Freedom Debt Relief reviews and managed to pay it off. We pay off our credit cards every month. We have a perfect credit score. For the past several weeks, however, we’d been treated like deadbeats. We were frustrated almost to the point of tears. It strained our relationship and we were at the end of the rope.
Pittman comforted us, complimented our baby’s pudgy cheeks, and then did what we wanted all along. She gave us two receipts showing zero balances on our St. Francis accounts. She signed her name and the date and told us we owed nothing else.
I remember all of this with a particular clarity. The day we finally had signed receipts showing a zero balance was the moment we knew we were free from everything and could get on with enjoying our new baby. There would be no more bills. Other than the bills that we’d be required to pay as adults of course. But we always had the option of borrowing a loan from the value of our car through places like Qik Car Title Loans, (https://qikcartitleloans.com) if we really needed to. At least the largest portion of our bills had been paid though; that takes off a lot of the pressure. There would be no more fear that the money we had saved for vacations and holidays would have to be spent paying for hospital bills we had already paid.
And just because I wasn’t sure any moment could be so good, I recorded it all on a digital voice recorder. It was a conversation I’d listen to several times over the next few months and wonder, “Did that really happen?”
For the services of Maria Claxton
That is where the story should end. That is where I could shake my head and tell you ruefully about how St. Francis overcharged us and manipulated the bill such that the cost of our son’s birth met the exact amount we paid in advance. This is where I could tell you about getting charged for drugs my wife was never given and nursery visits my son never made. This is where we could talk about how I was simply ready for it all to be over. This is where we would talk about how the healthcare industry is verging on corrupt.
There was no time for those conversations, because three months later we got another bill in the mail.
For anyone who has never been through such a Kafkaesque experience, this is the moment you want to cry. This is the moment you stand in the middle of the kitchen with your head bowed and wonder what you did to deserve such an endless cycle of frustration. This is the point at which you wonder if you are the victim of a very ugly joke, or worse, a very well-calculated crime.
The bill was $1,541 and arrived almost five months to the day after my son was born. It had obviously been recently submitted to our insurance company and had understandably been denied. The $1,541 was ostensibly meant to cover the cost of a Certified Registered Nurse Anesthetist (CRNA) named Maria Claxton, a woman with a North Carolina personal address and a South Carolina business address who neither works for St. Francis, nor Palmetto Anesthesia, the two companies with which we contracted and had been given zero-balance receipts.
My wife and I barely remember this woman. If she is who we believe her to be, she is the lady who followed the anesthesiologist into the delivery room when he gave my wife her epidural. The American Association of Nurse Anesthetists proudly proclaims that its members “enjoy a high degree of autonomy and professional respect” and that they are “the main provider of anesthesia to expectant mothers and to men and women serving in the U.S. Armed Forces.”
In our case, the woman we believe to be Claxton was there for less than half an hour and her duties seemed to be along the lines of standing there, handing the doctor things, and then monitoring my wife for a few minutes to make sure she wasn’t going to have a negative reaction. For this service we were being charged somewhere between $50 and $100 per minute.
Bear in mind here, we pre-paid Palmetto Anesthesia $900 for the entire cost of the epidural and doctor’s services. Now we were being charged more than $1,500 for the doctor’s assistant, a freelancer with whom we had never contracted. She was working for St. Francis Hospital, the company that told us that if we paid our bill in advance and settled up with Palmetto Anesthesia in advance that we would owe no more.
We called the number on the bill, which took us to the Jackson, Michigan-based Anesthesia Business Consultants (ABC). Over the course of three or four phone calls totaling nearly two hours, we began to recognize the sound in the background of poorly-trained call-center workers with fake names like “Jason B.” and “Steven No-Last Name.” Each time, they told us they couldn’t help us. Each time they told us it was a bill from St. Francis. So, we called St. Francis, who told us that we needed to call ABC. The strategy on both sides was clear-pass the caller along until he gets tired and gives up.
Over the next four weeks of phone calls and frustration, my wife took copious notes. We called the hospital patient relations line. We educated ourselves. It eventually became clear that St. Francis Hospital contracts with private CRNAs through the giant nationwide Anesthesia Business Consultants clearinghouse. We have no way of knowing how much Nurse Claxton received for her services, how much St. Francis scraped off the top, or what kind of kickbacks went to ABC. All we know is that for less than half an hour of service, we were being charged more than $1,500.
After four weeks, we’d gotten nowhere. It was affecting our relationship. It was affecting our family. What we believed was over had started again and we didn’t know what to do.
So, we did what we’d done every time before. I went back to the lady with the tilted apple Post-it notes. And this time she could do nothing for us. She shrugged her shoulders in a way that suggested we’d finally realized how inextricably stuck we were in a situation over which we had no control.
I left that office depressed, angry, and vowing to fight until there was no more fight to be had. Insurance companies had teams of lawyers. Rich folks have enough money to pay without thinking about it. We were just middle class people trying to make a living and we were being milked for every penny the hospital could squeeze out of us.
