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Billing of Healthcare Services
Lillian Reynolds
Radford University Carilion
Phil-112 Ethics and Society Professor Darrell Shomaker
04/27/2022
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On an early February morning Sarah went into labor at her home, where she labored for seven
hours before heading to hospital. Upon arrival at the hospital around 7:30am Sarah got checked
in and examined to find she was three centimeters dilated. The doctor on call allowed Sarah to
progress on her own for several hours before coming in to start the pitocin I.V. drip. While
progressing through labor Sarah hit the ‘transition’ phase and began vomiting. At this point the
nurse examined Sarah once more and found she was seven and a half centimeters dilated. The
nurse asked Sarah if she wanted any intervention for her pain to which she decided this was her
breaking point and requested an epidural. After a short period of time, the anesthesiologist
arrived and administered the epidural at 2:15pm. The epidural began only working on half of
Sarah’s body, the nurse had Sarah flip to one side to allow the epidural to flow to the rest of her
body. Sarah was able to rest once fully under the aesthetic and slept for an hour and a half. After
resting the doctor and nurse came in to assess the situation. At this time, baby was already
crowning and the doctor was ready for Sarah to push. Within thirty minutes Sarah gave birth to a
beautiful baby girl at 17:18 that evening. During the night shift of nurses change at
approximately 2:30am, the nurse examined Sarah and asked if she had been to the restroom yet,
which Sarah had not. With this the nurse became disturbed and went to get something to drain
Sarah’s bladder. Along with Sarah’s nurse came three other nurses, who then drained Sarah’s
bladder with a small device used from parts of a kit from the ER. Only one of the nurses knew
how to use this device so this became a teaching moment for the other nurses. After draining two
liters of urine from Sarah’s bladder, the nurse and doctor gave her six hours to see if she could
use the bathroom on her own. Monitoring her bathroom time the nurse on duty was not pleased
with the output Sarah was able to give and with this the nurse had to insert a catheter. Inserting
the catheter again drained another two liters off of Sarah’s bladder. With the catheter inserted for
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an extended period of time it was the doctors hope that it would allow the bladder to rest and be
able to fully function on its own after taking the catheter out. After several hours the nurse came
to remove the catheter and see if Sarah could now empty her bladder on her own. After a shift
change in nurses and doctors. The now on duty nurse did not check to see how much Sarah was
able to get out on her own rather once told Sarah was able to go some, the nurse along with the
doctor discharged Sarah and baby to go home. The next day Sarah was in discomfort but was
unsure what all the postpartum experience had to entail because this was her first child.
Throughout the day Sarah experienced more and more pain, she went to the bathroom often but
simply could not get any relief and was only able to relieve a little from her bladder causing her
to be unable to sit, lay or even walk properly. Sarah called her OB but was put on a list to be
called back, she then called the birthing center to speak to the nurse that discharged her and was
given instructions to drink cranberry juice because it sounded like an urinary tract infection. As
the day progressed at 4pm Sarah got cold and her fingers became purple, she got into the shower
to see if that would help while her husband called their brother-in-law, Kent, who is an EMT.
Kent was at his second job and was unable to come until 6pm. Kent came to examine Sarah and
once he pushed on Sarah’s abdomen she screamed out in pain and began to cry. Sarah’s husband
and mother rushed her to the emergency room which was a forty-five minute drive. Upon arrival
they inserted another catheter and drained 2300 liters of urine out of Sarah. The urine was blood
red and was starting to back up into her kidneys. They administered medication and finally Sarah
was able to get relief, with this from all the pain she had just experienced Sarah fell asleep in the
ER. After several hours the doctor came in and said they were sending Sarah home with the
catheter for four days to and to make an appointment with her OB that friday. Friday, Sarah went
to her appointment where her doctor said he wanted to give the bladder more time to heal so they
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would leave the catheter in until the following week which would give the bladder ten days to
rest with the catheter in. Upon the tenth day Sarah went back to her OB, they removed the
catheter and the doctor gave Sarah a few hours to be able to fill her bladder to see if she then
could empty it on her own. Sarah was able to empty 275 milliliters off her bladder however, once
the doctor drained the bladder to see how much was left, he was unhappy with the results. The
doctor then reinserted a catheter and sent Sarah to a urologist a few days later. Once at the
urologist, he felt that the bladder at this point was no longer damaged but rather had become lazy
and in order to be able to properly function they would need to again take the catheter out and
allow the bladder to go on its own. Nervous at being sent home with no real reason why her
bladder was or was not functioning, Sarah went home and her bladder slowly began to function
again. While her bladder is still not fully functioning properly Sarah before insurance was given
an emergency room bill of $8,677, while after insurance was $1,683.37. Sarah feels that she was
discharged too early and before making sure her bladder was truly functioning. Sarah also feels
due to the trauma of postpartum, the bladder issues, and the ER trauma she should not be held
responsible for her outstanding emergency room bill. Should the hospital be held responsible for
Sarah’s care or should Sarah pay the outstanding bill.
