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Bill Of The Month: $43,208 For Repeat Surgery To Replace Broken Medical Device

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Bill Of The Month: $43,208 For Repeat Surgery To Replace Broken Medical Device

DAVID GREENE, HOST:

So here's a question - what do you do when a medical device fails? And when it fails, who pays for it - the manufacturer, the hospital? Or are you stuck with the bill? Well, Dr. Elisabeth Rosenthal from our partner Kaiser Health News has been looking into this as part of our medical Bill of the Month series. This is when you, our listeners, bring us mysterious and inflated medical bills, and we try to dissect what happened. Dr. Rosenthal, welcome back to the program.

ELISABETH ROSENTHAL: Hi. Thanks for having me again.

GREENE: All right. So this month's bill involves someone who essentially had to have the same surgery twice because a medical device failed. That sounds terrible.

ROSENTHAL: That's right. And she had to pay for it twice. Today, we're going to meet Sarah Witter, a retired teacher in Vermont who loves skiing. She's still skiing in her 60s.

GREENE: Nice.

ROSENTHAL: But she had an accident earlier this year that sidelined her for a while.

GREENE: You and I are going to talk about the bills she ended up paying, but let's actually hear what happened to her. Nina Keck from Vermont Public Radio went to visit with her recently.

NINA KECK, BYLINE: Sarah Witter and I are sitting at her dining room table. To her right is a stack of medical bills. We'll get to those. But first, she wants to show me what's inside a large manila envelope.

SARAH WITTER: Since, in my eyes, the whole thing is about this.

KECK: This is a rather ordinary looking piece of hardware, about six inches long and bent up at one end.

WITTER: Sort of looks like a curved tongue depressor with one, two, three, four, five, six, seven, eight different shaped holes.

KECK: Those are meant for surgical screws, but there's also a gaping crack that's not supposed to be there. But let's back up to last February. Sarah was skiing with her husband when she took a hard fall. Ski patrollers had to bring her down on a toboggan. And doctors at a nearby clinic took X-rays of her leg.

WITTER: They saw right away that it was a bad break.

KECK: An orthopedic surgeon at Rutland Regional Medical Center told her she had a pilon fracture.

WITTER: Broken and sort of crushed - similar to the kind of accidents that skydivers get if they hit the ground too hard.

KECK: Wow.

WITTER: And I generally don't go in the air when I ski. But anyhow, I could - you could see little pieces.

KECK: This is where that odd shaped bit of hardware known as a locking plate comes in. Sarah's doctor used it to hold all those little pieces together. The surgery went great, the doctor told her, but to heal properly, the 63-year-old had to stay off her feet for 12 weeks - the hardest part. Moving anywhere meant using a walker she renamed the hopper.

WITTER: I developed calluses on my hands from holding the walker and hopping so much.

KECK: After three months, things were better, but then her leg began to painfully throb in a whole new way. After an X-ray, her surgeon broke the news. The steel plate had broken. She'd need surgery all over again.

WITTER: I don't know how it broke. He did - the first thing he said to me was it wasn't anything I did. So he said it just happens.

KECK: But unlike when a car part or some other costly appliance fails, Sarah learned there was no warranty on the hardware used on her leg. In fact, the Witter's insurance would be charged nearly $100,000 for her treatment, of which Sarah and her husband had to pay nearly $19,000.

WITTER: You know, I'm ruffling through approximately 50 pages of gobbledygook that I don't know how anyone can understand it.

KECK: But here's what we did find out. That second plate cost nearly $13,000, and Sarah thinks the hospital or the manufacturer should have paid for it.

WITTER: They made it. It broke. You know, if my coffee maker broke, I'd go back to the coffee maker or manufacturer and say, hey, you owe me a new one. You know, they can't give me back my time and all the discomfort and the weeks in the chair. But I do think for the billing of the surgery, they should do something.

GREENE: All right, listening there to a story from Nina Keck from Vermont Public Radio, and I'm still with Dr. Elisabeth Rosenthal from Kaiser Health News. And that - what we heard from her at the end there seems to make sense to me. They made it. It broke. But that's not the way it works with medical devices.

ROSENTHAL: Well, not at all. With medical devices, usually patients and insurers foot the bill if something goes wrong or breaks. And, you know, that - sometimes in medicine, that may be OK. Like, if you're prescribed the wrong antibiotic the first time and it doesn't work, you go buy another one - not a big deal. But in this case, as we heard, the replacement part for the $9,000 plate that broke was $13,000. And instead of saying, gee, sorry, you know, we'll take care of it, both Sarah and her insurer were billed a whole lot of money. So, you know, we all expect warranties from the electronics store, from a car dealership, from a builder, but that isn't the norm for medical devices, and we accept that. You know, what I like to say is in commerce, generally, the customer is always right; in medicine, the customer/patient is always wrong.

GREENE: Yeah, which doesn't sound fair. Why is that the way it is?

ROSENTHAL: Well, it's just become the norm in medicine, and it's not just the cost of the device. Of course, to get the device replaced, she also had a $50,000 hospital bill. So everyone kind of conspires against the patient in this case.

GREENE: OK. So you said the insurance companies maybe would have covered this in the past. What did Sarah Witter hear from her insurance company in this case?

ROSENTHAL: Basically nothing, you know, that this is how it works.

GREENE: OK. So she's stuck with this big hospital bill. She's stuck with the bill because of - the surgery went badly. Her insurance company is paying some of it. She's still stuck with paying a lot of money. Is there anything she can do here?

ROSENTHAL: Yeah, there are some things. First of all, if it's an elective surgery, some places are starting to offer warranties. If your artificial hip dislocates within the first year, they'll do it for free. That is reasonable, right? The other thing I tell people to do is fight the good fight. Don't give up on this. You know, you should not be paying twice because of someone else's fault. And, you know, your insurer may not go to bat for you, but ask the HR department at your company because they're paying and they should fight like hell against this.

GREENE: Is she at least back on the slopes yet as she's fighting the good fight and enjoying some skiing?

ROSENTHAL: Not quite yet. She's still healing, but you can see her out on the slopes working at the ski resort, so she will be back by next year.

GREENE: So she's at least getting back into that atmosphere that she loves. All right, Elisabeth Rosenthal is editor in chief of Kaiser Health News. Thanks as always.

ROSENTHAL: Thank you.

GREENE: And if you have a medical bill that seems mysterious or inflated or something that concerns you and you want us to take a look at it, go to our Shots blog on npr.org and just submit it to us online.

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