Welcome back to this week of The Resident! This week, we are dealing with how hospitals make money- By milking every cent they can from the patient and insurance company. Barb Olson, who is in charge of Billing, calls a mandatory meeting, teaching the first year residents and nurses about upcoding, to get more money. I know some places do this, but I have never experienced it myself, thank god. When I’ve had to go to the doctors, it’s usually short and sweet, except for one time, but no one knew what was going on with me. Still no idea what happened that day, but let’s get back to the episode.
Courtesy © 2018 FOX
We meet Louisa Rodriguez, a young intern working her way through medical school. Suddenly, she collapses, and Devon and Conrad take lead. Barb finds out she is uninsured, and tries to pull Devon and Conrad off the case. They refuse, and she huffs off. To explain, a hospital cannot refuse treatment because a patient cannot afford treatment. They can do payment plans, but most hospitals just eats up the cost. I had a good friend, 20 years old, heart attack at work. Pre-existing condition, her insurance refused to cover it. Before 21, she was pegged with a $17,000 bill because she needed a new pacemaker installed. Luckily, even though I work at a restaurant, and we were just servers at the time, our company paid half her medical bill. She is doing better, on a heart transplant list, and the service manager for the same company.
Courtesy © 2018 FOX
Back on Louisa, it seems she is an undocumented immigrant with cancer. The Sarcoma is wrapped around her spine, and if the hospital does the surgery, at best, it costs $500k and 6 months. At worse, 1 year, 2 mill. The CEO tries to pan the patient off to another hospital, negotiating a cash donation and medicaid patients, but no hospital will take Louisa. Someone calls Immigration and Customs Enforcement, or ICE, on her, but Conrad and his old army friend and fellow doctor, Jude Silva , force the hospital’s hand and does Louisa’s surgery. Nina actually is the one who does the surgery, even though it’s not her specialty. It has a good outcome, but when she cannot stand, Dr. Bell turns to the CEO outside the patient room and mouths 2 Mill.
Courtesy © 2018 FOX
Speaking of Jude, the episode starts with Conrad and Dr. Silva in a bike race. They are raising money for a local organization, but as they pass the finish line, a drunken fan, Hank, trips over a bike and breaks his leg. They rush him to the hospital, noticing he has Jaundice, or yellowing of the skin and eyes. It seems our drunken friend has drank so much, his liver became paralyzed. Acute hepatitis. Hank swears when he gets discharged, he will quit, go to AA. Conrad believes him, but Jude does not. Seeing as later in the episode, we spot Hank in his cast at the bar. Some addictions cannot be given up quickly.
Mina is making her patients race down the hall to get discharged. Unethical, but quite entertaining. I do love her character, almost as much as Irving, and brings a balance to the series. Speaking of Irving, he wants to create an acapella group called Say Ahh. Throughout the episode, we see him auditioning different staff. Nurse Jessica’s rendition of “Defying Gravity” was beautiful. We also see the last of Barb in this episode, as she talks a patient into getting a MRI, even though he has a metal implant. MRIs would rip out the implant, and could of sued the hospital. Nic catches it before they can run the test, and files a complaint on Barb. The episode ends with Lily being readmitted to the hospital.
I do like the dialogue in the series, really easy to follow, and well written. The actors also portray their characters well, and draw you into the situations. I am still a bit apprehensive of the series, but it is still winning me over, character by character. That’s all for now, so stay shiny, and see you all next week!!
Health insurance employee here! It’s actually 100% illegal to upcode, like Barb is trying to do. In fact, it’s illegal for her to walk into the MRI room and demand they stop; she has no legal right to determine any of the patient’s medical care. In fact, she has no right to tell a doctor to stop patient care, period. She’s a biller/coder. She doesn’t have a medical degree. Furthermore, it’s illegal to order and bill for unnecessary tests and procedures. If the patient doesn’t need an MRI, CT scan and blood work that tests for everything under the sun and they do it anyway, that’s what health insurance companies call Fraud, Waste and Abuse. Intentional fraud against the health insurance company for the upcoding, waste and abuse for the unnecessary services and procedures. If a hospital or doctor is caught doing these things, they can be subject to major fines, up to 10 years imprisonment or both AND be ineligible to participate in any government programs for a long time, possibly forever.
Upcoding is a serious issue in healthcare, make no mistake. But health insurance companies are legally bound to investigate and report when such situations arise. And, as a note? It’s illegal for them to bill this stuff both to health insurance companies, Medicaid, Medicare AND PATIENTS. If you suspect that you’re the victim of upcoding, you can notify CMS.gov and they’ll investigate.