The way health care takes place in the current society of the US is not something I (Kitty Antonik Wakfer) would ordinarily write about in a Focus on Freedom article, except to point to it as an example of how one's choices are severely limited by the government interference that takes place. I generally make comments along these lines at other sites where authors and/or commenters use the argument that "free enterprise (or the free market) has failed to be responsive to the public" and therefore government must regulate the providers. (See "Universal Health Care is a Fraud" for my entered comments as an example.)
However, it can be beneficial to others to understand that health insurance is not a necessity in order to maintain excellent health, even when beyond age 60. Also, I and husband Paul Wakfer think it benefits us to make it known publicly when we have had an especially good experience with a health care provider (see the January 2003 entry at Kitty Reflects at MoreLife regarding an emergency ureteral calculi) and also when we have had a very poor one. This article is about just such a situation - one that we now think is fairly common at Casa Grande Regional Medical Center in Casa Grande Arizona, which has employee physicians who it misrepresents as private practice physicians. This may seem to many as something inconsequential, but it definitely is not. And this practice adds expenses contributing to the upward spiraling health care costs that are fueled by the lack of direct patient oversight of expenditures as exists with customers/clients of other products and services. Imagine the eventual cost of food or car repairs if the customer paid some 3rd party on a monthly basis - or had the same amount as everyone else removed from his/her (hir) paycheck - to cover expenses for those items. How much incentive would there be to optimize one's use of food and to carefully use and maintain one's car or to seek the most cost effective food sources and car maintenance services under such a system?
I am not going to attempt to present all the arguments against the current arrangements - or the even more interventionist government methods that some politicians, groups and individuals are promoting. What I am doing here is providing information on a recent experience of our own. Email exchanges are a part of this report so that the reader can see the exact wording used by all parties and therefore is enabled to reach hir own conclusions about the reasonableness of each. This is what social preferencing is all about.
Paul has experienced for the past 8 years (since the beginning of March 2000), periodic episodes of a mysterious infection. Physicians in Toronto who saw it at the beginning were unable to diagnose it and even though over the past 5 years it has become little more than a nuisance every 3 to 6 months for a few days, it is something that he would like to eliminate entirely. (Currently, it may even provide some positive hormetic effects by keeping Paul's immune system "on its toes", however 20+ years from now if still persisting it may have resulted in a degenerated immune system.) I wrote about this mysterious malady in a Kitty Reflects entry and it has been discussed at MoreLife Yahoo (example - #497 - 4/7/2004 and #1461 - 2/26/2007).
The following message is what Paul entered at the website of Casa Grande Regional Medical (CGRMC) in the feedback form - "Ask the CEO" - for the Chief Executive Officer (CEO), J. Marty Dernier, on January 28 2008. http://www.casagrandehospital.com
This is a copy of what was sent by email to email@example.com with message subject:
Billing for Dr Mary Joseline Cenizal
This is to inquire about a statement received for fees for the above named physician as:
Account no. 11131
Statement date: 01/07/08
During this initial office consultation, I was explicitly told by Dr Cenizal that she did not have any information about fees because this was not her practice, as she was an employee of the Casa Grande Regional Medical Center. I therefore, expected to receive a bill from CGMRC both in line with the current office fees of other Casa Grande physicians and for which I could negotiate a greatly reduced fee since I am a self-pay client not requiring the paperwork, justification and wait-time involved with medical insurance claims. In addition, neither Dr Cenizal nor the receptionist knew anything about the hospital's practice of giving a minimum of 20% fee reduction for self-pay clients. Therefore, at the time of this initial visit on 1/3/08 we could get no information whatsoever about the fees that would be charged for consultation with Dr Cenizal.
With respect to the office fee on the statement above, a recent initial office consultation with Dr Paul R Fieldstone, a very senior urologist with both a well established private practice and a long-term association with CGRMC (who actually suggested Dr Cenizal to me), was charged at only $205.00 with a reduction to $120.00 for self-pay.
