Financial Pain in the ER

If you ever have a crash that lands you in the ER, be prepared for the pain - in your wallet. The latest ploy to separate you from your money is something called the “trauma activation fee”. Basically, it’s an admission charge assessed when you go through the front door of the hospital emergency room, billed on top of the actual costs for any medical services you might incur.

How much your health insurance may pay of that fee is a matter of secret negotiation between the hospital and the insurer. You may well, however, find yourself stuck with a significant share of the cost which could amount to thousands, even tens of thousands, of dollars.

Hospitals say that the special fee is necessary to offset the costs deploying the team of specialist medical professionals needed to meet a seriously–injured patient immediately upon arrival at the emergency room. Unsuspecting patients with less serious injuries, however, are being slapped with this fee as well.

Some very egregious examples have been reported in recent years, the latest by Jenny Gold (Kaiser Health News) and Sarah Kliff (Vox) in a June 28, 2018 article.

The eight-month old son of a visiting South Korean couple fell off the bed in their hotel room and hit his head. He had only a minor bruise but would not stop crying. Fearing that there might be an internal injury they could not see, the parents called 911. Everything checked out at the Zuckerberg San Francisco General Hospital emergency room. They were relieved. The young boy was treated with some formula and a nap.

But then the bill arrived: $18,836 for a 3 hour and 22 minute visit. The largest item on the invoice was the $15,566 trauma activation fee. The South Korean family’s travel insurance would only pay $5,000.

Happily, after Vox and other news outlets shamed the hospital by publishing accounts of the incident, San Francisco General agreed to waive the trauma activation fee. But should that kind of intervention have been necessary? What if you aren’t fortunate enough to have investigative reporters on your side?

This is not an isolated practice. Nearly all emergency rooms in the United States now have a trauma activation fee on their books that they can charge, seemingly at random. There is no regulation of the practice. A study by Medliminal, a company that works with insurers to control hospital billing errors, reported a range of trauma fees running from $1,112 at a hospital in Missouri to $50,659 in California.

In another recently reported instance, after a minor fall from a too-quick turn on his motorcycle (could have been a bicycle), the 28-year old rider was taken by ambulance to Queen of the Valley Medical Center in Napa. He was there for about a half an hour, no X-rays, CAT scans or other tests were needed. Because the ambulance team had alerted the trauma unit, however, his bill was $26,998, including a $22,550 trauma activation fee. What his insurance company paid is unknown but the fact that such a large trauma fee was charged for a relatively inconsequential emergency room visit is cause for alarm.

What can you do if this happens to you? After you’ve recovered, be prepared to push back hard against the hospital and the insurance company. You may be able to get the fee reduced or even waived. It’s not easy and you may need help from a patient advocate or your insurance agent. If you feel you are not being treated fairly, don’t hesitate to file a complaint with your state department of insurance. If all else fails, a good lawyer may be your best recourse. Sad to say but that is the reality of interacting with the health care system in America today.