We hit the phones again. The call-center workers in Jackson, Michigan promised three times to have a supervisor call us back. A supervisor never called.
St. Francis business office workers refused to do anything to help or even explain why we owed the money. Finally I got someone to give me the name “Terri Gibson,” the top dog in charge of St. Francis billing. I vowed to speak to her and settle it once and for all. I vowed to explain how St. Francis had entered into a verbal contract (and one on a Post-It note, as I saw it), how St. Francis had given me two receipts showing zero balances, how we had not only paid in advance, but had been overcharged for services we didn’t receive.
Gibson refused to speak to me. The call ended up with a woman named Patty. I quickly determined that she was the heavy at the office. It’s her job to imply we are deadbeats who don’t want to honor our contractual obligations. It’s her job to suggest that if we don’t pay the bill, our account will be turned over to a collection agent. It’s her job to ignore my pleas that I have a zero balance with a St Francis employee’s signature on it. It’s not her job to be friendly, and she was not. That is a long way of saying, when St. Francis does a commercial advertising its top notch patient care, Patty will be kept far away from the camera.
Despite the great healthcare we received from the hospital and its staff, we had finally found the person at St. Francis who not only didn’t care about us, but was paid to not care about us. Her only job was to make sure we paid a bill, and it didn’t matter how insulting she had to be to make that happen. Her job was to get the money.
I protested. I told her about my receipts. I told her I had a zero balance.
And that’s when she started talking about that moment.
You remember it, right? My wife is on the brink of having a child. I’ve paid all my bills in advance. A nurse is wheeling my pained lover of 13 years away from me. I can’t see my wife anymore and I won’t be able to until I…sign my name to the admittance papers.
That’s the moment the hospital asserts I consented to paying whatever it might want to charge for a freelance CRNA. I’ve never seen this document, save perhaps the moment I tried to find the line to sign so I could be with my wife. The hospital tells me that I gave them full right to charge me whatever it saw fit for a freelance nurse anesthetist.
It doesn’t matter that we were told we had paid everything in full in advance.
It doesn’t matter that the hospital had told us multiple times we owed them no more money.
It doesn’t matter that we didn’t complain when they charged us for services and drugs we never received.
It doesn’t matter that we’re being charged between $50-$100 per minute for a freelance CRNA to stand in the hospital room.
It doesn’t matter that the actual anesthesiologist and pain management procedure cost far less than the nurse who observed it.
That was it. Pay or be turned over to a collection agent. Pay or have a damaged credit score. There are no more appeals. We middle class parents who have now battled with a corporate giant for more than six months have three choices. We can hire an attorney, try to fight it ourselves, or pay up.
There were no more options.
I am not proud to admit that we folded. We gave up. We wrote the check. We mailed it. We protected our perfect credit. We let St. Francis Hospital get by with a billing practice that borders on criminal.
And we have no way of knowing that another bill won’t arrive tomorrow.
Wow! One of the biggest “red-ass” stories I have heard in a long time.
Sorry.
2-hands
Once, very early in our relationship, my wife needed to have a small procedure performed. It was an outpatient affair, and she had no insurance at the time. After talking with the doctor and getting a written quote, we arrived at the hospital with a check in hand for the amount we were quoted. As we left the building, I handed a check to the woman behind the desk, asking “Is this everything? There won’t be anyone calling us months later looking for more money?” After getting her assurances that there would be no additional charges, we left.
Of course, months later, we got the calls. The testing facility, the lab, the random other people. Being in our early twenties and not having anything resembling a perfect credit rating, we told the hospital to take a flying leap. Eventually they did, and eventually our credit was restored. But I’ll never forget the feeling of powerlessness as they harangued me even when I knew I was in the right.
Conversely, the most satisfying conversation with a bill collector I ever had was after my mother-in-law’s estate was well past probate and a bill collector from a hospital called almost two years after her death looking for money. I gave them the address of the memorial garden and suggested they take the matter up with her directly. Then I suggested they take a shovel with them to assist in starting the conversation. That one never called back.
I wish I could now tout something about health-care reform taking care of this, but it won’t, and I don’t want to politicize your personal horror story that way. I only hope that this post hits the first page of Google results searching for St. Francis Hospital.
Not to be too callous about the whole situation (which obviously sucks and highlights much about what is wrong with our healthcare system today)… but if I didn’t have a contract in writing, I wouldn’t have parted ways with almost $10,000.
I probably have too many lawyer friends, but as they always say, “A verbal contract is worth the paper it’s written on.” I know you had a post-it note in this case, but I suspect that, had the case gone to court, your signature (however hastily procured) on a legal document from the hospital would trump any handwritten, unsigned, un-disclaimer-ed post-it note.
I definitely sympathize, though… this not only highlights so much that is wrong with our healthcare system, but our legal system as well. You’d have to hire a Johnnie Cochran-type lawyer to try to prove that your signature was essentially required to be provided under duress, at a time that you were probably not of sound mind, and that the (verbal) agreement you reached months earlier should override that written paperwork. By that time, though, you would have easily spent more than the cost of the bill you received on your lawyer.