An additional complication arose because an error by the US post office caused the above statement to be forwarded to another address and thus I did not receive it until after a second office visit was necessary to view and discuss the onset of the intermittent health problem which was the topic of the first consultation. That second office visit was charged (and grudgingly paid by VISA) as $244.00 less a 20% discount for self-pay (the CGRMC minimum standard) making a final payment of $195.20. But it should be noted that this second and very short visit was still more than the charge of Dr Fieldstone for an initial visit and *far* more after the discount. The reason that I say "grudgingly" is particularly since I had not yet received the previous statement and therefore had no idea of the magnitude of the fee that would be charged. If I had realized that the second consultation would be that expensive, then I would not have requested a second consultation at all. Furthermore, although it was my own fault in not requiring a fee amount before beginning the initial office consultation, if I had known that it would be $338.12 then I almost certainly would not have proceeded with that visit (particularly since I have little confidence that this strange and intermittent affliction with which I have suffered for almost 8 years will be able to be diagnosed and cured by Dr Cenizal or anyone else that she recommends).
Some questions are in order here. 1) Just who has determined the billing rates for Dr Cenizal (certainly a more junior physician than Dr Fieldstone)? 2) Are these rates taking into account the generally lower fees charged by physicians, dentists, etc in Casa Grande than in the Phoenix area where Resolutions Billing is located?
Although CGRMC gave us a 35% discount of total hospital fees for my wife's urgent requirement for removal of a ureteral calculus in January 2003, I am willing to pay 80% of reasonable office fees (similar to those of Dr Fieldstone), which is what I anticipated when I made the original appointment.
Your attention to this matter and a speedy response is respectfully requested.
Although Paul had stated on the feedback form to the CEO that he wanted a response by email, approximately a week later he received a phone call from a Crystal Weber, who identified herself as Physician Practices Manager for CGRMC. She explained that she wanted to address his questions/concerns and some small conversation on them took place. At the end, Paul told her that her solution was not sufficient and gave the reasons why and asked her to speak to her supervisor. Paul also repeated this desire for email from her and she agreed to send additional remarks by that method. This is her message to him on February 7, 2008.
------- Original Message --------
Subject: Dr. Cenizals Office
Date: Thu, 7 Feb 2008 12:07:48 -0700
From: Weber, Crystal
To: Paul Wakfer
Hello Mr. Wakfer,
I wanted to follow up with you regarding your complaint and our telephone conversation. I am only able to offer you the 20% prompt pay discount that we offer to all of our cash pay patients at this time. If you find that you are having a financial hardship, we may be able to offer you a charity discount, however it can only be offered if you have applied for AHCCCS and you have been turned down. Then you can submit your financial papers and we can determine if you meet the National Standard of Poverty Criteria and if so, we can lower your payments. If you have any further questions or would like any information regarding our fees, please do not hesitate to call me. Thank you very much!
Physician Practices Manager, CGRMC
Here is Paul's response to the above which he sent on February 11, 2008, copied also to Kathy Young, owner of Resolutions Billing, the company name provided on the bill sent supposedly from Dr Cenizal's office and to which questions about it were to be directed. As Paul noted in his first message to Casa Grande Regional Medical Center via the CEO's feedback, what he was sending was also being sent to that billing company. Kathy Young had replied to Paul promptly that the charges were set by the hospital and not by Resolutions Billing.
------- Original Message --------
Subject: Re: Dr. Cenizals Office
Date: Mon, 11 Feb 2008 15:40:28 -0700
From: Paul Wakfer
To: Weber, Crystal
CC: Kathy Young
For completeness, I have appended the full text of my original complaint submitted to the CEO of CGRMC, the only contact method that I could find on the hospital's website. Unfortunately, I have no text of our phone conversation subsequent to that and preceding your email below. In future, please conduct all interaction with me by email only, so that there is a written record of what transpired.
It is true that it was my naive assumption that the fees would be comparable to those charged by Dr Fieldstone and my fault for not verifying this by requiring their amounts in advance of my visit. However, there were also errors of procedure by Dr Cenizal which have resulted in poor gathering of information necessary to diagnose my pathology. First, by her own admission, Dr Cenizal failed to include an order for a blood culture to be done at the acute time of the infection. Second, according to information on a routine blood culture test (CPT 87040) obtainable from the LabCorp website (http://www.labcorp.com/datasets/labcorp/html/chapter/index.htm ) "Three negative sets of blood cultures in the absence of antimicrobial therapy are usually sufficient to exclude the presence of bacteremia. One set is seldom ever sufficient." For these reasons alone, I maintain that my service was inept and that the fee charged should be reduced accordingly, at least to the Medicare level (see below), but the fee should certainly be no more than the Medicare level.
