THE ELDERLAW FORUM
By Professor Michael Myers
A person can usually recover from a non-life-threatening injury in a matter of days or weeks. But to recover from its cost may take years, or for seniors on fixed incomes, the rest of their lives.
Two calls this week to the Senior Legal Helpline are illustrative.
“I am 78 years old,” said the first caller, an Arizona resident. “I am on Medicare Part A and basic Part B. Two months ago I slipped and struck my head on the kitchen table, sustaining a two-inch cut on my forehead. I was dazed, but did not lose consciousness.
“My wife panicked and called 911. I was taken by ambulance to the nearest clinic with emergency service. They checked me over, took a CT scan and concluded I would be all right. My wife drove me home. I assumed Medicare would cover the cost of this brief encounter. It turned out I was wrong; terribly wrong.”
He now avoids answering the phone. “They keep calling me. They want $16,000. They say basic Medicare Part B won’t pay. Our only income is Social Security. We are barely scraping by. There is no way we can pay $16,000. What can we do?”
The second call came from Montana. The amount involved more modest. “But it’s outrageous,” said the caller. She and her husband are in their early 60s, uninsured and not yet covered by Medicare. “My husband had a fishhook embedded in his thumb. We went to the hospital outpatient department. The doctor removed it in 10 minutes. His charge: $710. The hospital charge is an additional $1,250. Do we have to pay that exorbitant amount?”
I told the Arizonan to copy his medical records. They should contain documented need for the CT scan. The number of CT scans per patient has doubled over the past 10 years while the number of MRI scans has tripled, according to a recent study in the journal Health Affairs. Financially, they are strong profit centers. Clinically, they expose patients to many times the radiation of film x-ray and, according to the New England Journal of Medicine, “the radiation from a CT scan actually has been shown to cause cancer—quite a bit of it.” The ordering physician, not the patient, should absorb the cost of unnecessary testing.
The Montana case is more difficult. The Montana Consumer Protection Act protects against unfair and deceptive trade practices. Outrageous charges for medical services no longer constitute a deceptive practice. They are the face of U.S. healthcare, a face that has become increasingly ugly; a face that needs marketplace surgery.
Pro bono legal information and advice is available to persons 55 and older through the USD Senior Legal Helpline, 1-800-747-1895, mmyers@usd.edu.
Opinions expressed here are solely the author’s and not from the University of South Dakota.
