Florida trauma centers charge outrageous fees the moment you come through the door jokes gas prices

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Before any X-ray was taken, any blood collected, any medicine delivered to his broken body, crash victim Eric Leonhard was charged $32,767 just to pass through the doors of a Fort Pierce trauma center. • The bill was not for the surgery Leonhard needed to piece together his shattered pelvis. In fact, after exactly 40 minutes, doctors decided to transfer him because they didn’t have the right specialist for the job. So they loaded Leonhard onto a helicopter and sent him to another hospital on Florida’s east coast. • Lawnwood Regional Medical Center still charged Leonhard, an uninsured tour boat captain, nearly $1,000 for every minute he spent with the medical team that couldn’t fix him. • Every day in Florida, injured people face the same kind of outrageous entry fees because they are taken to a state-designated trauma center. • With virtually no government oversight, these specialized hospitals can charge what they want, when they want, with little chance of being flagged for profiteering. • Patients have no clue about the fees until they get their bill. • In 2002, a national committee lobbied by the industry authorized hospitals to charge a "trauma response fee" — essentially a cover charge — when a patient goes to a trauma center. Hospitals set their fees, which are supposed to help offset the high costs of specialists and specialized equipment needed to save the most critically injured. • But a yearlong Tampa Bay Times investigation has found that hospitals are exploiting the fee, charging large sums even to patients whose injuries require little more than first aid.

A cyclist with road rash was charged $12,500 in Palm Beach County. After a car crash, a teenage girl who spent two hours in a Gainesville hospital with back pain was charged $9,835. An uninsured Pasco County woman was charged $33,000 even though she only needed someone to treat superficial cuts.

No one disputes that there is a higher cost to providing the kind of specialized care found in America’s trauma centers. Hospitals must pay specialists to cover emergencies at all hours and make sure high-tech equipment is available when a trauma comes in.

"Providing trauma services requires highly specialized teams of caregivers, equipment and processes that have to be available 24/7," J.C. Sadler, an HCA spokeswoman, said in a statement. "Our activation fees directly reflect the actual cost in each community of mobilizing these resources for patients who receive trauma care."

Trauma centers are generally housed in a space carved out of a hospital’s emergency room. They are specifically designated to handle catastrophic injuries, the kinds caused by car crashes, shootings or devastating falls, that are too complicated or severe for regular ER doctors to treat.

When Florida paramedics respond to an emergency call, they use their expertise and a state-approved checklist to decide if someone’s injury requires treatment at a certified trauma center. If so, paramedics identify the closest one and call in a trauma alert.

An uninsured stabbing victim spent five hours at Tampa General Hospital with wounds on his neck and forehead that turned out to be nonlife-threatening. His treatment totaled $3,804 before the hospital added an $11,414 trauma fee to his bill.

• Since 2010, at least 7,200 patients were billed a trauma response fee even though they spent less than 24 hours at the hospital. Two top officials from Florida trauma centers say such short-term patients should not be counted as true trauma cases.

• Despite the original intent to scale the fee based on injuries, half of Florida’s trauma centers bill the same amount to everyone they charge. As a result, people with minor cuts and bruises can face the same huge fee as life-or-death trauma patients.

• There is no consistency to how hospitals charge. Average fees differ from one hospital to the next by thousands of dollars, even for neighboring trauma centers. In Tampa, St. Joseph’s Hospital charges about $1,200. Five miles away, Tampa General Hospital charges $11,400.

In 2013, HCA hospitals charged the most, $27,644 on average. They were followed by two Palm Beach County trauma hospitals, Delray and St. Mary’s medical centers, both operated by the for-profit Tenet chain. Both hospitals charged an average of about $14,000.

Only three hospitals — St. Joseph’s, Jackson Memorial in Miami and Broward Health North in Deerfield Beach — charged less than $1,500 for the fee. They were the only hospitals charging anything close to the $1,000 limit the government has set for Medicare patients.

A month after the crash, the hospital offered Leonhard a discount that reduced his total bill by 65 percent. That sounds generous, but Leonhard still owes $15,779 to the hospital that flipped him through its ER doors in about an hour the night of Nov. 25, 2012.

Before the accident, the boat captain and former lifeguard had spent months setting up a charter cruise business that he planned to manage while taking over his family’s picture frame-making business. Now, he can’t handle the physical demands of fishing tours on his own, or work the machinery needed to slice frames.

"It’s just an easy thing to make a lot of money at," said Glenn Melnick, an expert in health care economics and a professor at the University of Southern California. "You get a local monopoly on your services, which you can set very high prices for."

When it comes to charging patients, the response fee is just the beginning. Using lesser known billing codes, hospitals engage in all kinds of accounting acrobatics under the guidance of experts specially trained in billing for maximum advantage.