It should also be noted that, during my first visit, Dr Cenizal stated that she was an employee of the hospital and had no idea what the fee for my visit would be. Furthermore, this is highly inconsistent with the fact that the statement that I received for that visit states that the check is to be made out to Dr Cenizal herself (which suggests that she is in private practice). I am amazed, intrigued and chagrined by these distorted relationships that are being apparently perpetrated here by CGRMC. How does the hospital even deposit such a check (made out to Dr Cenizal) to their own account? This all appears to be very bizarre to me, bordering on fraud.
If I had known that the fees would be as high as they turned out to be, then I most certainly would not have chosen to consult Dr Cenizal. After nearly 8 years of having this malady (getting less intense with each occurrence but still not terminating), my need to find out more information via such a consultation was not sufficiently great to engender such exorbitant fees, particularly when the service rendered was not sufficient to provide much more information than I already knew, and failed to do the best that could have been done in that regard.
I furthermore wish to inform you that as a result of this experience with what I consider to be outrageously high fees even for excellent service (which it was not), I will most certainly never again use the services of any CGRMC physician unless in dire emergency with no other alternative, and I will recommend that any others not do so also. This experience will also be included at some point in my future public writings concerning the status of and problems with the US medical establishment, which, while different than with other countries, is very little if any better at providing services in which individual clients have an effective voice of governing feedback (as in the standard marketplace of exchange of goods and services).
Particularly, after having been informed that the set fees are 200% of what Medicare will pay, it is clear that self-paying patients are being used to offset the lower fees paid by the government and by insurance companies.
Your statements below concerning my possible "financial hardship" are irrelevant to the above considerations. My concern about the size of your bill and my payment of it is no different than if I were paying for servicing of my car, which would not relate to hardship/poverty, but rather to contractual rights and responsibilities.
If your level of authority and responsibility is such that *you* cannot reduce my bill, then I insist that you pass this information on to someone who does have the authority to do so. In the meantime, I am holding these charges in abeyance and expect that there will be no additional penalty charges for lack of payment while this dispute continues. You also have my permission to pass on this message to anyone else.
MoreLife for the rational - http://morelife.org
Reality based tools for more life in quantity and quality
Self-Sovereign Individual Project - http://selfsip.org
Self-sovereignty, rational pursuit of optimal lifetime happiness,
individual responsibility, social preferencing & social contracting
As Paul said in his message above, letting others know of this practice by CGRMC of passing off employee physicians as being in private practice is a major purpose of this article. Hopefully many others will realize that some (?many ?all) of the doctors located at 1780 E Florence Blvd in Casa Grande (immediately adjacent on the west side of the hospital) are not private practice physicians, but actually employees of the hospital itself. The further question arises of how prevalent is this practice throughout the United States, particularly after the IRS ruling that services of private practice physicians at hospitals must be separated billed and declared as part of physician income.
But the saga is not finished and continues with a message from Karen Francis, the Chief Financial Officer of the hospital.
-------- Original Message --------
Subject: Dr. Cenizal's bill
Date: Tue, 12 Feb 2008 17:53:44 -0700
From: Francis, Karen
CC: Weber, Crystal
I am following up to your last conversation with Crystal Weber regarding your bill from Dr. Cenizal. As Crystal has indicated to you our fees are based on 200% of the Medicare fee schedule. I do not consider this to be an outrageous amount to charge for our services and I have worked at other facilities that charge at least that and in many instances more. It is well known that Medicare and Medicaid do not begin to cover even the costs of providing services to patients and that has been true for several years. The only place hospitals and physicians have to make up these shortfalls, when they are not even receiving enough to cover their costs from Medicare and Medicaid and be able to afford to stay in business is to shift part of those under funded costs to everyone else. We must cost shift to everyone, not just self pay patients, not funded by a government under funded plan or else all Hospitals and Physicians would be out of business.
