The sting of a broken system

In what world can the word "in" mean "out?" And the number "one" actually mean "two," at least when it comes time to pay your bill?

In American health care.

Where Keo Capestany has learned the hard way, strange math can mean a bee sting will cost you eight thousand bucks.

"I have to warn you, this is a pretty ridiculous story," Capestany said when he introduced himself the other day.

It started last August, when Capestany, a Seattle 73-year-old, was at a picnic and plopped a slice of steak in his mouth.

A yellow jacket was clinging to the bottom side. It stung or bit him right on the tongue.

Capestany is not allergic to bees. But over the course of the next 24 hours, his tongue swelled so much he worried it might choke him.

He drove to Seattle's Harborview Medical Center. After a few hours' wait, he was put on an IV drip with the antihistamine Benadryl, placed in a bed and admitted to a hospital room.

Or so he thought he was admitted.

He was there for the rest of that day and night. He ate lunch, dinner and breakfast. He continued to get antihistamine through the IV.

"I felt I got good medical care," Capestany recalls. "The doctors wanted to make sure I was OK. By the morning it was clear I was, so they sent me home."

Two weeks later, though, he got stung again: The bill was $8,200. The IV costs alone were $2,469. The emergency room fee: $2,822. The pharmacy tab ran to $964.

He also had room charges for two days, Aug. 4 and 5, totaling $1,488. Even though he was there only one night.

Eight grand seems pretty steep for a bee-stung tongue. It's far more than Harborview's Web site says it charges for everything from a broken arm ($262) to a colonoscopy with removal of a tumor ($1,796.)

But the story went further down a rabbit hole next.

Capestany found out that though he spent about 22 hours there in a room, his treatment is considered "outpatient."

His insurance (Medicare Part A and his wife's policy) only give broad coverage for inpatient hospitalizations, not outpatient visits.

"Your records show that although your tongue and neck were swollen, you denied any respiratory distress in the Emergency Department," Harborview officials wrote after Capestany appealed his bill.

"Your respiration was stable at 16/minute, your other vital signs were stable and your airway was not compromised. To be considered inpatient status, you would have to have some airway compromise and a respiratory rate greater than 24."

Translation: He wasn't sick enough to be "in." Yet he was too hurt to be "out." So they put him kind of sort of "in." Leaving only his money to go "out."

"For the purposes of my insurance, I never stayed there. For the purposes of my bill, I stayed for two days!" Capestany says.

Have I mentioned that Capestany worked 25 years as an insurance adjuster? He's not some naïf about how this stuff works. Or doesn't.

He's not saying Harborview or Medicare has done something illegal. Harborview couldn't discuss Capestany's bill with me, but said it's Medicare that sets the rules on whether someone is an inpatient or out.

In fact, Medicare puts out a six-page guide — with charts — on how to tell which is which. It's so complicated, they advise that if you're ever in a hospital for more than a few hours, you better ask about your status. I wonder: Would staff even know the answer?

Capestany's story is a microcosm of a broken system. Outrageous costs. Bills with little relation to the services provided. Rules too complex or hidden to be of any use to distraught patients.

We used to be debating how to fix these things. Now it's whether health-care reform is even worthwhile for Congress to consider.

Meanwhile, medical spending rose faster in 2009 as a share of the economy than at any time since the issue was first tracked in 1960.

I sure don't know what would work. A single-payer system, competing insurance exchanges, health savings accounts — all seem better than what we have now.

Yet some say no, slow down. Leave health care until we repair the economy.

At $8,200 for a bee sting, health care could become all that's left of the economy.

Danny Westneat's column appears Wednesday and Sunday. Reach him at 206-464-2086 or dwestneat@seattletimes.com.