Feb 5, 2015 1:22 PM
Van Adriance, of Center Sandwich, has full range of motion in his shoulder now, but this time last year that wasn't the case. He couldn't be happier with the results of surgery to his rotator cuff, but couldn't be more upset over the bill.
Adriance said, "I paid $2,704 more. Close to $3,000 more than I should have with the normal 80/20."
Adriance, in his 70s, is on Medicare. Medicare has it's own set fee schedule, typically quite a bit less than what private health insurance would pay. Of that lower fee, Medicare pays 80%, the patient is responsible for 20%. In Adriance's case, that's not how it worked.
Here's how his bill read - Littleton Regional Hospital charged $21,371.41 for the surgery, but because it was billed under Medicare that amount was reduced. Medicare ended up paying just over 5,000 for its 80% share. If that's 80% then Adriance's 20% should be around $1,200, but instead he was charged $3,950.82.
The reason? Adriance had surgery at Littleton Hospital. It's considered a Critical Access Hospital. That's a federal designation given to smaller hospitals typically in rural areas. They get more money from Medicare patients than hospitals in bigger cities. New Hampshire Hospital Association Chair Henry Lipman says it's designed to give equal access to health care for all.
Lipman said, "Just like we all get mail service no matter where we live, they want to make sure people can get health care where they live."
Critical Access hospitals have to be smaller, 25 beds or less, so they're allowed to charge Medicare patients more to make up for the lack of volume. Lipman said, "Taking risks when you have a small number of cases relatively may lead to financial distress and that hospital not being able to be there, so I think the federal government came up with a system that to make sure that the financing supported the access."
New Hampshire is unique in that 13 out of the states 26 hospitals are Critical Access Hospitals. That's half, and it's one of the highest ratios in the country. In most states it's 25% to 30%.
Lipman claims the steeper billing at these hospitals only affects a small number of people. Of the roughly 260,000 New Hampshire Medicare recipients, most have supplemental health insurance to pick up what Medicare doesn't pay. Adriance is one of the 26,000 that doesn't. What really has him steaming mad is he wasn't told that he could be paying more for his surgery at Littleton Hospital verses a larger hospital. Adriance said, "I was not told ahead, neither with the doctor, no nobody said a thing about this. I asked the billing department how much it would cost. She was really unhelpful. Didn't even try. (Said) every surgery is different. da, da dah, da dah."
Littleton Regional Hospital declined to comment.
Even Lipman says Adriance had a right to an estimate beforehand. He said, "patients have a right to have transparency about what costs might be. And if it's an elected procedure and they want to consider going somewhere else because of what it might cost them then they ought to do that and we want to help them."
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