Beware the Upcode–and Don’t Take it Lying Down.

October 7, 2011 in Member Stories

So I was standing at my kitchen counter making myself a fast breakfast one sunny morning in 1997 or ’98.  I was in a rush–I was working on a documentary and I had a full day of filming ahead of me.   I struggled with a big kitchen knife and a frozen bagel for a few seconds, and then, well, you know the rest:  The slip of the knife, the sharp intake of breath, the clatter of the knife on the counter.   I had a deep slice on my middle finger, clear through the flesh and halfway through the nail.

Now, I had to make a choice.  I lived in a working-class neighborhood in Brooklyn called Red Hook.  There  was a community clinic around the corner, where good people provided good, basic care.  I knew from experience they’d do a decent job stitching my finger (and charge me little).

But I had a long drive to Long Island ahead of me, and had to beat rush hour traffic. A team of cameramen, a make-up person and a bunch of under-employed young actors would be gathering soon on a beach on Long Island to dress up as French Foreign Legionnaires for some historical reenactment.  I had to be there.  The show must go on.  (Then again, an old man I knew used to say, “The graveyards are full of indispensable people.”)

So I wrapped up my finger, left the still- intact and blood-stained bagel on the counter, and roared off to Long Island.

Fast forward:  It’s late afternoon.  We’ve finished filming, I’ve driven north to the ritzy Westchester County town of Tarrytown with the film crew to drop off gear at the production company’s office.  Work was done, I’d let the finger go long enough, the drive back to Red Hook  was going to take another hour.  So I went to a local hospital.

Fast forward again:  A couple of weeks later, I had taken out my stitches myself and was admiring my scar when two bills arrived in the mail –one for the doctor and one for the emergency room totalling around $850. ( It’s been a few years so I may be off slightly on the figures.  I was shocked.  I called my local clinic and confirmed they would have charged me $30.

This was war.  After a few indignant calls, I convinced the Westchester doctor to accept around $150, about half his original fee.  But the hospital wouldn’t budge.  I made a couple of payments over a month or so amounting probably to around $200 …and then watched the bills pile up on my desk in disdain.  Finally, a collection  agency started sending threatening leters.

And  it just so happened that I came across an article in the paper about a health care company called Columbia/HCA in trouble with the Feds for fraud, including a practice called upcoding.  I checked the original bill from the hospital, and sure enough, I was down for a Level III emergency.  Funny, I didn’t remember them shouting “Code Blue” down the hall, or calling out “Clear!” before applying de-fribrillator paddles to my middle finger.  Intubation?  General anesthesia?  Brain scans?  Nope, nope and nope.

Well, I had a lot of fun writing the letter to the collection agency.  I wrote something along the lines of,  ‘Thank you for your collection notice.  I read in the New York Times recently that  Columbia HCA is in  a lot of hot water over a practice called upcoding.  And I notice in the bill that I was charged for a Level III emergency to get three stitches.  I look forward to discussing this with you further.’

Never heard from them again.


6 responses to Beware the Upcode–and Don’t Take it Lying Down.

  1. Stefano’s story is like one I posted about a month ago. Upcoding is all around, and in my case, the hospital hasn’t budged.

    What I’ve found so far, is that upcoding seems to be encouraged by a system that prevents the person from knowing what they are being charged for. Neither the coding rules for “Level III” or the prices for Level 3 at NWH are posted, and they may actually be secret. Partners has been somewhat evasive in our ongoing communications on this matter.

    “Don’t take it lying down” is good advice but dealing with collection agencies seems hardly the preferred method to increase transparency in a system that treats us this way. I’m looking into how increasingly sophisticated social networks might be brought to bear on this upcoding and secret pricing problem and would welcome input from everyone.

    • Adrian, I suspect dealing with the collection agency rahter than the hospital worked in my favor. Those folks take a big commission, I believe (I think they split it 50-50 with the hospital). Once I introduce a legal fly in the ointment, it probably ceases to be worth the collection agency’s effort, because they have to kick it back and forth with the hospital bureaucracy, while the hospital only stand to collect a smaller amopunt of money (and then there’s that legal threat), so I would guess they are more inclined to just toss the file in the wastebasket.

      I think you are completely right in saying that throwing down the gauntlet is not the best way to address this problem. I even felt guilty that my solution amounted to “looking our for No 1,” whereas the right (and possibly futile) thing to do would be to alert the attorney general’s office. I was surprised to learn of upcoding AND to find it in my own bills and just capitalized on the moment to get the collection agency off my back. Also: I should have mentioned in my original post that I had no health coverage at that time, and it really makes you wonder how many people would have read deep into a New York Times story, made the connection, and confronted their providers –and the providers yielded– to get a satisfactory result. ##

  2. Hi Adrian – so what’s next? Do you have any idea if there is a uniform definition of Level 1, 2 and 3 (is there 4, 5 and 6?) that all hospitals use? If so, I can ask for that breakdown from the Mass Hospital Association. I’ll try that on Tuesday unless you think the definitions vary from hospital to hospital. They would have to vary some, because not all hospitals offer the same services, but maybe there’s a level of intensity that is uniform. Thoughts?

  3. Stef – I forgot to give you the BEST JOKE OF THE MONTH AWARD (that’s it, in bold letters)!

  4. We should more care of our health and health issues so that we can treat our health issues more effectively as effective treatment of osteoarthritis & other diseases.

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