After Christine Malik gave birth to her first daughter three years ago, a clinician from Pediatrix entered the hospital room and equipped the baby with sensors and wires for a hearing test.
The child failed the statutory exam for all newborns, the tester said, which required a follow-up exam. “We were scared as first parents,” said Ms. Malik, who agreed to the second exam. The clinician, Ms. Malik said, didn’t tell them that infants often fail an initial screening due to fluid from the uterus in the ears that soon evaporates. The second screening did not reveal any problems with the baby’s hearing.
Last year when their second daughter was born, Ms. Malik declined a hearing test after another pediatrician appeared at her bedside. (Parents can opt out, but they rarely do.)
The infant hearing test – especially the more advanced technology Pediatrix uses – is an example of how some popular medical procedures have become significantly more profitable for their providers.
Pediatrix and its affiliates have received a number of complaints from dissatisfied customers such as Ms. Malik, who said she was surprised at Pediatrix’s hospital infant care fees. Many of these complaints relate to hearing tests in babies. Such tests used to be free or included in a hospital’s neonatal fee. Pediatrix generates tens of millions of dollars annually, according to regulatory documents.
Pediatrix was founded decades ago in Florida and, with its parent company Mednax, has developed into a network of doctors and other clinicians offering hearing screens, pediatric intensive care, pediatric surgery and obstetrics. They serve in more than 400 affiliated hospitals in approximately 40 states.
According to the company, Pediatrix now cares for around one in four babies in neonatal intensive care units and performs hearing tests on almost one million babies every year.
“I was involved in preventing them from going to hospitals,” said Lisa Hunter, a professor and hearing specialist for children at the University of Cincinnati, who generally opposed Pediatrix’s high hearing screen fees and billing confusion. “I am very empathetic with patients who have concerns.”
Pediatrix officials say their doctors and other clinicians deliver maternity and neonatal medicine of the highest quality, often to smaller and community hospitals as well as large systems that provide not only hearing tests but surgery and life-saving care for premature babies.
“Doing the right thing for the patient is our top priority,” said Dr. Roger M. Hinson, president of the child and obstetrics group.
Dr. Michelle Barhaghi, herself an obstetrician, said she was shocked at the $ 6,538 a pediatrician in California charged for her baby’s unplanned caesarean section in April during her trip.
“When I saw that, my jaw dropped,” she said. “I have sent this statement to all of my gynecologists.”
The insurance company paid Pediatrix $ 2,867 according to benefit bills. That’s still nearly three times the rate for the same procedure under the Medicare Physician Fee Schedule. The pediatrician introduced Dr. Barhaghi also billed $ 1,311 for expenses insurance did not cover for physical and discharge preparation for her baby. Pediatrix withdrew that bill after being asked for comment by Kaiser Health News, she said.
Three years ago, insurance giant Aetna sued Mednax and Pediatrix, saying they inflated 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 it under a confidential agreement. Neither Aetna nor Mednax would disclose the terms.
As part of the trial, Mednax admitted in court that it had destroyed internal emails that Aetna was looking for as potential evidence of corporate coaching to encourage doctors to participate in higher quality trials.
Pediatrix was a “first sponsor” of a campaign for state laws requiring babies to have hearing tests, records show in the early 2000s. Most states now have such laws, and the American Academy of Pediatrics recommends an initial hearing for all newborns before they leave the hospital.
The idea is that the rare baby with hearing impairment – two or three in a thousand – needs to be identified quickly to ensure adequate treatment and language development, even if some false positives worry parents.
A simple screen measures whether the baby’s inner ear is responding to sounds. A more expensive hearing screen, a technique originally developed to assess patients with severe neurological or hearing disorders, measures the brain’s electrical response to sound.
Many hospitals reserve this screening for high-risk babies in the intensive care unit or for those who have failed earlier, lower-cost screening.
Aetna’s failure analysis found that Mednax and its partners were three times more likely to be billed for these types of tests than those from non-Mednax clinics.
Pediatrix will charge $ 150 or more for the test, said audiologists familiar with the company. The company charged $ 326 for screening Ms. Malik’s first child, the billing records show, and the insurance company paid a discounted rate of $ 177.
“The cost of screening shouldn’t be more than $ 50,” said Professor Hunter, including the initial test and hospital follow-up. “More than billing for that and doing this for every single baby that is born sounds like a license to print money to me.”
Dr. Hinson said Pediatrix uses the more expensive auditory brainstem screening because it tests the entire auditory pathway. He said it had a lower false positive rate on infant screenings than the lower-cost alternative.
The Joint Committee on Infant Hearing, a body of experts believed to be authoritative on screening protocols, says any test can be used on babies initially.
But both variants in the hospital shortly after birth lead to a significant number of initial false indicators of hearing impairment, research shows, often due to fluid in the ears at birth.
This will require a second test either in the hospital or sometimes weeks later in a doctor’s office. In the meantime, families may believe that their baby may be deaf. If parents are approached by an infant hearing screener in the hospital, they should make sure that insurance will cover the procedure, patient advocates say. If the child fails the test, parents should be aware that the result may be a fleeting result and request a follow-up exam before leaving the hospital.
Unexpected or incorrectly handled Pediatrix and Mednax invoices have resulted in complaints to the Better Business Bureau and various online forums.
When a Mednax or Pediatrix doctor is outside a patient’s insurance network, “we will bill the patient for the remainder,” according to the company’s filings with the Securities and Exchange Commission. At least one hospital, Inova Alexandria Hospital in Northern Virginia, has warned expecting parents that Pediatrix “may not be a licensed provider” with their insurer.
From the beginning of 2019 until today, 192 people have filed complaints against Pediatrix and Mednax with the Better Business Bureau, according to BBB.
“We have to do things that make it smoother for our patients and our payers,” said Dr. Hinson. When Pediatrix isn’t on the network, the company works with families “to mitigate the surprise billing after discharge,” he said.
It took over a year, two dozen phone calls, and the help of the Better Business Bureau to solve a false $ 1,010 bill. It was billed for a pediatric nurse on standby from an obstetrician during the birth of Sarah Tela’s twins in 2018.
After doing research, Ms. Tela, who lives near Seattle, found that “I wasn’t the only one who went through this battle with you.” She added, “I could have easily paid the bill. But I knew that I was right. “
The problem turned out to be an incorrect delivery date on the invoice, which resulted in the insurer’s damage software rejecting the invoice, she said.
Mednax, the Dr. Barhaghi and Ms. Malik, contacted after their cases were brought up by a reporter, are “confident that their respective issues will be resolved to their satisfaction,” the company said in an email.
Jay Hancock is the senior correspondent for KHN (Kaiser Health News).
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health topics. Together with Policy Analysis and Polling, KHN is one of the three major operational programs of the KFF (Kaiser Family Foundation). KFF is a non-profit foundation that provides the country with information on health issues.