KUSA-TV Denver Investigative Reporter Chris Vanderveen says when people spot him in public they call him “the medical bill guy” because he has done so many stories about the outrageous bills that hospitals send to patients. 9News has produced stories and specials about medical billing — and is not letting up.
The 9Wants to Know team at KUSA says right up front that it is not accusing doctors of being bad doctors or hospitals of giving substandard care. But, as one doctor told the team, “The medical system is a not a system, it is a disaster.”
Vanderveen, investigative producer Katie Wilcox and photojournalist/editor Anna Hewson have produced more than 36 in-depth stories and two hours of prime-time specials about Colorado patients who were willing to share their detailed medical records to prove that hospitals, clinics, doctors and other caregivers game the system to charge patients for care that was never provided. And, the team learned, when patients can’t or don’t pay, they risk their homes and their credit ratings.
The Show Us Your Bills investigations have helped viewers erase nearly $300,000 in medical overcharges and billing errors. Every time 9News airs a story, another dozen viewers send them detailed highly personal medical bills looking for help. The series caught fire when 9News reported the story of a man who went to the emergency room to have a splinter removed from his thumb.
“He got a $2,100 bill,” Vanderveen said. “That seemed stupid.”
“We didn’t have any intention of following medical billing stories for years, but at the end of that first story we put up an email, firstname.lastname@example.org, and it became a treasure trove of stories. People were willing to send us their medical bills,” he said. “I knew they were mad but I didn’t know they were that mad.”
“We are not surprised by anything anymore,” Wilcox told Poynter. “There is no shocking amount of money that they charge that surprises us.”
This is how one story began:
It’s hardly unusual for a hospital to charge a mother for the circumcision of a newborn, but when Sky Ridge Medical Center sent Lisa Powell-Dejong an invoice showing a $1216.50 charge for one, she found herself beyond dumbfounded.
“I just laughed,” she told us.
“Because I had a little girl,” she explained.
The hospital said it was a coding error and fixed it. But some of the issues the team uncovered are ruinous for the patients. Last month, the team reported stories about surgeons who are so aggressive in collecting medical bills that they place liens on patients’ properties. The hospitals where the surgeries took place said they would never do such a thing and said they didn’t know the doctors did.
That is one of the great complexities that viewers are learning about from the Show Us Your Bills project. Doctors and other providers may work IN hospitals but not work FOR the hospitals. For that reason, a patient may carefully choose a hospital that is “in-network” for their insurance coverage only to discover that a surgical assistant or anesthesiologist they never met is not “in-network” and charges more than the insurance pays.
The patient can get stuck with a surprise that is called “balance billing” that can be hundreds of thousands of out-of-pocket expenses.
Getting creative and small
A topic as big and complex as healthcare costs has the potential to scare viewers, readers and journalists. So the 9News team produced some primers to simplify the issue.
TEGNA’s graphics are produced systemwide by “The Tank,” which happens to be located at KUSA’s Denver home. The design team includes animators, who produced the primer videos. Wilcox said the animations were invaluable because “how else are you going to visualize the concept of ‘out of network’ providers except using wallpaper video that gets boring?”
The imagery of stacks of medical bills and the exteriors of hospitals who would not allow the journalists inside created the sort of challenges that might keep some TV journalists from taking on these stories.
“I died a thousand deaths trying to edit this,” said Hewson, the project’s photojournalist. Whenever there was something to photograph, “I would shoot like crazy because you are going to need all of it.”
The team learned that the most effective way to take on the complexity of medical billing is to break it down into small, digestible, narrowly focused stories.
The 9News team, for example, looked at one of the cheapest and most used medical devices, a bag of saline solution. Vanderveen interviewed a man who was billed $359 for each bag of saline that the hospital administered to him. The station’s medical expert said a hospital could buy each bag for about $2.73. So, why is there a 13,000 percent markup? The story focuses on how hospitals try to make up for other losses by cost-shifting, moving the expenses from one procedure to cover another.
Vanderveen mingles touches of satire and mockery into some of the stories.
“Sure, it is a wink and a nod to saying ‘yea, this is really stupid, this does not make any sense,’” he said. “We are going to approach it as ‘we are part of this too — we have insurance ourselves.’
“My whole world changed five years ago when I had a knee surgery. That year our company, TEGNA, changed to a high deductible plan and the lightbulb went off. I said ‘whoa if you don’t pay attention to this stuff you get screwed.’ You are not going on on a limb here by making fun of a system—everybody knows it is messed up.”
One of the more complex issues the team took on involved a procedure called intraoperative neuromonitoring. They found insurance companies paying more than $100,000 for procedures that generally cost a few hundred dollars.
And then there was the story of a Colorado man who unexpectedly got a check from his insurance company for $169,600. A few weeks later, he got a bill from somebody he never heard of from Plano, Texas, saying he owed somebody named “Edie” $169,600.
Vanderveen found the service the insurance company paid for should have cost about $2,000 to $8,000. The patient tried to give the check back to the insurance company, which sent the check back again. After legal threats and no real answers as to why the insurance company was willing to pay so much, Vanderveen and the former patient, Dave Altman, turned over the money a law firm representing the out-of-network provider.