And for the self pay patient we do work with people if the financial piece is a hardship as Crystal indicated, we expend many of our own resources to get people signed up and qualified for Medicaid and if you don't qualify but still lack financial resources we do have opportunity for charity write offs. However you did declined that offer and indicated it was not a matter of financial hardship. We also did offer you a 20% prompt pay discount from your bill and I will honor that offer for another seven days. However I do not feel the charges are out of line, we have very few complaints from other patients regarding the charges from our physicians and therefore I am declining to offer more than the 20% discount to you.
Karen A. Francis
Chief Financial Officer
Casa Grande Regional Medical Center
1800 E. Florence Blvd
Casa Grande, AZ 85222
Paul replied to Ms. Francis the following day, inline as he almost always does, in order to make it clear to the receiver to what he is responding. This is a practice we think is necessary for forthright communication but is often neglected by others, especially when they are purposely avoiding addressing specific issues. Those who were privy to the previous exchanges, Crystal Weber from CGRMC and Kathy Young of Resolution Billing were included with copies.
-------- Original Message --------
From: Paul Wakfer [mailto:firstname.lastname@example.org]
Sent: Wednesday, February 13, 2008 5:08 PM
To: Francis, Karen
Cc: Weber, Crystal; Kathy Young
Subject: Re: Dr. Cenizal's bill
Dear Ms Francis,
Thank you for your email regarding my dispute of the fees that are being charged for Dr Cenizal's services. However, your message is inadequate for the following reasons:
1) It contains little information that I have not already been told and understand full well. For those parts that are new or amplified explanation, I respond inline below as I would ask you to do in the future, so that you are sure to cover all points that I have made.
2) It does not address several important points that I stated in my message to Ms Weber (appended below), some of which I expand on below and others which I merely itemize below.
Finally, I present additional information which strengthens my case that the presentation of employee physicians by Casa Grande Regional Medical Center (CGRMC) is fraudulent as I understand the legal meaning of that term or, at the very least, intentional misrepresentation and false advertising.
Francis, Karen wrote:
> I am following up to your last conversation with Crystal Weber regarding your bill
> from Dr. Cenizal. As Crystal has indicated to you our fees are based on 200% of the
> Medicare fee schedule. I do not consider this to be an outrageous amount to charge
> for our services and I have worked at other facilities that charge at least that and
> in many instances more.
I maintain that the fees charged for Dr Cenizal's office services are outrageous because they are far higher than the fees charged by highly qualified physicians in private practice in Casa Grande, namely Dr Fieldstone. Furthermore, Dr Cenizal did no special procedures during either office visit (requiring expensive equipment or supplies), even less so than Dr Fieldstone in his area of expertise, but merely did standard medical examinations, took information, gave opinions and advice, wrote out orders for tests and reviewed our documentation of the progress of the episode of my intermittent/acute infection of unknown type and origin which had just occurred prior to the second visit.
Perhaps the fees charged to me are not outrageous with respect to those currently being charged for hospital employee physicians, but that is a separate issue that I am not addressing here since all information available to me representing Dr Cenizal's status (until the end of the first office visit when I asked her how we were to pay and she stated that she was a CGRMC employee and had no idea what fees were charged for her services) indicated to me that she was in private practice and would charge fees according to that standard in the Casa Grande area, rather than some different standard of fees charged by CGRMC for its employee physicians. In fact, if I had any reason at all to suspect that she was an employee of CGRMC rather than in private practice, then I would certainly have required her fee structure before beginning the first visit.
Here is a relevant part of the AMA policy regarding "excessive fees" from http://tinyurl.com/2slcws :
"A fee is excessive when after a review of the facts a person knowledgeable as to current charges made by physicians would be left with a definite and firm conviction that the fee is in excess of a reasonable fee. Factors to be considered as guides in determining the reasonableness of a fee include the following: (1) The difficulty and/or uniqueness of the services performed and the time, skill, and experience required (2) The fee customarily charged in the locality for similar physician services (3) The amount of the charges involved (4) The quality of performance (5) The experience, reputation, and ability of the physician in performing the kind of services involved (II) Issued prior to April 1977; Updated June 1994."
The indications that she was in private practice include at least the following:
1) A Yellow Pages listing under physicians with the business name "Casa Grande Infectious Diseases" and no reference to CGRMC.