It’s all screwed up. I’m cynical and jaded when it comes to this kind of stuff now, but I don’t give people any large amounts of money (>$1,000) if we don’t have a written, signed contract.
I hate to say it, but I could tell about a dozen more stories like this from my own personal and professional experience working with insurance companies, and we actually had a similar experience with the payment of our first born child. What tends to piss me off worse as the consumer are those sweetly oblivious ones who hold the state Medicaid “VIP” card and never have to know a thing about their accounts except that the government paid the tab in full. Don’t mis-hear me…I’m not judging people who qualify for state assistance and come by it fairly and honestly. But there are certainly times, in my experience, when being a high functioning, well educated, working-my-ass-off-to-pay-my-bills-IN CASH-IN FULL, debt-free (except for a mortgage), responsible citizen gets me a pretty crappy rap in life.
Hope you’ve seen the end of it!
Isn’t this the sort of thing small claims court is for? I obviously have no clue on the legalities, but at the end of the day, chasing $1500 will either not be worth their time, or bring out who’s really responsible for the charge. Call a friend from the old work to swing by and ask a couple questions of the hospital at the courthouse and see how the implied threat of bad PR works for them.
Yah, all tough talk, I know. But it’s shameful how they use patients at their weakest times, and then use their size against them later. If they’d been up front about that cost at the beginning, then I imagine it wouldn’t have been nearly as big an issue.
There are a lot of things about the industry that I work within that I’m embarrassed about from time to time. This story made me simultaneously embarrassed, angry, and sick to my stomach. I hope the karmic payback that you and your family deserve is right around the corner somewhere and that maybe the opposite is in store for St. Francis Hospital.
I have to believe there is someone out there who needs to do a little pro bono work to fulfill their recommended yearly quota. This sounds like a fantastic case. Anyone?
Gas passer $900. Girl holding tray for him $1500. Something fishy.
Nuns run most of the hospitals around here. I had momentary dealing with them. Humility is only in their written job description. Arrogance they got!
One of the secrets in the ratings business is that any disputed medical charges get major relief when it comes to your FICO score. All credit agencies allow you to dispute reports. All lenders do the same. I had a similar occurrence when I got my mortgage and ER charges from places all over the globe. It was waived. Not saying you did wrong but the lending community understands hospitals as well as you now do.
Now, I have Medicare and just saw a bill for a simple cholesterol test — $300. These are automated. They put a pipit in a machine and it prints it out. You can buy a self test kit for a few bucks that gets almost as close. Even heard an ad for fish oil where they’d send you one for free.
The sad thing is they are trying to fix health care by throwing more money at it. Not fix it; just throw money at it.
I wish I knew about this extra bill, because I went through something VERY similar with “Greenville Hospital Systems” trying to get me for an extra $1000 for some of Jacksons speech therapy sessions when he was younger. They tried to tell us we owed about 40 co-pays that they never asked for at each visit nor ever billed us for. Until his therapy was over of course. Then it’s “Get what we can get” mode for these places. (Again – all vitriol directed to the billing department, not the amazing staff who work there.)
The heavy you referred to probably threatened to have your information sent to a collection agency and have your credit ruined. They did the same to me.
I called their bluff. I absolutely refused to pay the bill. I had a house loan, 2 car loans and said “Fuck you, I don’t give a shit about my credit score, I’m not borrowing any more money for a long time and trust me, people will lend me money when they see everything else I’ve paid for in my life.”
In reality, they don’t send your information to a real collection agency. There’s one in town that works directly with GHS and is really a 1st intermediary before the “real” collection agencies get involved.
They sent me a bill of course and I immediately called them to let them know they could kindly fuck off too.
These people immediately went into negotiation mode. Bill gets cut in half and a payment plan is introduced. This is the point where you now play the dead-beat they think you are. This intermediary company will accept almost anything. I’m sure they buy off these debts for pennies on the dollar and their tactics dictate they accept almost any reasonable offer.
I told them I’d pay them $50 a month for 6 months. They accepted.
Fuck the system and their empty threats and bogus $1000 bills out of nowhere. Seriously, the majority of us are responsible adults with real jobs and an ability and desire to pay every debt we owe. Just not these rail jobs.
Call their bluff next time. Fuck ’em and fuck ’em hard.
The system sucks. I had surgery last year in January and up to my wedding day I was still dealing with the pinheads about $45 Tylenol bill.
Just sickens me.
What you are dealing with is a health care system that is run like everything here in France with the exception of…its health care system.
That’s right. After dealing with red tape, endless forms, and a culture that reveres bureaucracy and artificial job-creation at the expense of getting things done correctly and efficiently, I realized that doing anything in France is like getting entangled in the American health care system.
The bizarre thing is that, as Frenchified as the American health care system is, their own health care system is quintessentially American.