But to make the point of how big the payment was, Vanderveen mocked up an oversized poster and kept asking questions — but got no answers — as to why the medical bill was so big.
Vanderveen sent invitations to CEOs of all of the Denver-area hospitals asking them to come to the station for an off-the-record sit-down meeting where they could review any of hundreds of billing complaints the viewers had sent to 9News. When none of the CEOs showed up, 9News did a story anyway, and read from a statement sent by four hospitals reminding 9News not to come hunting them down because, “News media representatives are not allowed to film at our facilities unannounced.”
Keep in mind that these hospitals are also big advertisers.
“They spend a ton of money on marketing,” Vanderveen said. “They are not used to being pushed back on. They are used to TV stations doing countless ‘medical miracle stories’ and those are good stories but the PR departments are not used to anybody questioning them on the pricing structure.”
9News took the reporting, which sometimes looked more like teaching, beyond the evening newscasts. Vanderveen and Wilcox produced in-depth Facebook conversations where for a half-hour they drilled down on hard-to-understand topics like “balance billing” and explained how to fight unjust charges. The social media conversations not only answered viewer questions, but they also provided some insight into the depth of knowledge that these journalists have developed after two years of studying hospital billings.
Wilcox told Poynter that journalists who want to take on a subject like medical billing have a ton of homework to do.
“When you are a reporter dayside, the hospital is going talk you out of the story,” she said. “They are going to say ‘it is complicated.’ How many different hospital employees tried to talk us out of these stories? They would say, ‘You are misunderstanding how that all works.’ How many in journalism get to take the time to do what we can do?”
“When they try to belittle us and talk down to us, when you come back and I know exactly what I am talking about,” Vanderveen added, “suddenly hospitals always return our phone calls now and they actually give us a response that is beyond ‘it is too complicated.'”
Wilcox said her induction into the medical billing beat began with a TEGNA groupwide investigation 9News called “Side Effects” that exposed the skyrocketing cost of prescription drugs. That project, spearheaded by Wilcox and Vanderveen, involved the company’s newsrooms nationwide and found 100 drugs that have increased in price by 70 percent or more since 2012. One drug increased in price by 12,000 percent. The next year, the list had expanded to 500 drugs.
Wilcox said the issue consumed her life.
“I had to read so much Medicare and Medicaid paperwork. We spent a lot of time reading books about this. We read at night and on vacations and I talked to my friends who work in health care so I think it was reporting all the time,” she said.
Wilcox used 300 detailed billing reports that viewers sent to the station to build spreadsheets showing what different facilities charged for drugs, devices and procedures — information that was not freely available otherwise. That database, which took more than two weeks to build, became useful later when the station began questioning other bills because they found the hospitals charging different patients different amounts for the same treatment, drugs or materials.
Vanderveen also has the benefit of a family of healthcare providers — “a twin brother who is an ER doctor, a sister-in-law is a surgeon and a mother who is an RN” — who he leaned on for advice.
‘I wish more newsrooms would do this’
“I sincerely wish more journalists would do these stories,” Vanderveen said. “It is not like we have tapped every story to be done. They think it is too complicated or they don’t think it would be good TV. If you ever want — I will take a call from any journalist around the county, I will help them get going on this.”
The problem for journalists, he said, is that “we are always looking for a bad guy. There is no one bad guy.
Just before the midterm elections this year, Pew Research asked 10,000 registered potential voters what the “major problems” were facing the country. The 56 percent of Republicans and 83 percent of Democrats named “affordability of healthcare” as their number one concern. The closest rival issue was “ethics in government.”
Americans spend, on average, 16 percent of our GDP, an average of $9,403 per person, on health care, according to the Journal of the American Medical Association. The organization found, “In 2016, the United States spent nearly twice as much as 10 high-income countries on medical care and performed less well on many population health outcomes.”
Vanderveen, Wilcox and Hewson say they hope their stories will draw lawmakers’ attentions to the problems of errant medical billing but, more importantly, they want viewers to understand that they are their own advocates.
“The status quo is the problem,” Vanderveen said. “It makes far too many people too much money for them to have any incentive to change. Insurance companies, hospitals, they are not going to change on their own. They are in on a system that makes them loads of cash and that is the problem.”
So the 9News team tries to answer every letter that viewers send in and their stories stress that patients have to ask lots of questions.
“Just going to the ER, for example, people do not know that the costs are based on a five-point rating system,” Vanderveen said. “The more treatment you get, the higher the number, the higher the expense. If they give you a splint or an antihistamine it can be enough to bump you up a rating point that that is worth $500 to $1500 in expense. You have to get used to asking, ‘Is that necessary?'”
“It is hard to push back against hospitals. This did make them mad,” Wilcox added. “Half of our interviews with patients cry — this is financial devastation for people. We have never done a story that says this doctor is bad at his job. The viewers we hear from are unhappy about the financial devastation they have after their care. People are not in pain anymore, but they have a lien on their house. All of those things are what our series has focused on.”