Gold-plated stitches

August 15, 2012 in Member Stories

A colleague at WBUR slammed her right pinky finger in one of our heavy studio doors a few weeks ago. When she got home that night she realized that the gash was deep enough to need stitches. It was after 8 p.m., on a Friday, so her doctor’s office was closed for the weekend. She went to the local ER.

Two-and-a-half hours later, most of which involved waiting, she went home with two stitches. She just got a $1,059 bill from the hospital (The total cost of her visit was $1,134, but the bill was reduced by her $75 ER co-pay).

She was mystified by “how two stitches could possibly cost more than eleven hundred dollars?” She called the hospital and asked for an itemized bill. Here’s what she got:
It’s a little hard to read the scanned copy, but if you look at the second line, that accounts for a $400 charge, you see this explanation: SIMPL REPR SCLP/AX/GEN.

We’ve been trying to guess, in the newsroom, what “simple repr sclp/ax/gen” means? Anyone? Couldn’t the billing staff at least send an explanation with full words?

My friend’s finger healed well.  It should, she says, for $1134.

3 responses to Gold-plated stitches

  1. It’s CPT code 12001:

    “Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.5 cm or less”

  2. Great Aaron – thanks!

  3. This is the “hospital charges” unfilitered by negotiated agreements with insurance provider. If your colleague has insurance, this bill is essentially meaningless – although frightening. Wait until you get your “EOB” from the insurance company.

    If you don’t have insurance, then you should call the hospital and negotiate with them. They probably will be happy if you offer to pay 50% of the charges. An insurance company that represents a significant payor for this particular hospital has probably been able to negotiate a payment around 1/3rd of gross charges – but it varies by CPT code.

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