Raising Cane
By Rob Perez
Straub’s medical bills
leave some patients feverishIn the last months of her life, Nell Cammack wasn't battling just the lung cancer that eventually would kill her.
She also was battling the Honolulu hospital where she was treated.
As her condition worsened, Cammack questioned the accuracy of Straub Clinic & Hospital's billing records.
She refused to pay more than $19,000 that the 159-bed facility billed her several months before she died.
Upon Cammack's death in November 2000, attorney Karen Essene, named administrator for her friend's estate, continued the fight, questioning other bills as well.
Essene is still fighting.
She says Straub tried to dupe her friend into paying amounts Cammack didn't owe and, until recently, ignored Essene's requests to correct the situation.
Responding to a Star-Bulletin inquiry, Straub, which has a good reputation for its quality of medical care, admitted having billing problems in the past and said it has been diligently working to improve its billing system and services.
"We are committed to providing the highest quality of service and, as always, we are very pleased to work with patients or their representatives who have questions regarding their bills," Rick Robel, a vice president for Hawaii Pacific Health, Straub's parent, said in a brief written statement.
Straub, however, refused to answer Star-Bulletin questions about Cammack's case or say anything beyond the one-paragraph statement.
The Cammack case reflects what some consumer advocates say is a national problem involving inaccurate hospitalization bills.
"There are a lot of mistakes," said Vickie Vertiz, a San Francisco analyst who deals with health issues for Consumers Union, publisher of Consumer Reports magazine. "Hospital billing procedures are different for everyone, and a lot of times consumers get caught in the middle."
In Cammack's case, Straub billed her more than $19,000 for chemotherapy treatments when she should have been charged at most around $150 based on her insurance policy with Hawaii Medical Service Association, according to Essene.
When Cammack raised questions about the amount, Straub refused to respond, and then the $19,000-plus mysteriously disappeared from a subsequent bill with no explanation, Essene said.
In its place, Cammack was charged more than $1,300, another erroneous amount, according to Essene.
At one point, she added, Straub tried to collect from Cammack amounts that HMSA rejected for lack of documentation or that the insurer already had paid. The hospital also tried to bill Cammack even though she had a credit with Straub greater than the amounts billed, according to Essene.
"It's not a lot of money, but it represents a great injustice," she said.
Essene spent countless hours over the past two years poring over Straub and HMSA billing records, talking to hospital personnel and dealing with the bill collector that Straub uses for delinquent accounts.
Like a financial sleuth, she painstakingly tried to connect the dots, wondering how Straub came up with amounts it tried to collect from Cammack even as the 58-year-old transportation planner was dying of cancer.
Some of the charges were listed on the bills as a "balance transfer" with no other explanation.
When Essene questioned Straub about the bills, the hospital sent documents that, to her, confused matters even more. The additional records did little, if anything, to clarify how the disputed amounts were calculated.
Worse, the regular monthly statements Cammack got from the hospital didn't match the amounts Straub or its bill-collection agency subsequently demanded she pay.
The documents "made no sense to me," she said. "They're almost impossible to understand. They're so mysterious."
Straub has been dealing with billing problems for years.
At the state Office of Consumer Protection, where consumers can file complaints involving billing and other possible unfair or deceptive trade practices, more than 90 complaints against Straub are on file dating to 1990. Nine cases are pending.
Based on its findings in the vast majority of the completed cases, the state sent Straub several warning letters in the mid- and late-90s and sought assurances that the hospital was taking corrective action about its billing problems.
The rate of complaints has tapered off significantly in recent years, according to OCP records.
By contrast, state files show only a handful of complaints against other Oahu hospitals dating to 1995. The consumer protection office typically purges its complaint records five years after cases are closed unless, like with the Straub ones, warning letters are issued. In those cases, the complaints are kept on file for 10 years.
No other Oahu hospital that the Star-Bulletin checked had complaints older than 1995.
Straub patients haven't just complained to the state about the hospital's billing.
HMSA, the largest medical insurer in the islands, said it has received more complaints about Straub than about any other hospital. In some cases, HMSA members were inappropriately billed for care they received long ago, according to Cliff Cisco, the company's senior vice president.
Part of the problem, Cisco said, is that Straub over the past decade has installed a number of billing systems. "They've been trying to correct their systems for some time."
Attorney Berlyn Nishimura, who dealt with Straub in the mid-90s for her father's medical care and then again in 1999 and 2000 for her own, said she was baffled by the hospital's billing system.
"It was totally confusing," said Nishimura, who stressed that she was nonetheless pleased with the quality of medical care the hospital provided.
When Nishimura asked for an itemization of charges from her billing statements, Straub simply sent her copies of the same statements she was questioning. She said she never got the itemizations.
"I just gave up at that point," Nishimura said. "I don't think many people have the endurance to deal with something like this ... How in the world could a senior citizen, probably very frail, contend with it?"
Although Essene says Straub has been largely uncooperative in trying to correct her deceased friend's accounts, the attorney may be getting a resolution soon.
After writing a letter Sept. 16 to the hospital hinting at legal action if the problem wasn't resolved, Essene said within days she got a call from Robel, the Hawaii Pacific executive, who left her a voicemail message apologizing for what had happened. He also said the company would agree to what she sought in the letter, Essene said.
Among other things, Essene demanded a refund from the hospital of $1,405, cancellation of any remaining balances in Cammack's accounts and compensation for the time Essene spent sorting out the billing mess.
Star-Bulletin columnist Rob Perez writes on issues
and events affecting Hawaii. Fax 529-4750, or write to
Honolulu Star-Bulletin, 500 Ala Moana Blvd., No. 7-210,
Honolulu 96813. He can also be reached
by e-mail at: rperez@starbulletin.com.
