Medical Bill Madness

I have hesitated to post much about our ongoing issues with our local hospital. More specifically, our issues with the for profit companies that are running our local hospital, which are *TeamHealth (a private equity firm) and Southern Regional TN who is actually called LifePoint (LifePoint is owned by private equity firm Apollo Global Management). LifePoint is who runs Hillside Hospital.

  • Team Health Holdings Inc. (NYSE: TMH), a clinical outsourcing provider in healthcare, on Feb. 6 completed its sale to funds affiliated with global asset manager Blackstone and certain co-investors, according to a filing with the US Securities and Exchange Commission. The transaction is valued at approximately $6.1 billion. Team Health operates healthcare staffing firm D&Y among its other business operations.

From the start of this ridiculous debacle, we have tried to use the proper channels to challenge the bills from TeamHealth and SO Regional after Jason’s treatment at Hillside Hospital. Even after asking for a review and audit, we have not received any correspondence acknowledging or explaining the discrepancies in the bills between TeamHealth and SO Regional, the IV that never happened or why Jason was coded a Level 4 ER Visit for a Simple Suture procedure. In addition, we have not received any explanation why SO Regional is charging astronomical rates for services. There is no reason why six stitches should ever cost $6000.

When Jason (my husband) went to the local hospital for treatment, he repeatedly asked about costs and insurance coverage. Nowhere were costs listed and at no time were costs discussed with Jason. Which we later found out was a violation of The Hospital Transparency Rule. (Hospital price transparency helps Americans know the cost of a hospital item or service before receiving it. Starting January 1, 2021, each hospital operating in the United States will be required to provide clear, accessible pricing information online about the items and services they provide in two ways: As a comprehensive machine-readable file with all items and services. In a display of shoppable services in a consumer-friendly format. This information will make it easier for consumers to shop and compare prices across hospitals and estimate the cost of care before going to the hospital.)

At the hospital when Jason asked about costs, he was told that his “insurance would cover it” but a month later we found out that insurance did not “cover it” and that he had been charged over $6000 for a simple suture procedure for less than a 1 inch cut. Upon requesting and reviewing the medical records, treatment and charges, we discovered that Jason had been coded a Level 4 emergency room visit-which is one level below a Level 5. A Level 5 is the highest and most serious emergency room visit (Level 5, Code 99285- “the presented problems are of high severity and pose an immediate significant threat to life or physiologic function.”)

After looking at the few lines on the medical statement for what was a quick and simple ER visit, it didn’t take a rocket scientist to see that Jason’s emergency room visit was upcoded and that he had also been upcoded to a Level 2 Intermediate Suture procedure by the emergency room physician while the hospital correctly coded Jason for a Level 1 Simple Suture procedure.

Of course, Jason called and asked for an explanation but NO ONE has bothered to explain to us why there are visible and undeniable discrepancies in Jason’s medical records or why he was upcoded to a Level 4 emergency room visit, a Level 2 Suture Repair or why Hillside Hospital’s prices were not only kept a mystery, but are grossly higher than the cost of treatment in our area.

Unfortunately, Jason and I have now witnessed firsthand what can happen and what is happening in hospitals and emergency rooms all around the country. After doing our own research and speaking with investigators, advocates, lawyers, reporters and other patients, we have discovered that no one is immune from being *upcoded, miscoded or overcharged.

In fact, this is so rampant that United Healthcare has filed a lawsuit claiming that “TeamHealth has deliberately upcoded tens, if not hundreds, of thousands of claims to the United Plantiffs for emergency room services, resulting in the United Plantiffs overpaying TeamHealth by more than $100 million.” In the UHC lawsuit against TeamHealth, UHC found that TeamHealth coded over half its claims to UHC as 99285, a Level 5 emergency room visit. United Healthcare also found that 62% of the claims that TeamHealth coded Level 4 or Level 5 were not supported by medical records.

“Upcoding is a type of fraud where healthcare providers submit inaccurate billing codes to insurance companies in order to receive inflated reimbursements.”

