Medical Over-charging is a U.S. Embarrassment, Yet Healthcare is Too Egomaniacal to be Ashamed
Two years ago, Margaret O’Neill brought her 5-year-old daughter to Children’s Hospital Colorado because the band of tissue that connected her tongue to the floor of her mouth was too tight. The condition, literally called being “tongue-tied,” made it hard for the girl to make “th” sounds.
It’s a common problem with a simple fix: an outpatient procedure to snip the tissue.
During a pre-operative visit, the surgeon offered to throw in a surprising perk. Should we pierce her ears while she’s under?
Experts estimate the U.S. health care system wastes $765 billion annually — about a quarter of all the money that’s spent. Of that, an estimated $210 billion goes to unnecessary or needlessly expensive care, according to a 2012 report by the National Academy of Medicine.
O’Neill’s first thought was that her daughter seemed a bit young to have her ears pierced. Her second: Why was a surgeon offering to do this? Wasn’t that something done free at the mall with the purchase of a starter set of earrings?
“That’s so funny,” O’Neill recalled saying. “I didn’t think you did ear piercings.”
The surgeon, Peggy Kelley, told her it could be a nice thing for a child, O’Neill said. All she had to do is bring earrings on the day of the operation. O’Neill agreed, assuming it would be free.
Her daughter emerged from surgery with her tongue newly freed and a pair of small gold stars in her ears.
Only months later did O’Neill discover her cost for this extracurricular work: $1,877.86 for “operating room services” related to the ear piercing — a fee her insurer was unwilling to pay.
At first, O’Neill assumed the bill was a mistake. Her daughter hadn’t needed her ears pierced, and O’Neill would never have agreed to it if she’d known the cost. She complained in phone calls and in writing.
The hospital wouldn’t budge. In fact, O’Neill said it dug in, telling her to pay up or it would send the bill to collections. The situation was “absurd,” she said.
“There are a lot of things we’d pay extra for a doctor to do,” she said. “This is not one of them.”
Kelley and the hospital declined to comment to ProPublica about the ear piercing.
Surgical ear piercings are rare, according to the Health Care Cost Institute, a nonprofit that maintains a database of commercial health insurance claims. The institute could only find a few dozen possible cases a year in its vast cache of billing data. But O’Neill’s case is a vivid example of health care waste known as overuse.
Into this category fall things like unnecessary tests, higher-than-needed levels of care or surgeries that have proven ineffective.
Wasteful use of medical care has “become so normalized that I don’t think people in the system see it,” said Dr. Vikas Saini, president of The Lown Institute, a Boston think tank focused on making health care more effective, affordable and just. “We need more serious studies of what these practices are.”