Lawmaker steps in after extreme hospital billing Investigation

A FOX 4 hospital billing investigation struck a nerve with our viewers, and now, an Austin lawmaker is stepping in.

The FOX 4 phones lit up and our email exploded after our investigation aired in November.

Patients highlighted in the report are not alone, and some of their bills even paled in comparison to a new batch of billing complaints.  Now, with the legislature getting underway, one lawmaker is calling for change.

Elizabeth Horvath loves being a mom to 3-year-old Tanner, and she loves her new shape after shedding a whopping 85 pounds, thanks to gastric sleeve surgery.

She was expecting the dramatic weight loss, but she was not prepared for the outrageous bill.

 "So, you pull [your bill] up and you see this, and what is your first response?" asked FOX 4 reporter Becky Oliver.

 "No way, this is not real," Horvath said. "This is an obscene amount to charge for a $15,000 to $20,000 surgery."

Examining the bill, Horvath was shocked to see the breakdown.

"$134,888 for the operating room," Horvath said.

 "Just the room itself was $25,000, just for the room," said Oliver.

Texas General charged another $12,000 for the recovery room. 

The grand total was $622,000, billed to her insurance company.  It says Horvath may owe a half-million dollars.

"I don't want to hurt my family and this will crush us," Horvath said.

Maria Martin is in the same boat.

"I went in for a hysterectomy and my final bill was $360,000," Martin said.

"Your operating room services were $211,000," Oliver said.

"$18,000 for a disposable cup," Martin said. "I thought this had to be a mistake."

But it's no mistake.  United Healthcare paid $17,119, leaving her with a balance of $342,685.

"When I spoke with the representative in the billing department, they told me absolutely that is what I owed, that that is what they charge," Martin said.  "They are an out-of-network provider and basically, they charge what they want."

And that's true. There is no national or state uniform standard when it comes to what a hospital can charge, but these excessive bills are now catching the attention of lawmakers in Austin.

"This hospital is not in network with anybody," Representative Chris Turner (D) of Arlington told a legislative panel during recent hearings. 

Texas General Hospital sits in Turner's district.

 "I was shocked, shocked when I saw your story," Turner said.

Turner has now fired off a letter to the Texas Attorney General and the Insurance and Health Services Commissioners.

"If you are brought there in an ambulance, you are not asking if you need life-saving care; ‘How much this is going to cost me?'" Turner said.  "You are going to say, ‘Get me into the emergency room as quickly as possible and save my life.' I think patients have a reasonable right to expect that whatever that bill is going to be, it is not going to bankrupt them."

Turner says his office did some research looking at the cost of cardiology, general medicine, pulmonology and urology at Texas General, then compared it to Texas Health Harris Methodist in Stephenville, a similarly-sized hospital.

The charges fall right in line with what we reported back in November.

National Nurses United told us that its research shows Texas General is the most expensive hospital in Texas and the eighth most expensive nationwide.

"This hospital is jacking up their charges over 10 times their cost," Charles Idelson said.  "It is scandalous. There is no reason for any hospital to set their charges that high."

Texas General is a private hospital.

State records show Suleman Hashmi serves as president, and his father Hasan is chairman of the board. 

Both declined an on-camera interview with FOX 4 again.  Instead, they sent another statement saying that "privacy laws prohibit them from discussing patient bills. The hospital gives patients a choice to receive care even if the patient's insurance company does not contract with the hospital." 

It says Texas General "always seeks payment from the insurance company first.  At no time does the ability to pay impede our delivery of care" and adds that Texas General has "never found it necessary to refer a patient's bill to a collection agency or credit bureau."  

Tyler Hanks ended up in the emergency room at Texas General.  His buddies took him there after a minor car accident.

He was bleeding and had glass in his arm.  The hospital billed $75,000 for X-rays, a CAT scan, labs and drugs.

 "He has had emergency surgery and it didn't cost that much," Tyler's mother, Gloria, said.

Gloria says Texas General sent them to Arlington Memorial because Tyler required surgery to remove the glass.  Arlington charged just $1,400 and sent them home. 

Blue Cross Blue Shield paid $16,000 of the Texas General bill, leaving a balance of $58,000.

"Would you ever go back there?" Oliver asked.

"No, not ever, not for a splinter, not for a heart attack," Gloria Hanks said.

Tyler's decision to go to Texas General was last minute. It was the closest hospital, so it made sense to go there. 

But both Horvath and Martin had scheduled surgeries.  They discussed the costs and their insurance coverage with their doctors before their procedures.

 "I had already met my deductible," Martin said.  "I was told I shouldn't get a hospital bill, but if I did, it would be minimal. It was not until I got the bill and called the billing department I was told it was an out-of-network hospital. 

 "A half million dollars?" Oliver said. "You talked about this up front."

 "Right," Horvath said.

 "You went over all of this," Oliver said.  "You were not expecting this to come in the mail."

 "No, absolutely not," Horvath said.  "I don't want this to hurt my family."

Horvath and Martin have not paid anything toward the balance of their bills. They are waiting to hear from their insurance companies.

Blue Cross Blue Shield says it encourages members to understand health benefits and what's covered and what's not. 

The company also asks members to report fraud and abuse to its hotline immediately.

United Healthcare says it is deeply concerned about hospitals establishing an out-of-network strategy to hike the rates they charge for services often surprising patients.

United says Texas General is unresponsive and unwilling to consider in-network participation.

It is not enough to ask your doctor if he or she is in your network. You must ask if the hospital is in-network; not just if the insurance is accepted.

STATEMENT

Texas General Hospital, like many others, believes that a patient should be able to receive medical care based on a personal decision and their doctor's advice. As an "out of network" provider, Texas General Hospital gives patients a choice to receive care at our facility even if the patient's insurance company does not contract with our facility.

As a result of providing this choice to patients, Texas General Hospital is required to follow certain federal and state laws and regulations regarding the creation and issuance of a bill for any care. When a patient is covered by insurance, we generate and provide an invoice for the care received to both the insurance company and the patient, simultaneously. Regardless of the amount of the bill, we always seek payment from the insurance company first. We then work with the patient to help them understand the bill and answer questions about any remaining balance, if the patient is able to pay. At no time does the ability to pay impede our delivery of care. Moreover, we are proud to say that we have never found it necessary to refer a patient's bill to a collection agency or credit bureau.

We are always available to discuss a patient's bill. Consequently, we are reaching out directly to these patients to discuss their specific situations.

As you know, federal and state privacy laws prohibit Texas General Hospital from discussing any patient's bill. Without the ability to comment on patient's bills, we hope that in pursuit of fair and balanced journalism, FOX 4 reports the out-of-pocket amount actually paid by each patient made the subject of this news story.

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