A friend of ours had a dermatological procedure done. Several things removed. He handled the minor surgery in his office. He prepared the instruments. He prepped the areas. He did everything except call her name to go from the waiting room into his office (after a 20 minute wait…but she arrived 10 minutes late for her appointment). He even printed the invoice and took her personal check for payment. Like us, she doesn’t have national insurance, so she paid full price and will seek a partial reimbursement from her employer. Full freight was under 100 Euros.
When I got the call last May that my daughter probably broke a bone while playing during recess at school, I picked her up and brought her to the x-ray lab down the street from the school. We walked in and as I was giving the receptionist my address, she was getting x-rayed. There was some concern about us not having national health insurance because I’d have to pay the full amount for the round of x-rays. At 32 Euros I almost felt silly submitting the claim for reimbursement. Before we left, the x-ray doctor (or maybe not a doctor, but the guy in charge of looking at them) explained everything to me and said we should see a doctor who would probably put her in a cast. The receptionist set up an appointment for us after lunch with a doctor a few kilometers away. All included in that 32 Euro fee. We were handed the x-rays and went on our way.
After lunch, we went to the doctor’s office. This time there was a nurse, too. She made up the plaster. There was a billing office. The only one I’ve seen. The lady there told us to just pay when we came back to have the cast removed as it was getting late and she wanted us to get to our pharmacy before it closed so we could get the pain meds. The goal was to make sure my daughter was okay.
Only in America — outside of health care — do you have that same “let’s just get the job done” mentality. In France — outside of health care — the concept of being goal-oriented doesn’t exist. When my wife asked co-workers here how to get in to the office on weekends, they looked at each other and then at her and didn’t comprehend the request. The end result of that conversation was that she shouldn’t press further with that question because people would find it suspicious that she’d want to be in the offices after hours.
Yet, for some reason, the French health care system seems to be designed by the same people who planned D-Day and undertook the Manhattan Project — not the people who have banks that close on Mondays and during lunch…and close their ATMs for lunch, too.
My daughter’s doctor bill came to about 80 Euros. The meds are dirt cheap, too, because they come in the manufacturer’s packaging. The pharmacist doesn’t remove the meds, count them out, repackage and relabel them and then ask you to sign a form saying you waived your right to have a consultation about the meds. The pharmacist simply scrawls “3 comprimes/jour jusqu’a fini” (or something like that) on the original packaging. If the pharmacist thinks you need extra help or are too stupid to follow instructions, you’ll get extra help. Otherwise, they keep it simple. Like most things American and unlike most things French. The meds came to 7 Euros. A pair of crutches cost us 10 Euros to own.
A few days later my daughter decided she still wanted to go on her school’s field trip. For that she’d need a wheelchair. I went down to the pharmacy after school and asked to rent one. This was a problem. They didn’t have one in stock — for a child. And her field trip was departing the next morning before the pharmacy opened. So they rush-ordered one to be delivered within the hour and told me to come back then. When I did they said that I’d have to rent the wheelchair for a full week to justify the rush delivery. “Bien sur,” I agreed. After all it was for my daughter. Whatever it takes. The price: 2 Euros per day. Of which 80% was later reimbursed.
The total bill for her broken foot — before reimbursement and insurance — came to less than 170 Euros. Other than people pausing out of concern for the cost because I didn’t have insurance, the goal was to make sure my daughter was cared for. And that concern about my not having insurance was a fear that I would be paying too much, not that they wouldn’t get paid. Sometimes, especially in tough economic times, people can’t pay. The medical community still takes care of them.
You don’t want to know what it costs for a French citizen to have a baby — vaginal or C-section — and how long they stay in the hospital after delivery, for a private room. Let’s just say it’s way less expensive than a broken foot.
And, yes, they make house calls here, too.
Triplet girls delivered in July of 2003. Wife in hospital for 6 weeks before. Kids were in the hospital for 4-5 weeks after birth because they were born at 31 weeks. Total cost before insurance? 850,000$. With insurance? About 350,000$. I paid about 7 grand in deductibles and didn’t get any additional inquiries from the hospital. Neonatalogists? That’s a whole different story….
Sorry hon . . . bad commentary on a part of our society that doesn’t run like the business it should be.
Now that you’ve taken the high road, if you could find a person to put a case back to the hospital for claims (pro bono would be great) – it would be wonderful to be a thorn in their side.
If you don’t have the energy, live with the knowledge that you took the high road and you are a better person than them.
While I used to work in a hospital billing office, I was just the computer guy. But I did pick up on a few things in my 15 years there.
I’m puzzled as to why you wanted to prepay? The hospital I worked at would give folks a pretty good discount for paying cash (and the Amish, who don’t have insurance, would always pay in cash). As you found out, hospitals can’t really tell you how much a procedure costs in advance. They have averages and things like that, but individual cases vary. If you were trying to get a deal, why didn’t you shop around with other hospitals? And why did you insist on prepaying? No one does that for medical care, and hospitals don’t have procedures to deal with it (as you found out).
