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Bicycle Accident Victim Discovers that Sole SF Trauma Center Does Not Accept Private Insurance

Bicycle Accident Victim Discovers that Sole SF Trauma Center Does Not Accept Private Insurance

When a 24-year-old San Francisco woman had a bicycle accident last year that resulted in a broken arm, a helpful bystander called 911. An ambulance took the woman to Zuckerberg San Francisco General Hospital, where she underwent X-rays to confirm her broken arm and a CT scan of her brain and spine. A doctor placed her arm in a splint, prescribed her pain medication, and referred her to an orthopedist.

A few months later, the woman received a bill of just over $24,000 from the hospital; her private insurance covered about $3,800, which is what the insurance company considered to be a fair price for the services provided. The hospital sent the woman’s bill of about $20,000 to collections.

Zuckerberg San Francisco General Hospital (Zuckerberg) is San Francisco’s largest public hospital and the only top-tier trauma center in the city. Nonetheless, Zuckerberg does not participate in any private health insurance networks, which is often a surprise to the patients who end up there. As a result, this hospital habitually bills patients who have private insurance coverage tens of thousands of dollars for medical care that would have cost the patients considerably less had they received the care at other hospitals.

For patients like this bicycle accident victim, gigantic medical bills can be devastating and completely out of reach. Only semi-lucid following her accident, the woman was taken by ambulance to a hospital with a trauma center for treatment, given her injuries. She had little or no choice about the facility to which she was taken, nor the ability to research and determine which hospitals were in-network for the purposes of her insurance plan.

Zuckerberg defends its ER billing practices by stating that its primary mission is to serve patients with public health coverage, even if it is at the expense of those patients with private insurance. Vox’s research, however, finds that these practices are highly unusual when it comes to ER care; just one percent of ambulances ultimately transport patients to out-of-network hospital emergency rooms. Most major trauma centers in large cities, such as Sacramento and Portland, accept multiple private health insurance plans.

For the woman injured in the bicycle accident, the billing dispute continued. Her insurer declined to pay an additional share of the bill, citing the fact that the charges for the services are about 12 times what the hospital receives for those same services provided to patients on Medicare; the insurer already paid about twice what Medicare would pay for the services.

Eventually, after Vox published a story on the woman, Zuckerberg reduced her outstanding bill to $200, which is her insurance plan’s regular co-pay for an emergency room visit. The San Francisco Board of Supervisors, which oversees the hospital, is also planning hearings on Zuckerberg’s billing practices. When you have been injured in a bicycle accident, you need an attorney who can stand up for your interests from the outset of your personal injury claim. It is our goal to evaluate the facts, assess your claim, explore your options, and help you build the strongest claim for compensation possible against those who are responsible for the accident that led to your injuries. Do not hesitate to contact Bonnici Law Group at 619-259-5199 today and set up an appointment to speak with us soon.

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