After media investigations uncovered fully insured patients getting billed five-figure sums for routine procedures, a red-faced SF General Hospital announces “out-of-pocket” maximums will henceforth not exceed $4,800.
We may get called the “enemy of the people,” but the press can make a real difference in forcing the powers that be into changing some of their most horrific and unfair practices. Consider Zuckerberg San Francisco General Hospital, which has been hounded by pesky reporters covering their “aggressive billing tactics” with privately insured patients.
In the wake a January Vox report showing a fully insured woman was charged $20,000 for a broken arm and a San Francisco Chronicle exposé detailing a $92,000 appendectomy, the city’s only trauma center (named for a billionaire worth $70 billion, give or take) has announced a significant change to its billing policy. The Chronicle reports that Zuckerberg General is reversing the policy, and establishing “out-of-pocket” maximum that should not exceed $4,800 for patients with copays. Vox got a copy of the announcement which claims the practice was “was halted on February 1, 2019 and will not resume.”
Justin Zanders was hit by a pole hanging off the back of a city bus. He was taken to Zuckerberg San Francisco General, where he received stitches and a CT scan.— Vox (@voxdotcom) February 20, 2019
Even though Zanders had insurance, he received a hospital bill for $27,660. https://t.co/gAzFZXkgXD
The practice is called “balance billing,” an Orwellian term that indicates some sort of fairness and balance in a system that bills fully insured patients tens of thousands of dollars for routine injury treatments. Zuckerberg General, which primarily serves Medicare, Medi-Cal, and uninsured patients, had employed an unusual system where fully insured patients’ insurance companies could just choose how much they wanted to cover or not cover, effectively ignoring whatever copay amount they had communicated to the patient.
Since these media investigations, S.F. General has been addressing each of these cases as a one-off. Basically, if some reporter had written a story about you that went viral, then and only then would they reduce your bill. The patient profiled in Vox had her bill reduced from $20,000 to $200, the amount of her copay.
It has not escaped the pesky press that our top elected officials signed off on the practice. As Heather Knight reported in the Chronicle last month, “Guess who approves these ever-rising rates each year? Yep, the mayor and Board of Supervisors — even though it seems they’ve had no idea what they were approving.”
BREAKING NEWS: It's goodbye to $92,000 appendectomies after San Francisco General Hospital announces changes in its billing system. Patients will no longer be balance billed, and any patient with an open account as of February 1 will see bills slashed. https://t.co/SaKQopFMYO— Heather Knight (@hknightsf) April 16, 2019
This sounds like Keystone Kops-caliber legislative bungling, but S.F. General says in their statement that the changes came “at the request of Mayor London Breed and Supervisor Aaron Peskin.” So those two deserve some credit for undoing their mistake. Peskin has boldly “called a hearing on the practice,” according to the Chronicle, and in Sacramento, our state senator Scott Wiener and Assemblyperson David Chiu have introduced a bill banning balance billing.