Throughout this entire upsetting and unwanted experience, I have tried to believe that people do not know about what is happening in our local hospital. Likewise, I have wanted to believe that what happened to Jason was just an isolated incident. But today, I heard another story from a really nice hardworking local man who had his credit ruined because of his time spent at Hillside hospital ran by LifePoint and TeamHealth. Unfortunately, he is not the first person who has contacted me. In fact, every single person who has spoken to me about our NPR interview has responded “Don’t you know not to go to Hillside” of which I respond that I didn’t get that info in my welcome home packet.

At this point, I am really curious to find others who have gone to Hillside Hospital or any local health care facility and have been fraudulently upcoded, miscoded or grossly overcharged for services. Jason and I are still fighting these bills and have no other choice but to go to small claims court just so we can force someone from TeamHealth and SO Regional to explain and justify why we were upcoded, miscoded and charged exorbitant rates for basic medical services.

According to fairhealthconsumer.org and healthcarebluebook.com, Jason’s charges should have been no more than $1600 not $6000. We have repeatedly offered to pay $1600 and they have repeatedly ignored and just sent us another bill. It is obvious that neither TeamHealth or SO Regional care about us. These are for profit companies who care about their shareholders. They are corporations and the only thing they care about is making money- they don’t take or follow the Hippocratic Oath. Their allegiance is to money- whatever the costs to the people and their places.

The situation has showed me once again that Wendell Berry is right again when he said:

“A corporation, essentially, is a pile of money to which a number of persons have sold their moral allegiance. Unlike a person, a corporation does not age. It does not arrive, as most persons finally do, at a realization of the shortness and smallness of human lives; it does not come to see the future as the lifetime of the children and grandchildren of anybody in particular. It can experience no personal hope or remorse, no change of heart. It cannot humble itself. It goes about its business as if it were immortal, with the single purpose of becoming a bigger pile of money. The stockholders essentially are usurers, people who ‘let their money work for them,’ expecting high pay in return for causing others to work for low pay.”

Do you think it bothers a corporation to know they bankrupted a person, ruined their credit, hurt there chances of owning a house, starting a local businesses or severed relationships in a community? Not only is one person a nobody to a corporation, but a whole town means nothing to a corporation who sees them as a commodity and not as individual people with names, families, jobs and a future life. Furthermore, a corporation will never see a person as a child of God or a neighbor who they are called to love as themselves. Instead, they will see them as an opportunity to use as a means to their own ends.

I have to ask “What’s the point of have local businesses that are not local but are ran by corporations that do not live, work, worship or send there kids to school here? What’s the point of having businesses that put all the local businesses out of businesses so they can make money and have no real presence or participation in our community? How has that worked out for our communities thus far? What have been the results of the fast food restaurants, the big box stores, the fast cash places and industries in our communities? Are we thriving? Are we healthy? How are our schools? What businesses line our streets? How well are we feeding, clothing and helping our neighbors?”

Walmart, McDonald’s are no different than Lifepoint and TeamHealth. They are all billion dollar corporations that DO NOT care if our homes and towns are filled with junk, jobs barely pay, they put local businesses out of business, they devastate people’s lives or they destroy their local economies. These companies have no morals and they have no God, because they are corporations. They are not people.

I keep asking myself where are the leaders standing up against such predatory businesses? I know we all know something is wrong here. So, what is it going to take to stand up and say NO MORE! No, it’s not funny that our local hospital is called Killside or Billside. It’s not funny to see the mass majority of our family and friends physically unhealthy and the trap that is waiting for them when the get sick. It’s infuriating that insurance companies, TeamHealth and Lifepoint are making record profits during a pandemic and at a time when the majority of Americans have diet-related disease and sickness and insurance rates are through the roof. This is not only absurd, but this is morally wrong.

Trust me, I have discovered how intimidating it is to stand up to a corporation and know it will cost something but like our southern prophet Aaron Tipen once said “You got to stand for something or you will fall anything.” Yes, doing what is right, good and true will come at costs but if we don’t stand up for what is right, then it will cost us more than we can ever afford to lose.

Finally, if you are experiencing a medical bill nightmare or you feel like you shouldn’t been charged $2400 for a BP check and to get a script, then Marshall Allen is an incredible resource and he has told me that he will help anyone who has found themselves at the mercy of these private equity piranhas. If just a handful of individuals would start to stand up to these corporations who have no problem putting profits over people again and again, then we could start to make a difference and change this broken healthcare system.

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