No Emergency Here

There is a new series on CBS called Medical Price Roulette and I love it. Listen to how the insurance company screwed this patient:

Frank Esposito says it started last March with unrelenting back pain. He could barely move, and an MRI soon showed a bulge in his spine. A specialist told him to go to the closest hospital — immediately. 

Doctors at the emergency room said he needed surgery. The herniation was so severe it could cut his nerve, Esposito said, and render him paralyzed. 

The surgery was a success, but then the bills started coming: over $650,000 in all. 

His insurance company said his back surgery didn’t qualify as an emergency and wasn’t medically necessary.

“What was my choice? Just be paralyzed for the rest of my life?” asks Esposito, a tool and die maker from Long Island, New York. “Then to get these bills that were so overwhelming. You say, this can’t be real, I mean, I really don’t have to pay this. How am I gonna pay this? And you sit there. And you start cryin’ ’cause you don’t know what you’re gonna do.” 

Are you f%cking kidding me? As much as I hate the government running healthcare, I hate these guys the same.

Esposito has already taken $49,000 from his retirement savings. He hired a company to negotiate down some of his bills. After appeals, Esposito’s insurer, Oxford United Healthcare, did pay some of his doctors’ bills. But he still owes $220,000 — CBS News is still waiting for a response to questions about that balance. 

Still owes $220K! These companies need to be stopped. The hospital could also eat this. This kills me as a doctor. And as a human.

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Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  4 comments for “No Emergency Here

  1. Natalie Newman, MD
    September 24, 2019 at 8:12 pm

    Forget appeals. Sue the insurance company for practicing medicine w/o a medical license and the medical director for practicing outside of his scope. I can guarantee you he was not a neurosurgeon, so how can he override a decision made by an expert?

  2. R Stuart
    September 24, 2019 at 2:16 pm

    Patient is at fault.

    He should have been a better consumer and shopped around for a better price.

    Snark.

  3. Randy
    September 24, 2019 at 1:48 pm

    I know nothing at all about this case other than the article but it seems to me there is probably more to the story. What kind of hospital stay/surgery costs 650K? How often is a HNP a surgical emergency and how often does that “cut his nerve” and cause permanent paralysis, and what spinal surgeon and hospital doesn’t know you need prior auth? My guess is there’s more going on than just a bad insurance company.

    • PW
      September 25, 2019 at 2:35 pm

      I agree, disc bulge, ER docs say he needs surgery, $650K? Something fishy.

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