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methrees — USA

Jun 15, 2021

Stanford Health Care — Billing

This is a complaint about billing (not against the doctors, nurses, or other staff).

My dad is a Kaiser patient with Type 2 DM and two small non-healing foot wounds. Kaiser told him that he will have to amputate his leg from the knee down, so he came to Stanford Advanced Wound Care Center in Redwood City, CA for a second opinion on 3/30/2021.

My dad set up a single one-time appointment with Stanford to obtain a second opinion letter which we would share with Kaiser in hopes that they would (a) authorize care with Stanford, or (b) consult with Stanford and reconsider the bleak care plan and prognosis they had given my dad. We knew that Stanford favored a limb preservation approach.

Kaiser did not authorize the obtainment of a second opinion outside of its own network (i.e. my dad paid out-of-pocket). He was told by Stanford that the appointment would cost $1, 057.00 after discounts. Despite the high cost (3x that of UCSF Limb Preservation Clinic's second opinion which was more detailed and interdisciplinary), he paid the amount immediately on the day of his stand-alone appointment.

A few days after the appointment, he was shocked to receive a new $985.20 bill for a biopsy that had seemed to be part of the appointment. He was not warned of any associated costs, otherwise he would have rejected the non-urgent procedure. This could have been covered at Kaiser by his insurance. Stanford should have stated *in the second opinion document* that a bone and tissue biopsy was recommended as a part of the treatment plan. In fact, he was told to get an MRI at Kaiser so that insurance would cover it -- so why was a biopsy done that was nearly the same cost as the appointment itself, had no immediate need, and no impact on the second opinion? We wouldn't even receive the lab results for a week, well after the second opinion write-up was given.

That was just the beginning.

Now we are seeing a total outstanding balance of $5, 299.20. Let's break this down:

• He had paid $1, 057.00 for a single appointment with a vascular physician that lasted well under an hour and included (aside from the biopsy) mostly entering information in his chart about past medical history that Stanford was missing, and making visual observations, all done my nurse staff; standard debridement of the wound by the doctor; and ultrasound pulse measurements -- basic assessments and cleaning done at Kaiser regularly by his podiatrist, and which we all assumed was covered by the $1, 057.00;

• He is being billed $985.20 for a non-urgent biopsy that would have been covered in his network and which had zero urgency or bearing on the second opinion write-up;

• He is additionally being billed $4, 314.00 that was completely unexplained.

I had to proactively call Stanford to get a breakdown of the charges (which were -- again, above and beyond the initial $1, 057.00 for who-knows-what -- for "clinic - general classification" and "treatment/observation room - general classification").

It took two weeks to receive the itemized list. I tried to reasonably discuss the problem with Billing, and was told to fill out a Financial Aid form. I explained that this completely missed the point. The person on the phone was only there to de-escalate and avoid immediate conflict rather than to help meaningfully resolve anyone's issues. When I told her that this is not about financial aid, her response implied that the fees would be waived for any first-time patient regardless of income and the Financial Aid form was a formality.

So we began down the dead-end path to which we were directed. My dad submitted the financial aid form by mail (he is elderly and the financial aid letters are hidden under three unclearly nested subsections, adding to his stress, so we asked for paper communication). Billing responded to our Financial Aid application with a confusing letter that loosely resembled a "wordle", saying we were missing the backup items that we had in fact submitted. The letter stated that we had 15 days to send in the backup items (which we had given them).

• Stanford's letter said that we had 15 days to resubmit.
• My dad received their letter on 6/5/2021.
• Stanford had dated the letter 15 days earlier, 5/21/2021.
• It takes *one day* for a letter to arrive to us from Palo Alto.

Luckily, I happened to see a copy of the letter online earlier, so I had responded immediately with a revised form and a letter of explanation mapping the "missing" (already provided) info to backup copies of my parents' social security letters and Form 1040, and one section filled out that I had accidentally left blank in the initial application.

I checked today, online, and there is a small note hidden under the nested subsections under "Billing" with a small red "x" that says "not eligible".

To be clear -- we were told he would be charged $1, 057.00 for an isolated 1-time visit (about 40-45 minutes max) and we are being charged a total of $6, 356.20. This is over *six times* the amount quoted to us.

For some scale: this would have covered a round-trip flight and stay for two in France, and a limb-saving revascularization procedure that is not yet approved in the US -- not to mention, an actual cure for his wounds so that he could be active again.

First, how can anyone bill thousands of dollars without explanation, and why is it the patient's responsibility to obtain the explanation as some kind of special request?

Second, "financial aid" is missing the point entirely, and is transparently a conflict-avoidance measure. There is no recourse for a patient to disagree with a charge, only to get financial assistance or pay in installments.

Third, what services were included in the $1, 057.00 appointment? Why are some unnecessary procedures done, and others included as recommendations in the assessment and write-up? Why are the doctors not made aware of the billing practices that their patients are subjected to?

Fourth, why would it take sixteen days to get a letter to a patient, when that letter has a fifteen day response requirement and is coming from a town 30 minutes away? Where is the explanation for rejection?

On the one hand, my dad is told that it is absolutely vital that he keeps his blood pressure under control; and on the other hand, he is receiving exorbitant bills, making his blood pressure shoot dangerously high. It's a shame that Stanford billing is working against healthcare.

Due to Stanford's shady billing practices, my dad was denied his right to exercise choice in his care, and denied his right as a consumer to transparency -- what he is getting and for what price.

He would have exercised multiple other options had he been informed of Stanford's charges and billing practices, but we naively chose Stanford because of its reputation in healthcare. Every single one of the itemized charges could have been done at Kaiser. His situation was time-sensitive and they wasted what little time he has.

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