Regardless, you’ve discovered one issue in the health care system that needs to be addressed. Over the past 30 or so years (or maybe longer), we’ve gone from a system where the patient is responsible for the bill to the insurance company being responsible for the bill. Hospitals send bills directly to the insurance companies, and the insurance companies pay the hospitals directly. The insured doesn’t generally pay but a tiny amount of the total bill. Hospitals bill the insurance companies directly so that they’re sure of getting paid. You can imagine what would happen if the guarantor was actually responsible for submitting the claim to the insurance company, then paying the hospital when he got the check from the insurance company: hospitals would never get paid.
The hospital I worked at had about 100 people in the hospital billing department, and about 150 people in the physician billing department. That’s another issue: you get charged by the hospital for “technical” services (room, drugs, etc), and then you get billed by the physicians for “professional” services. Doctors should be employees, not “contractors”. But that has to do with laws, not hospital policies; I daresay that the massive health care bill that’s being debated now doesn’t fix this issue.
The hospital in this case could have done a better job. Why not post this on Consumerist.com?
Hey, Glen. Thanks for the insight. I’ll probably respond in greater detail in another post, but I thought I should clarify a couple of things.
1) We didn’t actively seek out an option to pre-pay. We were given the option of pre-paying (with a small discount) or paying when it was all said and done. The way it was presented to us, we could pre-pay for everything involved in a routine birth and then just hope everything went routinely.
2) As to shopping around, that was almost impossible to do. When no hospital will give you a schedule of charges, it’s hard to do any shopping. In this case, we decided on this hospital because the facilities are good, and billing office trouble notwithstanding, the level of healthcare is very good. We love the staff at the hospital. It’s a shame the billing office gives the hospital such a bad reputation.
You did everything you could in good faith to handle things neatly and cleanly in advance. In return, you got royally screwed. I have three things to say:
1. This is a painful reminder (for all of us) to always, always, always get a written contract when dealing with large sums of money.
2. If it doesn’t exist already, there is money to be made creating a website for people to compile specific details (pricing, procedures, etc.) on their hospital visits. Then, anyone in the world could just search by zip code and find data and personal anecdotes on hospitals in their area. Similar online services exist for nearly everything. Why not hospitals?
3. I have a reasonably clean criminal record. I’m not a big guy, but with anger, the element of surprise, and a willingness to fight dirty, I think I can cause a lot of pain to the people who have caused you a lot of pain. Physical violence is rarely the answer, but sometimes Karma needs a helping hand, and I *really* want to hurt someone after reading this.
Okay, I probably won’t beat anyone up. But retweeting the link to my Twitter followers just doesn’t seem like it’ll be enough to quench my anger.
That blows. I think we as a society, need to hold these business out in the light. In many states, there are or need to be laws against any business from doing what you describe.
Awesome awesomeness, as always! And to think, some say the “system” doesn’t need reform.
Otis, this would be a great story for your former TV employer to cover on the consumer side. This is the stuff awards are made of, and the negative publicity would shun St Francis into coming clean on this extortion.
As many have mention, a great case for pro-bono lawyers to fill their quota.
Sorry to hear such a story, but greed is everywhere in our society, even a “religious” sponsored hospital.
Keep up the great work!!! One of the best blogs on the intertubes.
Based on principle dont cave on this. Does the hospital have an ombudsman to deal with billing disputes? Or what about the local paper or your former employer. We have a weekly column in our paper called the Advocate where some dude helps people who have been screwed over and have exhausted trying to resolve disputes on their own, be it a contract with Bally’s they cant get out of or Work never completed by a contracter etc. check this out
http://www.healthcareombudsman.com/
Many thanks to everyone who has commented so far. While this is a very personal issue for us, it’s also one that affects just about everybody in one way or another.
While we caved on paying the bill to preserve our sanity and credit score, we haven’t caved on the issue. What you read above has been already passed on to friends by hundreds of people. It’s also in the hands of hospital management, state and federal lawmakers, and various media outlets (plus, many of the good local reporters read here regularly anyway). I’ve already received a personal response from a state lawmaker interested in the issue and expect more in the coming days and weeks. I’m not much of a crusader, but I’ve always believed in the maxim of knowledge equating to power. The more we regular folks share like this, the less likely it will be for this to happen to someone else.
Hola Otis:
For the next one – come to Mexico. The cost is $700 for regular and $900 C Section – All inclusive (Doctor. hospital, nurse, anesthesia, etc.). They do rip off “gringos” by coming up with some crazy extra charge of $50 To $75. Same concept as St. Francis – just a matter of scale.
Great blog – Thanks.
You’ll flip out before this gets to the 1:00 mark.
http://www.youtube.com/watch?v=uNR_6UuVl4s
I experienced a similar mix-up when I fell off a horse and broke my arm. Let me see if my memory can get this all straight. We had insurance, so we just had to pay a co-pay for the emergency visit, and that was all. A year later we get a bill from the physician that set my arm. According to all we knew, it should have been paid by the insurance company except for the co-pay. We called the insurance company to inquire about their lack of payment and they said they did pay the claim. Gave us a check number and everything. Check had been cashed… So then we contact the physicians office and after some prodding they conceded to the fact they had been paid. It had all the appearances of a physician’s billing office trying to collect twice.
