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Medical bill is out of joint: Hospital quotes are not always accurate, writes Christine Stopp

BILL BAILEY, a retired squash coach from Virginia Water, Surrey, was told last October by his consultant at the Woking Nuffield Hospital that he would need a hip replacement operation.

Before going home, says Mr Bailey, he told the hospital he was insured and asked to speak to the accounts department about costs to check whether his insurance, with the Exeter Friendly Society, would meet the full amount.

The only figure that could not be accurately predicted was the replacement hip itself. The hospital referred him to his consultant, whose secretary, he claims, gave him a figure of pounds 800 for the hip. Since his policy only offered cover of pounds 350 for replacement parts, he accepted that he would have to pay the pounds 450 shortfall. The policy covered the other hospital costs.

After his operation on 9 January this year, he was amazed to be handed a bill showing a cost of pounds 1,974 for the hip - leaving him with more than pounds 1,600 to pay. The increased cost has meant cancelling a holiday and taking out a bank loan.

In reply to Mr Bailey's letter of complaint, Jack Jones, the Nuffield group's director of finance, apologised for 'any misleading information' that might have been provided by staff. Mr Bailey was not impressed by Mr Jones's comment on 'how difficult it is to provide a precise estimate'. 'My insurers and bank manager, alas, find it simple.'

Elizabeth Shepherd, hospital manager of the Woking Nuffield, is adamant that the hospital always gives a range of prices on replacement hips, as it is impossible to tell in advance of the operation exactly which one will be used, and prices in the past year have risen dramatically.

Hospital mark-ups range from 12 per cent to 100 per cent. Mr Bailey believes the mark-up on his hip was around 30 per cent. The price range quoted has 'for several months' been pounds 800 to pounds 2,000. The upper limit went up to pounds 3,000 this week, following an operation using a prosthesis costing pounds 2,800.

Miss Shepherd says that Mr Bailey may have been referred to his consultant for guidance on the type of hip to be used. His consultant's secretary says that she is unable to keep up-to- date records of prices: 'I just do my best to give a figure based on what previous people have been charged.'

She claims that Mr Bailey did not tell her his insurance cover was limited.

'If he had, I might have gone back to the hospital to check,' she says.

The Nuffield press office says that Mr Bailey 'didn't ask the right person' originally and 'didn't say on admission what his insurance arrangements were'.

If he had, normal practice would have been to contact the insurer to check cover levels and give an accurate estimate 'there and then'. The hospital has declined to give any form of refund to compensate for Mr Bailey's difficulties.

Asked whether it would not be wise in such cases to give a written estimate - albeit quoting a range of prices - the hospital said that its normal practice is to quote over the phone unless the patient's inquiry is by letter.

Interestingly, all 'self-pay' (uninsured) patients are given a written quotation.

Though hospitals may claim to give accurate information, there is obviously great scope for misunderstanding, and an expensive degree of 'imprecision'.

As well as checking policy terms and cover levels carefully with the insurer, policyholders should inform the hospital if cover is limited and get a written quotation from the hospital accounts department.

If the experts 'find it difficult to be precise', patients should be careful to get an idea of the maximum possible liability.

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