By Peggy O’Farrell, Staff Writer Updated 7:51 PM Wednesday, May 23, 2012
A regional children’s hospital is making changes as a result of a billing dispute between a man and one of its subcontracting surgeons.
In May 2011, Steve Mahoney of Oakwood took his youngest son, Ryan, then 6, to the emergency room at Children’s Medical Center of Dayton after the boy sliced off his fingertip in a door.
Doctors at Dayton Children’s — the region’s main pediatric hospital that often serves Springfield families — told Mahoney they’d have to call in a plastic surgeon to re-attach the boy’s fingertip.
But no one told Mahoney that the plastic surgeon, Dr. Stanley Edwards, doesn’t accept health insurance. Edwards doesn’t work for the hospital. He’s one of two plastic surgeons who currently serve on an “on-call” basis for the hospital, said chief operating officer Matt Graybill.
Hospitals are “somewhat constrained” in what they can tell families about payments and insurance coverage, Graybill said.
The same federal law that requires hospitals to treat anyone who comes to their emergency department whether they have insurance or not also limits what staff can say to families about paying for that treatment, he said.
“Hospitals can’t tell parents anything that might in any way encourage them not to be cared for there, anything a parent might construe as telling them not to be cared for at Dayton Children’s. and that includes telling things like, ‘you might have a big co-payment’ or ‘Your insurance might not cover this.’”
Edwards’ bill for the procedure, which included several follow-up visits, was $8,200. Mahoney’s insurance company paid $2,600 — 80 percent of what it considers to be the reasonable or customary charge for the procedure.
Mahoney said he tried to negotiate with Edwards’ office for the remainder of the bill, but was told to make monthly payments with 1.5 percent interest. he refused, arguing the charges were unfair.
Now he’s getting calls from a collection agency, and wants to warn consumers to ask questions before they sign any documents giving doctors permission to treat loved ones and agreeing to accept financial responsibility. he owes Edwards’ office about $6,000.
Edwards did not return calls to his office or home seeking comment for this story.
Edwards, whose specialties include plastic surgery and hand surgery, operates a private practice in Centerville. Physicians aren’t required to accept any kind of health insurance. many plastic surgeons in private practice don’t accept insurance; many of the procedures they perform are considered elective, and wouldn’t be covered by most insurers anyway.
Mahoney has no complaints about the treatment his son received either from the hospital or Edwards. His only complaint is that he wasn’t informed that Edwards doesn’t take insurance.
But, he adds, he didn’t ask. His son was injured and bleeding, and he signed the forms without thinking because he was worried about the boy.
And when he took Ryan to Edwards’ Centerville office for follow-up care, he said, “there’s a great big sign” informing patients that the doctor doesn’t accept insurance.
Mahoney said if he’d known that Edwards doesn’t accept insurance, he might have taken his son somewhere else to have his fingertip re-attached.
After Mahoney called the Springfield NewsSun, officials at Dayton Children’s told the newspaper that they’re making changes, even though they’re not a party in the dispute.
Because of the situation with the current on-call plastic surgeons, the hospital’s lawyers are in touch with the Department of Health and Human Services and the Department of Justice to find out staff can give more specific information to families who bring their children to Dayton Children, Graybill said.
The hospital has also contracted with Wright State Physicians, a Dayton-based physician group, to arrange for one of their incoming plastic surgeons to work at Dayton Children’s both in an on-call capacity and at some clinics at the hospital. That surgeon is scheduled to begin working in Dayton in August, and will accept all of the insurance plans the physician group accepts, Graybill said.
The real lesson, Graybill and Mahoney said, is that consumers need to ask the physician treating them or their loved ones whether they accept their insurance plan.
“It’s perfectly appropriate, when that physician comes into the room, to ask, ‘You’re going to work on my son. do you accept my insurance company?’ then the parent can make the decision whether to continue treatment or not,” Graybill said. “Our emergency department physicians, one of the roles they play is helping parents know who’s out there who can take care of their child, if it’s something that can wait.”