All the responses to your blog have been disturbing and enlightening. I’m not sure if it’s the “health care system” that needs reform. I feel fairly comfortable that if I get sick or injured I can go to the emergency room and be taken care of. Of course I do have health insurance purchased through my husband’s employer. What I think really needs an overhaul are the billing practices of hospitals and physician’s offices, and the general cost of health care as a whole.
I do think that health insurance should be available to everyone with coverage on every type of health care that is required.
When you try to put it all together and come up with “what is fair” it can get so complicated. A hospital is ran with more than just physicians and nurses. There are so many behind the scenes that also have to be paid. Janitors, cafeteria workers, housekeeping, security… I can understand a little why health care is so expensive. But when a patient gets a bill for $1000 for an MRI that takes 45 minutes – that’s crazy. But then again, it’s not just the machine you’re paying for. The technician has to be paid, and the electricity to run the machine has to be paid.
Fixing the health care system is really quite a complicated task, I can only hope that somehow they do come up with a system that is fair to everyone without jeopardizing the quality of health care we have. As you said, it wasn’t the level of care you were upset about. It was the way the billing was handled. We want to keep the quality at a superior level.
Horrible story, Otis, but one that is far too common for anyone with children that were not born at home in the tub without the assistance of any helpers, doolas, doctors, nurses, nurse’s assistants or midwives.
For each of three children, our total hospital bills have been roughly $30,000 apiece before insurance, and that is all for perfectly healthy, normal, quick births with no complications or agitating factors. In each case we have paid far less thanks to insurance, but to tell the truth with all three kids we have *still* received bogus bills of varying amounts for literally years after the deliveries. I can proudly say that, while my oldest is now considered “full paid for”, my 4 year old still has some outstanding charges according to the hospital / insurance that I have never paid and will never pay, and the bills for last year’s delivery are already starting to create quite a pile on my desk.
Bottom line: the health care system in this country is an abject joke, and clearly is in dire need of fixing. There is so much corruption top-to-bottom in the medical field, from the doctors to the nurses to the hospital administrators and of course to the insurance companies. Everyone has just gotten used to overbilling, lying, cheating and hurting the patients until they just give in and keep paying more and more money. And they will never change until someone makes them change. That’s why I was so excited when I heard our president was making health care reform his #1 issue for his first year in office (until I saw the content of his reform plans).
Best of luck with everything, many of us are right there with you in this same situation.
I’ve never met you but I must tell you what a moving story you’ve told; I mean ‘moving’ in a bad way, in that it moved me to sadness and outrage at how you and your family have been treated. I cannot begin to imagine how something like this would affect me and how I would feel. I am passing it on to everyone one I know.
Answering Jim Hennigan,
On 02/19/09, at 11PM, my wife said she’s ready to go. We arrived at the hospital in Voiron (20 000 inhabitants, in France) at about 12:30 PM.
As we called during the trip, a nurse was waiting for her with armchair and my son came out in this winter night.
My wife spent 5 days in hospital, they provide food, medecines, laundry…
Total billing amount : nothing,
We are not homeless, we are middle class, we own our house and cars etc. and of course, we pay every month a part of our salaries for these advantages but the part we pay depends on our salaries.
Unfortunately, we have a president (a friend of GW Bush but not of B. Obama) who is everyday reducing these public services, selling them to private companies…
Take care of your new president 😉
Wow, what a sad story. I’ve just had my first child two weeks ago so can empathise with what you must have been going through at the time of birth. My wife’s birth became complicated and required epidural anaesthesia and a forceps delivery, so no the ‘normal birth’ you had. Thankfully we live in the UK where the NHS does the most amazing job and there are no bills at any point. I just can’t imagine living somewhere where the accountants and lawyers run the show. Shocking really
That’s a really terrible situation and it definitely serves as a wake up call to a lot of people I think.
@KenP: A nurse anesthetist is not simply a person who “holds a tray”. I’m in AA (anesthesiologist assistant) school, which is essentially the same thing as a CRNA. We operate in a virtually autonomous environment in the OR, with an attending MD who “oversees” several rooms at a time. Believe it or not, mid-level anesthesia providers are much cheaper for everyone involved, hence the rising popularity of our field!! If you don’t believe me, go check out gaswork.com for anesthesia jobs and salaries.
Sorry for your experience. I have been in healthcare for 19 year with 5 years of consulting experience. St. Francis is no different than any other hospital. I had a similar experience with GHS.
The general rule in healthcare is to bill insurance and people and see who pays.
The entire system is broken. Amazingly, the cost of billing medicare is lower than the admistration cost of billing private insurance. That is how bad it is, the Govt beats the private sector.
