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Treacherous banks of the root canal


MY WIFE and I have become very punctual about visiting th ophthalmologist at frequent intervals these days. We have to keep our eyes sharp so we can read our health-care bills with the fine scrutiny they deserve.

We're both avid readers, my wife leaning more to fiction than I -- but "creative writing" in medical billing is foreign to our tastes.

The other day we succeeded in snatching back $75 from our endodontist. How sweet it was! Against the backdrop of the nation's gargantuan health-care cost crisis, $75 is an invisible speck, but we were as exhilarated as if we had recovered $75 billion.

Let Hillary Clinton think big about the crisis; our approach is to break the problem into its myriad component parts and work on them one by one.

Unlike Robert Benchley, who once reported his adventures "down the alimentary canal with gun and camera," the missus and I were unarmed as we plunged into our amateur navigation of the root canal, which turned out be to be hardly less tortuous than Benchley's alimentary channel.

Early on, "endodontics" was something we had to look up in the dictionary. Now we're all too familiar with the monetary shoals along the "banks" of the root canal, where both substantial and comparatively insignificant amounts flow almost imperceptibly from payers' (patients') accounts into payee coffers.

Our recovered $75 was the sum of three $25 "emergency oral examination" charges -- two assessed against my wife, one against me. We got the money back, belatedly, because it was only after the third go-round that I noticed this obscurely itemized rip-off appearing on the usual standard billing, typically technical-looking and certainly not reader-friendly.

The day after completing payment of a $725 bill upon leaving the endodontist's office, I called up to ask, "What gives with this 'emergency' stuff?"

I pointed out that the doctor had not made a house call or come in on a Sunday to fix my toothache. He didn't have to send an ambulance. No other patient was "bumped." Nothing out of the ordinary had been done for me. In short, there was no "emergency."

The staff member who took my call kept her cool, but she blundered at the end of the conversation. "It doesn't matter how it's broken down," she confided. "The fee is $725." In other words, her employers (an outfit owned by four endodontists) had arbitrarily pre-determined the amount they would squeeze out of me, by hook or by crook.

The thing rankled. Months later, I seized the opportunity presented by a scheduled post-operative check-up to confront my endodontist personally about the $25 "emergency" item. He was surprised and visibly upset. Said he would have to take the matter up with the bookkeeper (as if she, not he, decided such questions). And he speculated that perhaps "same-day service" had been involved. (If that were true, I contended, it would only have meant one more patient -- and one more major fee -- for that day's work.)

Finally, the doctor mounted a counter-attack, cynically offering me a deal. "I'll return your $25 if you'll return the 10 percent senior citizen's discount I gave you!"

Nothing doing, I replied. There's no connection between the two. You can't "give" with one hand and take away -- by imposing phony charges -- with the other. (I refrained from reminding him of the simple fact that senior citizens are walking gold mines for health-care providers, and those who allow a discount are doing so for sound business reasons.)

Again, the mysterious authority of "the bookkeeper" was invoked. She would make a determination. About 10 days later, a $25 refund check appeared in the Lichtenstein mailbox. While we were waiting, my wife and I did some bookkeeping research of our own, discovering the two previously unnoticed $25 "emergency oral exam" charges that had been assessed earlier against her. We pressed for another 50 bucks, and we got it.

Case closed. But we must not lose sight of its larger significance. If health care is a "business," it is not an ordinary one, and consumers should be up in arms over the widespread fakery that health-care "merchants" (doctors, pharmaceutical purveyors, hospitals and cooperating insurance companies) use to victimize patients.

One can smile ruefully over the skulduggery practiced by other businesses -- as, for example, I did when my mixed retriever's dog food ceased to be available in 25-pound sacks, appearing instead as a so-called "improved" product in 20-pound sacks sold at the same price. The smaller sack was emblazoned with a lot of blather about the "New Advanced Formula" of its contents, developed to "Help Your Maturing Dog Stay Active and Healthy." My dog still swallows this food, but not the accompanying hokum, and he will bite the manufacturer first chance he gets.

But no one can afford to smile over the slick exploitation -- much of it "legal" -- that patients encounter.

Sometimes the exploitation can hurt the body as well as the pocketbook. My daughter, when she was about 11, was sent by prudent school officials for a check-up after a playground fall. She was sensible enough to ask, as they began to x-ray her chest, why that was necessary since the injury was to her scalp. "Everybody who comes in here gets a chest x-ray!" she was firmly told. The people operating that clinic well knew that needless radiation is a threat to health, but hey, there's money in x-rays!

Fellow consumers, be suspicious, be alert. Don't worry about ruffling the sacred doctor-patient relationship. If you have "coverage," don't think it's only the insurance company that will pay for phony charges. And don't buy the pharmaceutical industry's line that astronomical pill prices reflect the industry's devotion to "research." The devotion to advertising, promotion and profit-taking is far deeper. As for hospitals, I once facetiously predicted that they would eventually put in pay toilets -- exclusively -- in all the wards. What a mistake! I shouldn't have joked -- they'll probably do it.

Stan Lichtenstein writes from Bethesda.

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