2) A business card on the receptionist window ledge with the same business name and no reference to CGRMC.
3) Letterhead and envelope return addresses indicating the same business name and no reference to CGRMC.
4) An office external door stating the same business name with no reference to CGRMC.
There is nothing stated inside Dr Cenizal's office nor on any forms that I was given to indicate that she is anything but a private practice physician sharing an office with a neurologist, Dr Harry S Morehead, in a building close to CGRMC (similar to how Dr Fieldstone's office is located).
5) A statement from Resolutions Billing asking for payment to Dr. Mary Joseline Cenizal with no reference to CGRMC. The fact that CGRMC uses a billing service separate from their own adequate in-house service, again suggests intent to misrepresent the status of Dr Cenizal (and likely many other CGRMC employee physicians) as being in private practice.
6) Just yesterday evening, a phone call about that statement from a "Kimberley" at Resolutions Billing, who first stated she was phoning from Dr Cenizal's office, later admitted that she was with Resolutions Billing, but was still adamant that Dr Cenizal was in private practice and only related to CGRMC by having staff privileges there. I am not accusing Kimberley of lying; I think that she did not realize the true status of Dr Cenizal as an employee of CGRMC rather than a private practice physician as many others of Resolutions Billing's clients may be. Kimberley may also have been instructed to state to patient/customers that she was "from Dr Cenizal's office", but I do fault both her for accepting such a dishonest task and Resolutions Billing for giving such an instruction to an employee.
I want to make it clear that I was given a cordial response by Kathy Young of Resolutions Billing, who knew full well that Dr Cenizal was a CGRMC employee whose fees were set by CGRMC and stated that fact to me as explanation of why Dr Cenizal's fees were far different than Dr Fieldstone's and why Dr Cenizal had no power to alter those fees as Dr Fieldstone could alter his fees. Therefore I have no dispute with that private agency (Resolutions Billing), except to advise them that in my opinion they may be guilty of aiding and abetting the fraudulent behavior of CGRMC with respect to their misrepresentation of employee physicians as being in private practice, particularly if Resolutions Billing does not tell their employees of this status and have them clearly state on the phone that they are calling from the physician's billing agency.
> It is well known that Medicare and Medicaid do not begin to cover even the costs of
> providing services to patients and that has been true for several years. The only
> place hospitals and physicians have to make up these shortfalls, when they are not
> even receiving enough to cover their costs from Medicare and Medicaid and be able to
> afford to stay in business is to shift part of those under funded costs to everyone
> else. We must cost shift to everyone, not just self pay patients, not funded by a
> government under funded plan or else all Hospitals and Physicians would be out of
I do not know the legal status of a hospital's requirement to be part of the Medicare/Medicaid systems. However, if participation in the Medicare/Medicaid systems is voluntary (as it is for physicians), then CGRMC has *chosen* to be part of them and by charging higher fees to everyone else to offset such lower payments is effectively forcing all non-Medicare/Medicaid patients to make charity payments. However, even if CGRMC is legally compelled to accept Medicare/Medicaid patients (by what law - perhaps to qualify for some government funding of some kind?), what you have failed to state and may not even think about, is that the very same government that you are now maligning also enforces the special status regulations under which hospitals and physicians operate. Without such licensing and myriad other regulations (greatly restricting entry into and availability of a variety of offerings of such services), hospitals and all health care workers would need to compete in a truly free market in health care services. This would both greatly lower the prices of services and bring many new choices into the marketplace. Worst of all, in the current monopolized bureaucratic health care system, is that there is virtually no industry regulating feedback on procedures and prices by the individual patient/customer. The trend toward universal health insurance coverage is greatly exacerbating this lack of any feedback to reign in the use of medical procedures that are mostly advised without any regard to cost relative to benefit. As a self-pay health care client, I am trying to do my part to give this necessary feedback to this runaway system.
> And for the self pay patient we do work with people if the financial piece is a hardship
> as Crystal indicated, we expend many of our own resources to get people signed up and
> qualified for Medicaid and if you don't qualify but still lack financial resources we do
> have opportunity for charity write offs. However you did declined that offer and indicated
> it was not a matter of financial hardship.
