On the first morning of Jang Yeo-im’s vacation to San Francisco in 2016, her eight-month-old son Park Jeong-whan fell off the bed in the family’s hotel room and hit his head.
There was no blood, but the baby was inconsolable. Jang and her husband worried he might have an injury they couldn’t see, so they called 911, and an ambulance took the family — tourists from South Korea — to Zuckerberg San Francisco General Hospital.
The doctors at the hospital quickly determined that baby Jeong-whan was fine — just a little bruising on his nose and forehead. He took a short nap in his mother’s arms, drank some infant formula, and was discharged a few hours later with a clean bill of health. The family continued their vacation, and the incident was quickly forgotten.
Two years later, the bill finally arrived at their home: They owed the hospital $18,836 for the 3 hour and 22 minute visit, the bulk of which was for a mysterious fee for $15,666 labeled “trauma activation,” which sometimes is known as “a trauma response fee.”
“It’s a huge amount of money for my family,” said Jang, whose family had travel insurance that would cover only $5,000. “If my baby got special treatment, okay. That would be okay. But he didn’t. So why should I have to pay the bill? They did nothing for my son.”
American hospital bills today are littered with multiplying fees, many of which don’t even exist in other countries: fees for blood draws, fees for checking the blood oxygen level with a skin probe, fees for putting on a cast, minute-by-minute fees for lying in the recovery room.
But perhaps the kingpins are the “trauma fees,” in part because they often run more than $10,000 and in part because they seem to be applied so arbitrarily.
A trauma fee is the price a trauma center charges when it activates and assembles a team of medical professionals that can meet a patient with potentially serious injuries in the ER. It is billed on top of the hospital’s emergency room physician charge and procedures, equipment, and facility fees.
Emergency room bills collected by Vox and Kaiser Health News show that trauma fees are expensive — typically thousands of dollars — and vary widely from one hospital to another.
In the past six months, Vox has collected more than 1,400 emergency room bills submitted by readers in all 50 states and Washington, DC, as part of an investigation into emergency room billing practices.
The dominant storyline to emerge is what anyone who has visited an emergency room might expect: Treatment is expensive. Fees have risen sharply in the past decade. And when health insurance plans don’t pay, patients are left with burdensome bills.
Charges ranged from $1,112.00 at a hospital in Missouri to $50,659.00 at a hospital in California, according to Medliminal, a company that helps insurers and employers around the country identify medical billing errors.
“It’s like the Wild West. Any trauma center can decide what their activation fee is,” says Renee Hsia, director of health policy studies in the emergency medicine department at the University of California, San Francisco.
‘I Can’t Afford That’: Trapped and Injured by Subway Car, Woman Begged Bystanders Not to Call Ambulance Due to Expense — “In the face of a grave injury, a series of calculations follow…This discord, between agony and arithmetic, has become America’s story, too.”
As Americans across the country celebrate Independence Day with parades, barbecues, and fireworks displays, the story of a woman begging bystanders not to call an ambulance after she was injured in an accident went viral this week—with universal healthcare advocates pointing to the incident as clear evidence that a Medicare for All system would bring gravely-needed relief to all Americans.
— Dr. Joe Jarvis (@DrJoeQJarvis) July 4, 2018
The woman’s leg became trapped between a subway car and platform on Friday night in Boston. Surveillance footage showed other passengers rushing to help the woman, who sustained a deep wound on her leg. A Boston Globe journalist who happened to be on the platform reported that the woman told the crowd she wouldn’t be able to afford a hospital bill if they called an ambulance.
Awful scene on the orange line. A woman’s leg got stuck in the gap between the train and the platform. It was twisted and bloody. Skin came off. She’s in agony and weeping. Just as upsetting she begged no one call an ambulance. “It’s $3000,” she wailed. “I can’t afford that.”
— Maria Cramer (@GlobeMCramer) June 29, 2018
Another bystander told CNN, “She made it a point to say ‘you don’t understand, I have terrible insurance.'” The woman was eventually convinced to go with emergency medical technicians who arrived at the scene.
While the Affordable Care Act (ACA) has expanded access to healthcare, noted the New York Times editorial board on Monday, it has left many Americans with inadequate coverage and struggling to pay high deductibles and medical bills.
A study conducted by the Times and the Kaiser Family Foundation in 2016 found that 20 percent of insured Americans have trouble paying for medical care. Sixty-three percent of those surveyed said they had used up all or most of their savings to pay doctor’s and hospital bills.