Thursday, May 1, 2014

Facility Fee

UCLA Medical Group Physicians’Billing Office
PO Box 240005
Los Angeles CA 90024
April 30th 2014

To Whom It May Concern:

I received a letter today requesting that I pay an outstanding medical bill. The tone of the letter was accusatory. Apparently I have not heeded several notices for payment of the enormous sum of $40.78 (forty dollars and 78 cents). I have not ignored any of your bills. I have simply failed to comprehend them. They are written in a language and in a manner deliberately intended to confuse and frustrate me so that I will concentrate on the sheer impenetrability of the bill and not the outrageous sums you charge me. I made an appointment a few months ago to see a dermatologist. I was told I could see a doctor at an office in Santa Monica some time in the future or see a doctor on the UCLA Campus that day. However, should I choose to see the UCLA doctor there would be a “facility” charge: $25 (twenty five dollars). Yes, you charged me because you operate out of a building. I looked for an outdoor doctor, one whose overhead might run to the occasional trimming of a tree or the unblocking of a storm drain, but failed to find one. I went to the UCLA based doctor because I was afraid the blemish I had found might be cancerous. Is that worth $25 extra dollars? For being able to see a doctor indoors? I was shocked when I was not charged to use the bathroom.

Here’s what really sticks in my craw. A couple of years ago I went to one of your very prominent Ear, Nose and Throat surgeons, Paul Kedeshian. I had suffered from sore throats for a while and they were getting worse. Dr. Kedeshian diagnosed me with acid reflux. He did this in about seven minutes. The rest of the ten or so minute appointment was taken up by my insisting this was not possible since I felt no discomfort in any area of my gut or esophagus. Well, says the expert, that’s perfectly possible. I am foolish enough to think an experienced surgeon might know a thing or two so I try a slightly restricted diet which does no good. Did I mention I make my living as an actor? This is really important.

When this first corrective fails I am referred to a vocal therapist. She is very good. She puts me on an extremely restricted diet and puts me through vocal exercises. On this diet I lose twenty pounds in three weeks because it is so boring I cannot eat. I buy a wedge shaped mattress to elevate my head, thus driving my spouse to distraction. My voice continues to deteriorate. Eventually my voice disappears completely. I am unable to work and am now disappearing into a deep depression. When I visit the vocal therapist in an emergency she sends me to see whatever surgeon is available. I see a resident who diagnoses post-nasal drip and prescribes appropriate medication. It helps for about two days. Then I become, essentially, unable to speak. That’s when I am referred to an ENT surgeon named Dr. Long who has been advised to put a strobe camera down my throat. Yes, I know, you’re thinking - What? All these weeks and months and no one thought to do this when the patient first came in? Guess why this was not done? Because my HMO would not have paid for it. Now I can hear your next question: why was the patient not offered the possibility of paying for this himself? After all he is an actor. If a carpenter came in with a smashed hand we would x-ray it. Wouldn’t we? 
Doctor Long puts a camera down my throat (this is a camera on a stick which takes precisely three tenths of a second to find what is actually wrong with me and for which I am charged more than eight hundred dollars). I have, and have had for a very long time, a cyst on my vocal chords. It has grown very large. It will require surgery. Now, here’s my favorite part. By coincidence, as I leave the room in which the root of my problem has been found, I encounter Doctor Kadeshian. I ask him if he remembers me. He does. I tell him that I do not have, have never had and almost certainly never will have acid reflux. I have a cyst. Do you know what his response was? “I knew we’d find out what was wrong eventually.” Then he went off down the hallway to ruin another life. 

I used to work in the Standardized Patient Program at UCLA in which actors pretend to be patients to help medical students get a sense of what it is really like to encounter human beings. My favorite part of the whole program, though I only encountered it anecdotally and never took part, is the session in which the students get to practise their prostate exam skills. The men who volunteer for this are a mixed bag. Some of them live quite marginally, borderline or even entirely homeless, drug addicted and the occasional man who is rectally stimulated. Any of those men, even while another man’s finger is inserted in his ass, would have done a better job than Doctor Kadeshian. 

I relate this so long after the events because I want you to know that I am, firstly, not a litigious person and have no interest in pursuing the matter legally. Secondly because I want you to know that I do pay my bills even when part of any given bill is for the privilege of being indoors while being treated. Thirdly because the Audiology Department was excellent and Doctor Long was excellent (she removed the cyst, I stayed silent for twelve days and I now am as normal as I will ever be). I know that part of my payment will make its way into Doctor Kadeshian’s pocket and, in exchange for that small dividend from me, I hope you will let him know that I am aware that he diagnoses people with acid reflux because it gets them out the door quickly even though he knows that very few people actually suffer from the condition and certainly not to the extent that they need any kind of serious treatment. His incompetence and arrogance almost ruined my career. The resident who saw me, by the way, was right. I do suffer from post nasal drip sometimes. Tell Kadeshian that, too. The residents at UCLA are more competent than he is. 

I hope my payment helps the building.


John Lee