The latter is an incorrect assumption on your part. Nothing that I said indicated anything of the sort. Whether or not there is any "financial hardship" is both totally irrelevant to my dispute here and *only my judgment to make*. It has nothing to do with any of the points I have raised. Please *do not* bring it up again.
> We also did offer you a 20% prompt pay discount from your bill and I will honor that offer
> for another seven days. However I do not feel the charges are out of line, we have very few
> complaints from other patients regarding the charges from our physicians
The obvious reason for that is first, that the vast majority of people are fully insured and pay no attention whatever to any actual underlying costs of medical procedures that they have done, and second, that most of the rest are indigent and unquestioning because they are happy to get whatever they can. How many patients do you have who have *intentionally elected* to be self-pay after analyzing the cost/benefit parameters related to the decision and who therefore care about the cost/benefit ratio of the procedures that are suggested to them, rather than simply being insured through employment or otherwise because they could afford it?
> and therefore I am declining to offer more than the 20% discount to you.
And I serve notice that I am declining to pay Dr Cenizal's bill (actually CGRMC's bill) for services until I get satisfactory answers to all my questions and some changes in the policy of CGRMC with respect to its misrepresentation of the practice status of Dr Cenizal (and likely other employee physicians.
Here are the additional points that I raised in my previous correspondence (see below for details) to which I require a response.
1. The failure of Dr Cenizal to order a blood culture for when the infection was at its height, likely causing the failure of the later blood culture to show any pathogen, which effectively made it useless and wasted effort. In addition, my statement below (reference: Aronson MD and Bor DH, "Blood Cultures," Ann Intern Med, 1987, 106(2):246-53.) shows that an additional error was made by not ordering at least 3 blood cultures within 24 hours of the acute occurrence. These errors alone are a clear indication that a fee reduction is in order.
2. Since I was not told what the fee would be on my first visit (and even after finding out that Dr Cenizal was a CGRMC employee, still reasonably assumed it would be similar to that of Dr Fieldstone), I was denied the information necessary to decide whether or not a second visit would be worthwhile at the large fee that it turned out to be.
3. Since I have had this intermittent/acute pathology for almost 8 years and am now fully confident that I can quickly recover from it every time, at least until it wears me down as I get much older, if I had had any reason to suspect in advance what Dr Cenizal's fees would be, then I would certainly not have used her services.
If you can not or will not deal with this, then please pass it on to CGRMC higher management.
>Karen A. Francis
> Chief Financial Officer
> Casa Grande Regional Medical Center
> 1800 E. Florence Blvd
> Casa Grande, AZ 85222
The receipt of the following email from Karen Francis the next day, February 14 2008, was not a surprise, given the tone of the initial message from her.
-------- Original Message --------
Subject: RE: Dr. Cenizal's bill
Date: Thu, 14 Feb 2008 09:12:58 -0700
From: Francis, Karen
To: Paul Wakfer
CC: Weber, Crystal
I am the highest level of management at Casa Grande that these issues are passed on to. You are commenting on many points below and while you asked that I address each I'm do not feel compelled to do that. You obviously have your opinion on the matter and I have my own. I have spent 20+ years in the healthcare profession and am very well versed on patient billing and pricing for both physicians and hospitals. A bill had been generated from our system for your first visit by the time you made your second visit. And even though you did not have it because of a "postal error", you had the opportunity to inquire to us as to the balance on that visit since the bill was outstanding in our account receivable system. But you did not do that, so that is your error in continuing to utilize Dr Cenizal the second time when you had the opportunity to find out the balance on your first bill and did not.
I have stated I do not consider our charges excessive, if they were I would continuously have patient complaints - but I do not. If you choose not to pay the remaining balance on your bill, that is certainly your choice to make. However you do need to be aware that we will follow our normal collection practices and if the balance on your account remains unpaid it will eventually be turned over to a collection agency and appear on your future credit reports.
