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After Christine Malik gave birth to her first daughter three years ago, a clinician affiliated with a company called Pediatrix entered the hospital room and fitted the baby with sensors and wires for a hearing test.
The child failed the screen required by law for all newborns, the tester said, requiring a follow-up exam. Accepting the second exam, Malik said, “For the first time, we were scared as parents.” The clinician, Ms. Malik, said she didn’t tell them that babies often fail the first scan. fluid from the uterus in the soon-to-be-scattered ears. In the second scan, no problems were found in the baby’s hearing.
Last year, when her second daughter was born, Ms. Malik refused a hearing test after another Pediatrix clinician appeared at her bedside. (Parents are allowed to disable it, but they rarely do.)
Infant hearing testing – specifically the more advanced technology Pediatrix uses – is an example of how some common medical procedures have become significantly more profitable for their providers.
Pediatrix and related companies have received a number of complaints from dissatisfied customers such as Malik, who said he was surprised at Pediatrix fees for hospital babysitting. Most of these complaints are related to infant hearing tests. Such tests were once free or included in a hospital’s new baby fees. Pediatrix generates tens of millions of dollars a year from them, according to regulatory filings.
Founded decades ago in Florida, Pediatrix and its parent company, Mednax, have grown into a network of doctors and other clinicians providing hearing screens, pediatric intensive care, pediatric surgery and obstetrics services. They operate in more than 400 affiliated hospitals in approximately 40 states.
According to the company, Pediatrix now cares for approximately one in four infants in neonatal intensive care units and performs hearing tests on approximately one million infants per year.
“I struggled with trying to keep them from coming to hospitals,” said Lisa Hunter, a professor and pediatric audiologist at the University of Cincinnati, who often objects to the Pediatrix’s high fees for hearing screens and the billing confusion they can cause. “I’m very empathetic towards patients who have concerns.”
Pediatrics officials say their doctors and other clinicians often provide top-tier maternity and neonatal medicine to smaller and community hospitals and large systems, providing not only hearing tests but surgery and life-saving care for premature babies as well.
Head of the Pediatrix and Obstetrix group, Dr. “Doing the right thing for the patient is our top priority,” said Roger M. Hinson.
As an obstetrician herself, Dr. Michelle Barhaghi said she was shocked by the $6,538 a Pediatrix doctor in California received for her baby’s unplanned cesarean delivery while traveling in April.
“My jaw dropped when I saw this,” he said. “I’ve sent this invoice statement to all my OB-GYN friends.”
According to the benefit statements, the insurance paid Pediatrix $2,867. That’s still nearly three times the rate for the same procedure, according to Medicare’s doctor’s fees schedule. Pediatrix also features Dr. She billed Barhaghi $1,311 for expenses that insurance did not cover for her baby’s physical preparation and discharge preparations. Pediatrix said it withdrew this bill after contacting Kaiser Health News for comment.
Three years ago, insurance giant Aetna sued Mednax and Pediatrix, saying they had increased fees by more than $50 million, performed unnecessary tests and treatments, and diagnosed babies as sicker than they really were.
Mednax denied Aetna’s allegations, and the case ended in July when Aetna withdrew as part of a collusion. Neither Aetna nor Mednax would disclose the terms.
As part of the proceedings, Mednax admitted in court that Aetna destroyed internal emails it sought as potential evidence of corporate coaching to force doctors to “code” into higher-value procedures.
Pediatric a “first sponsor” In the early 2000s, according to records of a campaign for state laws to require hearing testing for babies. most states such laws now exist and the American Academy of PediatricsRecommends first hearing screens for all newborns before they leave the hospital.
The idea is that even though some false positives may worry parents, the rare infant (two or three in a thousand) with hearing impairment needs to be identified quickly to ensure appropriate treatment and language development.
A simple screen measures whether the baby’s inner ear responds to sound. A more expensive hearing screen, a procedure originally designed to evaluate patients with severe neurological or auditory disease, measures the brain’s electrical response to sound.
Many hospitals reserve this screening for high-risk infants in intensive care or for those who cannot undergo an earlier, cheaper screening.
Aetna’s claims analysis found that Mednax and its affiliates billed three times more for these types of tests than those given by non-Mednax clinicians.
Audiologists familiar with the company said Pediatrix charges $150 or more for testing. The company charged $326 for the screening of Ms. Malik’s first child, showing billing records, and the insurance paid a discounted price of $177.
“The cost of the scan should not be more than $50,” said Professor Hunter, including initial testing and in-hospital follow-up. “Billing more than that and doing that for every baby born sounds like a license to print money to me.”
Dr. Hinson said Pediatrix uses the more expensive auditory brainstem screen because it tests the entire auditory pathway. He said it has a lower false positive rate in baby scans than the cheaper alternative.
The Joint Committee on Infant Hearing, a body of experts deemed authoritative for screening protocols, says any test can be used Initially for babies.
But when done in the hospital soon after birth, both varieties cause a significant number of initially false symptoms of hearing loss. Research shows that, usually due to fluid in the ears from birth.
This requires a second test at the hospital or sometimes weeks later at a doctor’s office. Meanwhile, parents may believe their baby may be deaf. Patient advocates say that when parents are approached by a baby hearing scanner at the hospital, they need to make sure the procedure is covered by insurance. If the child does not pass the test, parents should be aware that this may be a temporary result and should request follow-up before leaving the hospital.
Surprise or misused invoices from Pediatrix and Mednax filed a complaint with the Better Business Bureau and various online forums.
When a Mednax or Pediatrix clinician is outside of a patient’s insurance network, the company says “we bill the patient the balance” in its filings with the Securities and Exchange Commission. At least one hospital, Inova Alexandria Hospital in Northern Virginia, parents warned With Pediatrix’s insurers it may not be an “approved provider”.
According to data provided by the BBB, from the start of 2019 to date, 192 people have filed complaints against Pediatrix and Mednax with the Better Business Bureau. According to the data, most of the complaints are about billing and collection issues.
Dr. “We need to do things that make things smoother for our patients and more seamless for our payers,” Hinson said. When Pediatrix is out of the network, the company said it’s working with families “to reduce surprise bills after discharge.”
It took more than two dozen phone calls and the Better Business Bureau’s help to resolve a false $1,010 bill. She was blamed for a Pediatrix nurse standing next to Sarah Tela’s twins being delivered by a doctor. Obstetrician in 2018.
After researching Tela, who lives near Seattle, she “realized that I wasn’t the only one fighting this battle with them.” “I could easily pay the bill. But I knew I was right.”
The problem turned out to be an incorrect service date on the invoice, which caused the insurance company’s claims software to reject it, he said.
In an email, the company said that after their case was brought up by a reporter, Dr. Contacting Barhaghi and Ms. Malik, Mednax said he was “confident that their respective issues have been resolved to their satisfaction.”
Jay Hancock is a senior reporter. KHN (Kaiser Health News).
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Along with Policy Analysis and Polling, KHN is currently one of the three main operating programs. KFF (Kaiser Family Foundation). KFF is a non-profit organization that provides information on health issues to the nation.
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