I recently had a not-so-fun experience with our local hospital which reminded me of how important it is to ensure one’s front-line staff are empowered to question things.

During our childbirth class – which was sponsored by the hospital where I was going to be giving birth – we were told by our childbirth educator that circumcisions at the hospital cost approximately $500. As we were told this by a professional representing the hospital, we had no reason to believe it was not true.

After our son’s circumcision, we first received a bill for $423, which represented the pediatrician’s charge. This seemed a reasonable amount for her skilled services. Shortly thereafter, we received a bill from the hospital for $2150.80. The surgical procedure itself was billed out at $1907.67 This minor procedure required a local anesthetic and took 5 minutes, after which we spent 30 minutes alone with Reed before the nurse checked our son out and let us leave. I couldn’t fathom why it would be so expensive and assumed it must be a mistake. So last Monday, I marched over to the hospital to get the bill straightened out.

When I spoke to staff in the billing department (including their supervisor) I was told that indeed this was the charge for infant circumcision and that the charge was designed to match what other hospitals in the region charge. The supervisor said that it sounded awfully high, but that was the right price and was actually less than our major University hospital in the area. He offered to give me a 20% discount if I paid it in full right away. I said I wasn’t going to pay it period because I thought the price was absurd. I also contacted the billing departments at three hospitals in our area and found that what they’d claimed was far from the case. All of them charged significantly less for a circumcision and their charges included the physician’s fees. Including the physician’s fee, we were charged $2573.80, of which 16% was for the physician. I can’t imagine what services or facilities were provided by the hospital for this particular procedure that would warrant its fees being so much higher than that of the board certified physician.

So, armed with this information, I spoke again to that supervisor in Patient Financial Services, who said it was out of his hands since he has nothing to do with pricing, but that he would let staff in the relevant department know what I found. His response sounded rather noncommittal, so I emailed the CEO and CFO with my story. The CEO emailed back and wrote that the price sounded very high to her too and that they were looking into it and would get back to me ASAP. The next day, I received an email stating that yes, there had been an error and they’d been charging parents quadruple the price for a circumcision since January 1st. (Scary to think of how many may have made the decision not to circumcise their child solely based on the erroneous price they were quoted.) She said my bill would be adjusted and they’d be reimbursing all others who’d paid the incorrect fee almost $1500. This is when I did my happy dance around my office. :)

The CEO said she was grateful for my spotting this error and told me to stop by her office sometime for a free lunch voucher. This is what I asked her for instead:

Rather than a free lunch, what I’d really like is to see the folks in your financial services department be/feel empowered to question things. They are the first and often last stop when people have issues with their bill, and if they do not feel empowered to question what they see on their computer screen, patients will not receive the best service. Many patients would have been stopped in their tracks by the financial services staff’s insistence that this was the right price and would not have called other hospitals, especially when I was offered a 20% discount if I paid the bill immediately. I once worked in a public library where we were told that the system is always right; that patrons who claim they returned books that show as still being out are lying or wrong. However, this informal policy disregarded the fact that the library staff were as human as the patrons and sometimes made mistakes. Some of my colleagues wouldn’t even check to see if a book that a patron claimed to have returned was on the shelf; they’d just insist that the patron had to pay for it. I sometimes would find books on the shelf that patrons had been billed for, so I always operated under the assumption that the customer was right until proven otherwise. I think it’s the right way to operate any organization, even Patient Financial Services in a hospital. And sometimes it takes an error like this to remind staff that the computer isn’t always right.

I think it’s something we in libraries should remember. We must ensure that people at all levels in our organizations feel empowered to ask questions and advocate for the good of our patrons/customers. Patrons shouldn’t always have to go to the head honcho to get their issues resolved, because so many will give up after the first roadblock and will simply never use the library again. Hospitals often have an ombudsman who investigates and advocates on behalf of patients. Since that doesn’t exist in our profession, we need all of our front line staff to take on that role rather than blindly reciting policy to our patrons.