First of all AA’s are not the same as CRNAs. Philip, you have been misinformed. CRNAs are licensed (AAs are not), and are able to practice independent of anesthesiologists (AAs are not) and have over 100 years of stellar record of safe practice (AAs do not). Remember you are entitled to your own opinions, but not your own facts.
Now, to the matter at hand. What you experienced was very sad indeed and is an example of everyone trying to get their piece of the action for the health care dollar. The hospital contracted with an anesthesiology group, who should have been able to provide an epidural without assistance. For some reason, the hospital also contracted for nurse anesthetists services with a separate group. That information should have been disclosed to you in your financial discussions with the hospital. Because they didn’t disclose this, I would take them to Small Claims Court and ask for the money back.
My partner is in the same boat with no insurance. Since she has no insurance we NEVER give out our SSN when filling paperwork. If you don’t have insurance there is no reason for a hospital to have your SSN except to hold your credit rating hostage.
I had similar problems with my middle child also delivered at St. Francis. We did have insurance, but still had to pay 20% of the bill. We didn’t have much money and after receiving the bill, I wanted an explanation. It seemed too much for a normal fast delivery. I ended up asking for a detailed bill, which came in the mail a few weeks later. I realized that the wipes (not box, just a few wipes before my husband went and got some) cost us $12, and the “free” thermometer was $108. I didn’t even ask or needed it. Also, they had charged us for some test that they had to repeat because they made a mistake on the time it was taken. I was able to get that charge deleted, but everything else had to be paid. The worst part is a mom of a newborn sitting on the phone for hours trying to figure out these details with billing. A few times crying on the phone while my own child is crying in my arms as well needing attention.
When I found out that we were expecting our third and we didn’t have insurance, I knew that delivering in a normal hospital was stupid. Trusting that all will go well, I contacted a natural birthing center. The insurance still gave me a headache about the center being our of network, but eventually they agreed after many phone calls.
http://www.bshsi.com/contact-us/index.htm
That’s an online email service to the parent company that owns the ‘not-for-profit’ hospital.
Here was my message to them:
I read about your order with disgust. Having a parochial education, I have a passing acquaintance with the bible. Why are you acting in a manner that will send you to hell?
https://rapideyereality.com/archives/2010/01/19/st-francis-hospital-the-real-cost-of-having-a-baby/
*************************
I’ll put a blog up about all this today and urge others to do the same. Urge others to use their mail drop!!!
Wow, I found this on a random search and had to comment, because we are so very similar to you guys. We live in Simpsonville, have our own company, and also have private insurance w/o maternity insurance.
I recently found out I’m pregnant, and I called St. Francis (where I had our first baby with maternity insurance) to find out if they could help us out with a pre-pay plan, and the lady in billing told me that they do not offer that.
That was yesterday, January 21.
I haven’t had a chance to call Greenville Hospital System, but I’m assuming that if they do offer a pre-pay plan, we’ll be going through these same battles in about 8 months.
I really wanted to deliver at St. Francis since my first delivery there was such a dream, so this makes me a little sick to my stomach. I’m nervous already just thinking about what we need to do to have this baby.
Keli: I’m happy you ended here and discovered what you’re in for before you get started. We, too, had maternity insurance when we had our first son (at St. Francis). It was a good experience the first time when we didn’t have to worry about the billing office.
The hardest part for us was doing everything we could in advance and attempting to do the right thing at every step, only to be beat up by the billing office time after time.
In any case, hopefully your eyes are a little more open after reading this and you can use whatever knowledge it provided to make more informed decisions. Feel free to send me a private note in the contact box above if you have any questions you don’t want in a public forum.
Arguably, you entered into an enforceable agreement with the hospital. They may have a document you signed later, but you had a great argument you signed under duress. “Sign here or we won’t be able to deliver your baby.”
Did you give the hospital any indication you were finally paying the bill solely to avoid a negative indication on your credit report and intended to continue to contest the bill? If you did, I would have a lawsuit file immediately. If not, they may have an accord and satisfaction defense.
I hope you are not tilting at windmills here.
Just a few seconds ago I googled “St. Francis Hospital Greenville SC” and your post was near the top of page 3.
After the search I received an email from google thanking me for finally searching for something other than porn.
Just a little something that’s only slightly off topic, but I thought you might find amusing…a little background info first to help set the context: As a Licensed Professional Counselor who owns my own private counseling practice, I also do all of my own medical billing. This can be a major headache with 90% of the time I spend on billing/bookkeeping being spent on trying to “fix” the errors that the insurance companies make when processing the claims. They are not even MY billing errors, but the INSURANCE COMPANY’s errors that I have to waste MY TIME bringing to their attention. Often the errors boil down to me being underpaid according to my contracted rates with them, and I am fighting for the REST of my contracted reimubursement rate. But because I am a good and honest person, I also spend hours of my time trying to correct mistakes the insurances make in OVERPAYING me. This is time I spend (including hours of hold time on the phones) for which I will never be paid.
