Investigation - Extreme Billing for Imaging
Imagine getting a bill from a hospital and you never even walked through the door. It is happening to patients across the Dallas/Fort Worth Metroplex.
FOX 4 started investigating extreme billing at Texas General Hospital in Grand Prairie late last year, and this latest set of bills took patients by surprise. They had never visited the hospital.
As a pilot for American Airlines, Captain Dan Caviglia flies all over the world. He knows one place he's never been is Texas General in Grand Prairie.
“It has to be a mistake,” Captain Caviglia said. “I wasn't even there and I never had a procedure that could possibly cost $30,000.”
But it was no mistake.
Captain Caviglia had visited urologist Dr. Nathan Graves in Grapevine. Caviglia has Blue Cross Blue Shield insurance. Prior to the visit, he checked to make sure Dr. Graves was in network.
During his check- up, Graves sent him down to Suite 100 for a CAT scan. Turns out, Suite 100 is TGH, or Texas General Hospital Imaging, and it is out of network with his insurance plan.
“It is deceptive, it's abusive and it is just wrong,” Caviglia said.
FOX 4's research shows CAT Scans usually cost anywhere from a few hundred dollars on the low side to several thousand dollars on the high side. Blue Cross Blue Shield picked up Caviglia's entire $30,000 tab, leaving him with a zero balance.
So why is this pilot so fired up?
“We are a self-insured company, and so this money comes directly off my company's bottom line,” Caviglia said. “I am concerned about the welfare of my company, so it affects me indirectly.”
Verna Hale doesn't know Captain Caviglia, but the grandmother and cancer survivor does have two things in common with him: Dr. Graves and Suite 100.
“I had gone to this doctor for over 30 years,” Hale said. And she's had dozens of CAT Scans.
“The insurance usually pays $400, and I pay $150,” Hale said.
“So when you saw this $27,000, what did you think?” FOX 4 reporter Becky Oliver asked.
“I just thought it was outrageous,” Hale said. “I just couldn't imagine why they would charge that much for five minutes. That is all it takes.”
Hale was also sent down to Suite 100, but in her case, she says the office told her it was out of network, but not to worry.
FOX 4 called Dr. Graves' office several times. We wanted to know why he is sending his in-network patients down the hall to an out-of-network imaging suite that charges these rates.
He never returned our calls.
Texas General told us by email, “It is not uncommon for a hospital to operate an off-campus outpatient department through a joint venture or other ownership mechanism for the convenience of its patients and physicians. Each off-campus outpatient department owned in full or in part by Texas General Hospital is clearly identifiable to each patient through posted signs, placards, and information provided to the patient before any service is performed.”
FOX 4 did not see any signs on Suite 100, but there is a sign in the hallway and another one outside that says TGH Imaging.
Caviglia says he glanced at his paperwork and did not notice if it said anything about Texas General.
“I was shocked, shocked when I saw your story,” State Rep. Chris Turner said.
Our earlier report caught the attention of Turner after FOX 4 profiled patients after patient with six-figure bills from Texas General.
They are patients like Maria Martin. Her hysterectomy totaled nearly $360,000.
Cynthia Sustaita's gallbladder surgery came in at $186,000.
Texas General sits in Turner's district.
“I think patients have a reasonable right to expect that whatever that bill is going to be, it is not going to bankrupt them when they get it,” Turner said.
Texas General says it has never turned anyone over to the credit bureau or to collections, and they work with patients to understand their bill. What these patients don't understand is why their insurance company paid these excessive bills.
“If the insurance picks it up eventually, it comes back to other premiums, other deductibles,” Hale said. “Other people have to pay for it.”
“It is awful,” Caviglia said. “We may not pay it directly, but the insurance companies don't print money. They get it from us.”
FOX 4 requested a sit-down interview with a representative from Blue Cross Blue Shield numerous times.
The company declined. The insurance giant will only say that “When claims are submitted, we pay them according to the member's specific plan design as we are required to do. “
Blue Cross Blue Shield points out that Texas General has chosen not to participate in the company's network.
Texas General Hospital full statement:
“Federal and state privacy laws prohibit Texas General Hospital from discussing any patient's bill.
As Grand Prairie's only hospital, we take great pride in our responsibility and commitment to providing the highest degree of patient care and quality – from the bedside to our billing office. We work with each patient to help them understand their 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.
It is not uncommon for a hospital to operate an off-campus outpatient department through a joint venture or other ownership mechanism for the convenience of its patients and physicians. Each off-campus outpatient department owned in full or in part by Texas General Hospital is clearly identifiable to each patient through posted signs, placards, and information provided to the patient before any service is performed.
We remain dedicated to providing compassionate, quality medical care while serving as a faithful steward of the Grand Prairie community.”
--David J. Chamberlin Executive Vice President, Edelman
BCBSTX full statement:
“More than 500 hospitals and 80,000 physicians and health practitioners in the state of Texas participate in our network. To date, Texas General Hospital has chosen not to participate in the BCBSTX network.
When claims are submitted, we pay them according to the member's specific plan design as we are required to do.
We are committed to preventing, detecting and investigating health care fraud, waste and abuse and always encourage our members to review their medical bills and explanations of benefits for accuracy. BCBSTX members who suspect fraud or abuse, should report it immediately by calling our Fraud Hotline at 1-800-543-0867. It is open 24 hours a day, seven days a week. The Fraud Hotline number is printed on every explanation of benefits sent to members. “
Louis Adams
Director, Media and Public Relations
Blue Cross Blue Shield of Texas