Karen A. Francis
Chief Financial Officer
Casa Grande Regional Medical Center
1800 E. Florence Blvd
Casa Grande, AZ 85222
Karen Francis failed to address any of the particulars of Paul's message and instead took a stubborn stand that simply because she did not "continuously have patient complaints", then the charges were not excessive. This individual apparently cannot fathom Paul's simple explanation for why she has no complaints from patients. Either that or she wrote what she did simply because she thought that was the way to bully a patient. It is also quite possible that hospital lawyers advised her not to address any of Paul's complaints, but simply to ignore them and demand payment, again claiming the fees to be not excessive.
I and Paul discussed how to proceed and the following is what we sent along with a check made out, as directed on the bill, to Dr Mary Joseline Cenizal.
14782 W Belmont Dr
Casa Grande, AZ 85294-7358
February 15, 2008
Mary Joseline Cenizal, MD
1780 E Florence Blvd
Casa Grande, AZ 85222-4784
Subject: Payment of Account 11131 per Resolutions Billing
As detailed on the enclosed email correspondence with Karen Francis, Chief Financial Officer of Casa Grande Regional Medical Center (CGRMC) all indications were that Dr Cenizal was a private practice physician, rather than an employee of CGRMC.
Therefore, the enclosed payment of $31.20 itemized as follows is based on fees obtained for private practice physicians located immediately next to CGRMC and having staff privileges there. The level numbers reflect length and complexity of the visit. The number that I have assigned is based on a comparative visit to a private practice physician.
Initial visit fee for a level 4 visit: 205.00
Second visit fee at level 3: 78.00
Less 20% discount for self-pay 56.60
Less VISA payment 01/18/2008 195.20
Total due: $31.20
I thank you for useful suggestions concerning my ongoing efforts to obtain a diagnosis of my strange intermittent/acute infection and I ask that you accept this as full payment of your current bill for services rendered.
Although the personal check for $31.20 was cashed on March 14 2008, another bill from Dr Cenizal's office was received in mid-April for $188.20 and designated as 90 days past due. The accepted check was clearly marked "Acct#1131 Paul Wakfer IN FULL". We consider the services obtained from Mary Joseline Cenizal to be paid for in full and this entire transcription of written exchanges also serves as public notice of the same.
One of the main problems of the delivery and receipt of health care in the US and virtually all of the industrialized world is that the one-to-one patient-physician relationship has disappeared, having been replaced by intermediary health insurance companies and government, this last either directly or indirectly by way of literally hundreds of rules and regulations. The fact that prices for all types of services are ever increasing while the satisfaction of those receiving them very often is decreasing, is very much because the patient is not directly making payment for those services and therefore not interested in determining the cost vs benefit analysis such as s/he would do for the purchase of a new car in comparison to the repair of an older one, or the same prior analysis relative to buying a house or any other major purchase. Simply because a person's body is essential for one's continuation does not make this need for personal involvement in the analysis less important, but actually more - much more.
The lack of personal responsibility for one's own bodily health and the costs involved are undoubtedly a part of the reasons behind the enormous growth in the percentage of the population who are obese and their ensuing health degeneration. It has caused the ballooning health care costs that are passed down to individuals via direct premium increases or reduced take home pay from employers who pay the premiums. It has resulted in enormous government budgets - and increased national debt - to cover health care costs of those individuals who governments have decided should be taken care of via tax money (often from the individuals themselves and always from others). And finally, it has now apparently caused many hospitals (and perhaps some physicians?) to inflate their prices so that those who can pay are again, in addition to their payments through taxes, forced to support those who supposedly cannot pay, but are getting the services anyway, at least partly because governments compell the hospitals to provide them.
The purpose of our presentation here about our own difficulty with the local hospital, that has a deceitful practice of representing employee physicians as being in private practice, is not only to make clear to others that this is happening, but to encourage others to be responsible consumers of what health care they do decide to obtain. When individuals are taking measures to be responsible for maintaining their own vigorous health, they will have less need to depend on the paternalism of health care providers, whether in private practice or as employees of a hospital. Such individuals will seek consultations only as they determine necessary and will be responsible for the mutually agreed upon fees.
As a resource for further information on re-establishing the one-to-one patient-physician relationship, I recommend The American Association of Physicians and Surgeons.
This article appeared on OpEdNews.com on June 1 2008 http://www.opednews.com/articles/An-Outrageous-Health-Care--by-Kitty-Antonik-Wakf-080531-82.html