There are several studies when it comes to hospitals and the way they bill their patients. When
looking at the hospital billing system there are several billing practices that should be taken into
consideration. Upcoding
is a form of upcharging or overbilling. It occurs when a patient is billed
a higher amount than is necessary for a specific service. Duplicate charges, related to upcoding
in that it is also a form of overbilling. As the name indicated, this is getting billed twice for the
same procedure. Phantom charges means a patient has been billed not for incorrect services but
for services that were never actually rendered. Unbundling refers to the separation of charges
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that should have been billed under the same procedure code. Incorrect quantities is an unethical
medical biller could charge a patient extra by falsely inflating the total amount of items or
medications received by the patient. With all this information if we break down Sarah’s ER bill
we can find that the insertion of the catheter alone was $2,544.00 and emergency services
$2,172.00 and the list goes on. However; if you look at both Sarah’s emergency room bill beside
her labor and delivery bill you will see some of the same service types but with different pricing.
Here are the moral and ethical dilemmas we start to run into. A code of ethics was established by
the American Medical Association in 1980, called the Principles of Medical Ethics. Although we
are not bound by law to follow the code of ethics set forth by the AMA, it's a good idea to use
them as a general rule of thumb. Most of us know the difference between right and wrong, and
many ethical issues can be reduced to just that. Use common sense and aim to treat others with
grace and dignity. In this case, Sarah feels that she was discharged too early and that is what
overall sent her back to the hospital therefore leaving her with a large bill. A too-early discharge
from a hospital or other care facility can cause as much harm as any other medical error
committed by a health care professional. That means a situation like this can form the basis of a
viable medical malpractice claim. The question of whether a doctor committed medical
negligence in these cases boils down to "How early is too early?" Determining the appropriate
medical standard of care
under the circumstance. What would a similarly-skilled doctor have
done under the same treatment scenario, and pointing out exactly how the doctor fell short of
meeting that standard. While Sarah was in the birthing center before the shift change of doctors,
the doctor that delivered her child had previously stated that he was concerned about a
neurogenic bladder (the nerves that carry messages back-and-forth between the bladder and the
spinal cord and brain don't work the way they should.) However, it would seem that after the
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change in doctors that her chart either did not state this or her chart simply went unread by the
ones that discharged her. In order to win a medical malpractice
lawsuit, the patient must prove
that the doctor's negligence caused foreseeable harm
. This harm can take many forms, including:
pain and suffering
, cost of medical bills, loss of earning capacity, and loss of the ability to enjoy
life's pleasures. The critical issue is whether the negligence actually caused harm. It is
insufficient to show that a patient suffered harm after a mistake was made. In this case the harm
was that Sarah’s urine was backing up into her kidneys and if left much longer her bladder could
have ruptured but not only did she suffer physically she also suffered mentally. On top of the
postpartum struggles she now was struggling further with the trauma the early discharge gave
her. Which she then believes sent her into postpartum depression. While 10-20 percent of
mothers experience ‘baby blues’ or postpartum depression, Sarah believes both traumas together
increased not only her chances of getting postpartum depression but overall sent her mental
status into overdrive and really having the most risk of having it. While the doctor and nurse that
discharged her were both travel employees, they still work for the hospital putting them at fault.
The doctor that discharged her did however see her through until she recovered but that doesn’t
necessarily mean that the incident should be swept under the rug. Sarah is not looking for a
lawsuit but simply a drop in charges. She is expected to pay the bill of her labor and delivery
because she wanted to have this child however she did not plan to find herself in the ER one day
after being discharged with her husband and three day old infant. Sarah plans on going to the
administrative office at the hospital to dispute her bill.
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