Last week I was trying to verify that an insurance had received some claims (long horror story precludes all of this regarding how the hell to communicate with this particular insurance’s claims dept. regarding the filing of claims with them, but I’ll spare you that story). It was my first experience with this insurance company. I called the 1-800 number on the back of the insurance card that was specifically assigned to providers of mental health services. I kid you not, the number printed on the back of this insurance card got me a national toll-free television and small electronics repair line. I called it three times and repeated the number back to be sure I was dialing the number as it was printed on the insurance card. Sure enough. They obviously had no idea about the medical claims I submitted on behalf of a client, but they offered to repair my television. I’m not making this up. It took me the better part of a couple more hours of being sent around in circles by the floating heads at this insurance company to get me to someone that could answer questions about these claims. And that’s still only the beginning of the nightmare. I’ll spare you the horrors I’m experiencing in getting these claims processed correctly to the client’s deductible. At least I finally have a correct phone number to keep following up on things with them. And the hold time to get through usually only averages about 45 mins per call.
It’s obvious from all the posts that in America, healthcare providers have a licence to print money. I was absolutely astounded reading story after story of how your citizens are absolutely gouged by your medical community. And on the backs of people who can ill afford to be battling with the “system”. It really makes me very grateful our country still maintains “most” of our universal healthcare. Your government really needs to reform healthcare so those $934 monthly bills disappear!
It’s unfortunate that this billing mishap spoiled what should have been a glorious time in your life. This hospital obviously needs better policies and procedures regarding price estimates and should overhaul its customer service department.
As a consumer, however, you decided to forego maternity coverage and paid a high price for taking a high risk. From day one, this business transaction with the hospital was flawed yet you did nothing to protect yourself or correct the situation. Post its? Verbal contracts? Really?
I understand that you’re trying to get a point accross, but your account is not objective and your conclusions are unsubstantiated. The hospital and care providers should be held accountable for their mistakes, but please accept responsibility for your actions as well. It’s easy to jump on the bandwagon and scream at the top of your lungs that “healthcare is corrupt”. It’s much harder to look in the mirror and say “I screwed up..big time.”
Control the truth? Really?
Just a few thoughts from a lawyer. And I don’t offer this as criticism against Otis but solely as something to think about for others in a similar situation.
First, I wouldn’t have paid any additional bills absent a presentation of a contract. I seriously doubt you would have a contract with the CRNA. I would have said, you produce a signed contract and I will take a look at it. Otherwise, you need to collect from the hospital or the doctor who called you in.
Second, there is a little federal statute called the Fair Debt Collection Practices Act. Google it. It carries serious penalties for individuals or companies who engage in practices which violate its provisions. Also, your state may have enacted it’s own version which may be even more beneficial to you. Some jurisdictions may even allow you to recover for the mental anguish suffered over the situation.
Third, and this is the hard one for people, don’t be afraid to be sued over this and don’t hesitate to countersue for a violation of the FDCPA. Threaten to take the deposition of the billing office people who told you the account was square. Let them know that there will be consequences if they lose. I can GUARANTEE THIS … GUARANTEE … had Otis’ case gone to lawsuit, absolutely no hospital attorney would have wanted to be defending the hospital’s actions in front of 12 average citizens.
All the best,
Soop
FYI … the “duress” argument people have asserted in the above comments would never fly.
Thanks for the continued comments. Insight like this will probably help people who face the same situation.
One note to kas–I’d be curious if you can find me a hospital that will provide a written contract up front before services. If you can, it should be a model for all medical facilities in the country. That was one of the underlying themes here. In any other business transaction, I would feel like an idiot. In this one, I never felt like I had a choice.
Wow, I’m so angered that a hard working conscientious family have to go through something like this. I worked in healthcare in Canada for 15 years and thought it was bad that people had to wait 4-6 weeks to see a specialist. I guess universal coverage is not such a bad thing. I hope Obama works hard at getting this for Americans. Maybe they could take some of the billions out of the military.
I am a sole-practitioner plaintiff’s attorney, and have been an attorneyr for 17 years. I have been out on my own for almost 12 years. I hate insurance companies. I hate big government. I hate mega-companies. They all run over people with relative impunity. Are there good people in all of these fields? Certainly. But looked at as a whole, they are almost all inherently evil. What happens when the little guy makes a mistake or fails to pay? Interest. Penalties. Late fees. Credit gets ruined. Loans get called. Foreclosure. Collection agencies. Lawsuits. What happens when the government, insurance company or big business makes a mistake, or worse, acts intentionally to screw somebody? Most of the time…absolutely nothing. I hate them.
Brad, I will take this case. I’m not exactly sure what the cause of action will be, I’m not sure what our chance of recovering anything will be, I’m not sure someone won’t laugh at us along the way. But you are a friend and I’m sick of this stuff happening to the little guy. At the very least I’ll bet we can make them spend about $10K in legal fees having to deal with us. Hey – I got berated when I took the poker cases as well and now we are going before the freakin’ South Carolina Supreme Court having won on every issue below. Occassionally right does win.
Jeff Phillips