ER triage/billing

[frappuccino1]

Hi, I'm coming at this from a healthcare consumer standpoint here, wondering if someone with some ER/triage experience or an ED charge nurse might be able to shed some light on this situation for me, since it's been a long time since I've practiced in a hospital.

My son recently broke his thumb, and we received a bill for $800+ under the classification "ED services." Ok, fine. I probably wouldn't have thought anything of it, except for the fact that this same son broke his wrist almost exactly a year ago, and the "ED services" amount was $100+. Well, I was naturally curious about why the huge disparity, so when I called the billing office, they said that this year's injury was triaged as a level 5 trauma, and therefore was charged at this higher rate, whereas last year's incident was triaged as a level 2. When I asked if this could be appealed, the lady checked into it and spoke with the charge nurse of the ED, who apparently has the authority to review these charges. The only answer I got back was that triaging this injury as a level 5 was indeed deemed appropriate for this admission, and therefore the payment amount stands. I just don't get it. Why the huge difference when, for all I could tell, it was the exact same protocol, same treatment, even the same doctor as last year. Help!!

[thinkertdm]

You didn't hear it from me, but in back there is a big wheel, with various prices and codes on it. The reason the wait is so long is because they are spinning that thing to see what to charge. They used to use a plinko board, but it kept landing on the cheaper codes.

[TDCHIM]

Perhaps you could try to get your insurance company lined up behind you? After all, it stands to lose money on this inconsistent logic.

[rjflyn, ASN, RN]

Well since you dont give enough information, its hard to say. An example could be he fell a year a go and broke his wrist and got that class and that charge. But this time it was a car crash and he suffered a broken thumb. The devil is in the details.

[mamamerlee, LPN]

Ask for an appeal, since you feel the charges are too high. If you do not have insurance, offer to settle the bill for a reduced amt. Often, they will take a small amt just to close it out.

Sometimes they will take 25-30% as the payment in full. Can't hurt to try.

[frappuccino1]

deleted

[frappuccino1]

Thanks for the helpful advice. Yeah, I'll be checking with my insurance since my appeal was denied.

As far as details of the injury go, crazy thing, but it was the exact same event both times: jumping out of a swing in our backyard and having a somewhat less than graceful landing

[Mulan]

Call the CEO's office and see if you get the same answer.