MYFOXNY.COM - Sometimes you can fight the system and win. That is what a Fox 5 viewer did when he stood up to the health care bureaucracy with the help of reporter Arnold Diaz.
Bill Trautz lives in Newton, N.J. He was upset after getting what he considers an outrageous charge for a simple arm sling his son received at a doctor's office.
"I'm sick of seeing people getting ripped off and I think people should start paying attention and speaking up," Trautz says.
His son was injured playing hockey.
"It's basically a piece of canvas, a couple of d-rings and some Velcro, Trautz says. "I noticed the appliance company billed $199. I said, 'It must be a mistake'."
$199 is the amount that Jack Gold Surgical Appliance billed to Aetna, his insurance company.
Trautz says Aetna approved $111.00 for the sling; a figure he thought was ridiculous.
He went onto the internet and found the Ossur Berschultz Universal Arm Sling for sale for $15.95.
Trautz says he first thought that Jack Gold Surgical Appliance, which has seven offices in New Jersey and Pennsylvania, used the wrong billing code.
He claims he was told it was not coded wrong and he shouldn't care about the price because he had insurance.
But, because he had not met his insurance deductible, the $111 would have to come out of his pocket. And he says, even if his insurance company was paying, it would still be wrong.
Trautz says, "I pay for my insurance. I work hard for my company to pay their portion of my insurance. I just don't think it's fair."
He fired off a letter to Jack Gold saying, "This is why our healthcare system is in the dire straights it is in at this time....I have enclosed a check for $25.00 which would cover a fair retail price and shipping for this item."
When he refused to pay the balance, he got a letter from a collection agency. That's when he called Fox 5's Arnold Diaz.
Diaz went to Jack Gold Surgical Appliances to speak with company president Joshua Schenkman.
"A potential 700% markup on a very low end item helps compensate for the 15% markup, gross markup we get on our high end items," Schenkman says.
He also places the blame for the high price on the insurance company.
"His insurance company is the one that said 'we're willing to pay a $111 for this item'," Schenkman says.
Aetna would not take the blame on the price. A Company spokesperson says it doesn't set the prices. It says that prices are set by Medicare.
A check of the Medicare fee schedule shows the sling is priced at $111.07.
Diaz went to Medicare headquarters in Washington, D.C. to try to get some answers.
Jonathan Blum, Director of the Center For Medicare says the price is wrong and the actual reimbursement rate for the sling is less than $8.
A spokesperson says Jack Gold Surgical Appliance has been billing with a code for a much more substantial brace.
In a letter to Fox 5, Jack Gold Surgical Appliance's attorney says, "The patient in question was inadvertently billed under an incorrect code." And, "Over the past three years a portion of the patients who received this same device were also mistakenly billed."
The company says it is issuing refunds for patients who were over billed.
Aetna says, with millions of claims, it can't possibly check the code on every bill.
Trautz has now received a letter of apology from Jack Gold Surgical Appliance saying the company will accept the $25 he sent as payment.