It occurred to me that an example of the fees charged by Lenox Health Greenwich Village on 13th Street might be a useful addition to your continuing coverage of the facility.
On September 29 of last year, I went to the walk-in treatment center for an x-ray to determine whether or not I had a broken elbow. A week earlier I had fallen, hurt my elbow and it had gotten worse instead of better. I presented my Medicare and secondary insurance cards at the desk of the spanking new and very impressive space. Soon I was introduced to the very pleasant and, as it turned out, capable young woman who took care of me. She looked at my elbow, had it x-rayed and confirmed that it was broken. She then wrapped it, put a splint on my arm and gave me a shoulder sling. She gave me a set of instructions which included the names of doctors she recommended for follow-up treatment and walked me to the exit. On the way she may have introduced me to a man. I have a vague memory of wondering why she did, and I left.
I wasn’t asked for money or given a bill. That was not surprising because I knew they accepted Medicare payments and after that was received they would send the Medicare EOB, estimate of benefits, to my secondary insurance who would pay 80% of the balance.
What did surprise me was that on March 3, 2015, the union that provides my secondary insurance wrote saying that they were not allowing a claim from Lenox Hill Hospital for charges of $4,065.05 until they received the Medicare EOB. I was out of town until May, so I didn’t see the letter until then. I assumed that the amount was the total for my visit and wondered why the secondary insurer would have been billed for the total cost when that would have been Medicare’s responsibility.
Also in the mail I opened a bit later were Medicare Summary Notices, the customary summary of periodic medical visits and payments. These were dated January 8, 2015 and contained the following breakdown of charges:
North Shore-Lij Medical PC, Service provided by Dr. Corujo Vasquez, O., M.D. (I received no treatment from an M.D. Perhaps that was the man who shook my hand on the way out?)
Emergency department visit, problem of high severity. Amount Provider Charged: $806.00. Medicare Approved Amount: $130.47. Amount Medicare Paid: $102.29
Two sets of x-rays, one of my hand which I don’t remember, one of my elbow which I do, 3 x-rays each. $43.02 for each set, provided by an M.D.
Application of long arm splint, shoulder to hand, $634.00.
A second Medicare EOB, also dated 1/8/15, listed Lenox Hill Hospital as the claiming facility.
Emergency department visit, moderately severe problem. $1,701.00
X-ray of elbow, minimum of 3 views, $679.00.
X-ray of hand, 3 views, $757.00.
Application of long arm splint, $571.00.
Total for claim: $3,708.00.
Grand total including Lij Med. PC: $4600.04, higher than that charged the secondary.
When I sent these EOBs to the secondary insurer, they paid their part of the balance. That was the last I heard from the Lenox Hill Hospital, which I never saw, or the walk-in Lenox Health Greenwich Village, which I did.
—Robert, West Village