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His hernia surgery shouldn't have cost more than $50,000. So why was his bill for $116,000?

Posted: 5:06 PM, Nov 12, 2019
Updated: 2019-11-12 17:06:54-05
His hernia surgery shouldn't have cost more than $50,000. So why was his bill for $116,000?

RICHMOND, Va. — When Jeff Samford learned he needed surgery for double hernia repair, he did some research and found it would likely cost in the neighborhood of $10,000 to $12,000. According to the surgeon's notes, the outpatient procedure was routine and lasted 91 minutes.

He was home within hours.

"Then we received a bill from Henrico Doctors for $116,000," Samford said. "I first thought it was an error."

Among the charges:

$45 for a single oxycodone
$1,700 for scissors
More than $18,000 for two kits of 10 ml tisseel topical

A search of drugs.com showed they charge a little under $700 for one kit, meaning HCA Virginia, the hospital's parent company, charged Samford 12 times that amount.

"I was dumbfounded then, and I'm still dumbfounded," Samford told WTKR.

Samford's medical coverage from Liberty HealthShare pre-approved the surgery for up to $50,000. Samford thought there was no way it would cost that much.

Yet almost a year later, he is still left with a $67,326.24 balance from HCA Virginia.

"I kind of look at them and ask, 'how do you justify that?' " Samford said. "It can't be justified."

Health attorney Jill Hanken with the Virginia Poverty Law Center agreed that "the bill did look to be extreme."

WTKR researched the cost of a hernia repair surgery in central Virginia, reaching out to Virginia Health Information.

VHI collects health care data from around the state, in part to assist patients in comparing prices.

According to VHI, it did not make a big difference in cost if the patient had one hernia or multiple to repair.

Their numbers showed Henrico Doctors' Hospital charged the most of any central Virginia hospital for a hernia procedure in 2016, with a median price around $47,000.

Bon Secours Richmond Community Hospital billed the least at around $22,000.

None of the numbers came close to Samford's $116,000 bill.

Where is the regulation?

"It doesn't make any sense, where is the regulation on that? Where it the standardization on that?" Samford asked.

But Jennifer Obenchain with the Patient Advocate Foundation said the wide variation in charges is perfectly legal.

"Can hospitals charge whatever they want for procedures?" WTKR asked.

"Unfortunately, yes," Obenchain said.

"Medical debt often leads to bankruptcy"

Samford, according to health insurance experts, is even more exposed because he does not have a traditional insurance plan. Instead, he opted to enroll in Liberty HealthShare , a non-profit Christian ministry organization that pools resources among self-pay patients to assist in covering each other's medical costs.

"You're not getting the same protections that you would with real insurance. In fact, the hospital is treating this patient as they would treat an uninsured patient," Hanken said. "Uninsured patients get the rack rate, the full charges from hospitals, rather than the negotiated rate that hospitals have with regular insurance plans."

According to Hanken, hospitals agree to the negotiated rate with an insurance provider, but charge somebody that's uninsured or in a health share much more because they can.

Terrie Ipson, a vice president at Liberty HealthShare, told WTKR the organization worked to negotiate lower payments for health care services charged by medical providers.

"Many medical providers negotiate with and give self-pay patients significant discounts and accept reasonable and customary payment for medical services," Ipson wrote.

Hanken said Samford's only recourse, after trying to negotiate with the hospital, was to hire an attorney and go to court.

"If this bill being so high is truly an outlier, a judge could determine that, in fact, the value of the services received is 'X' number versus this charge," Hanken said.

Samford said Liberty HealthShare contracted attorneys to work on his behalf, but the $50,000 was paid before they even received an itemized bill. To date, negotiations to lower the remaining balance have not been successful.

"Where are we going to come up with that kind of money?" Samford, a self-employed father of two, wonders of his $67,000 medical debt.

"That's true, and that's why medical debt often leads to bankruptcy — 60 percent of bankruptcies happen, in part, due to medical debt. So it's a real problem," Hanken said.

And even if Samford never sends a check, Hanken said the hospital can still make money.

"They would sell the debt to a collection agency, let's say, even 10 percent of it, (the hospital) pockets $7,000 and they're done," Hanken said.

It's a situation Samford hopes to avoid.

"It's been a constant point of frustration to say the least," Samford said. "The stress, the strain of understanding what is this going to mean for us? Is this going to mean we have a black eye on our credit?"

Samford recently filed a complaint with the Consumer Protection Section of the Office of the Attorney General of Virginia. He requested, "for Henrico Doctors' Hospital to write-off the outstanding balance due, and to be held to higher standards going forward."

WTKR asked HCA Virginia about Samford's bill.

They sent the following statement: "We are dedicated to serving our patients and are committed to assisting with individual matters until they are fully resolved."

This is the same statement HCA Virginia provided in response to a previous story regarding billing concerns. WTKR then requested a formal interview with the hospital's new CEO, Ryan Jensen, but HCA Virginia replied the above statement is their response to our inquiry and they are unable to provide an interview at this time.

This story was originally published on WTKR.