After Christine Malik gave birth to her first daughter 3 years ago, a clinician associated with a business called Pediatrix entered the hospital room and fitted the infant with sensors and wires for any hearing test.
The child failed the screening necessary for law for all newborns, the tester said, requiring a follow-up exam. “We were scared as first-time parents,” said Malik, who decided to the second exam. The clinician, Malik said, didn't tell them that infants often fail a preliminary screening due to fluid in the womb within the ears that soon dissipates. The second screening found not a problem using the baby's hearing.
Last year, when her second daughter was born, Malik refused a hearing test to another Pediatrix clinician appeared at her bedside. (Parents are allowed to opt out but rarely do.)
The infant hearing test – particularly the more complex technology Pediatrix uses – is definitely an illustration of how some common medical procedures have become significantly more profitable for his or her providers.
Pediatrix and related companies have drawn a string of complaints from dissatisfied customers like Malik, who said she was surprised by Pediatrix's charges for in-hospital infant care. Such tests were once free or included in a hospital's new-baby fees. Pediatrix earns tens of millions of dollars a year in revenue from their store, according to regulatory filings.
Founded in Florida decades ago, Pediatrix and it is parent company, Mednax, have become right into a network of physicians and other clinicians delivering hearing screens, pediatric intensive care, pediatric surgery and obstetric services. They be employed in more than 400 affiliated hospitals in some 40 states.
Pediatrix now cares for about 1 in 4 babies in neonatal intensive care units, based on the company, and administers its hearing tests to almost millions of babies annually.
“I've been associated with attempting to prevent them coming into hospitals,” said Lisa Hunter, a professor and pediatric hearing specialist at the University of Cincinnati who objected generally to Pediatrix's high charges for hearing screens and also the billing confusion they are able to cause. “I'm greatly empathetic with patients who have concerns.”
Pediatrix officials say their doctors and other clinicians deliver top-level maternity and newborn medicine, often to smaller and community hospitals in addition to large systems, providing not just hearing tests but surgery and lifesaving take care of premature babies.
“Doing what's right for the individual is our highest priority,” said Dr. Roger Hinson, president from the Pediatrix and Obstetrix medical group.
Dr. Michelle Barhaghi, an obstetrician herself, said she was shocked by the $6,538 that a Pediatrix doctor in California charged for that unplanned cesarean delivery of her baby in April while she was traveling.
“When I saw that, my jaw dropped,” she said. “I sent that bill statement to all my OB-GYN friends.”
Insurance paid Pediatrix $2,867, according to benefit statements. That's still nearly 3 times the speed for the same procedure under Medicare's schedule of physician fees. Pediatrix also billed Barhaghi $1,311 for charges that insurance didn't cover for an actual and discharge prep on her baby. Pediatrix withdrew that bill after being contacted by KHN for comment, she said.
Three years ago, the insurance coverage giant Aetna sued Mednax and Pediatrix, saying they inflated charges by more than $50 million, performing unneeded tests and treatments and diagnosing babies as being sicker compared to what they really were.
Mednax denied Aetna's allegations, and also the case ended in July when Aetna withdrew it as a part of a confidential agreement. Neither Aetna nor Mednax would disclose the terms.
As area of the proceedings, Mednax admitted in court that it destroyed internal emails Aetna had sought as potential proof of corporate coaching to nudge physicians to take part in “upcoding” to higher-value procedures.
Pediatrix would be a “premier sponsor” of a campaign in the early 2000s for state laws requiring hearing tests for babies, records show. Most states are in possession of such laws, and the American Academy of Pediatrics recommends initial hearing screens for those newborns before they leave a healthcare facility.
The idea would be that the rare baby with hearing deficiencies – two or three in each and every thousand – needs to be identified quickly to make sure medicine and language development even if some false positives worry parents.
A simple screen measures whether the baby's inner ear responds to sound. A far more expensive hearing screen, a procedure originally designed to assess patients with serious neurological or auditory disease, measures the brain's electrical reaction to sound.
Many hospitals reserve that screen for high-risk babies in intensive care or people who fail an earlier, less expensive screening.
Aetna's claims analysis found that Mednax and affiliates billed 3 times more often for those types of tests than for those provided by non-Mednax clinicians.
Pediatrix charges $150 or more for the test, said audiologists familiar with the company. The organization charged $326 for Malik's first child's screening, billing records show, and insurance paid a reduced cost of $177.
“The cost of doing the screening should not be a more than $50,” said professor Hunter, including the initial test and in-hospital follow-up. “To bill in addition to that, and also to do this on every single baby that's born, to me that sounds like permission to print money.”
Hinson said Pediatrix uses the more expensive auditory brainstem screen since it tests the entire hearing pathway. He explained it has a lower false-positive rate on infant screenings compared to more affordable alternative.
The Joint Committee on Infant Hearing, a board of experts considered authoritative for screening protocols, says either test may be used initially for babies.
But completed in a healthcare facility soon after birth, both varieties create a substantial quantity of initial false warning signs of hearing deficiency, studies have shown, actually because of fluid in the ears from birthing.
This requires a second test either in the hospital or sometimes weeks later in a doctor's office. Meanwhile, families might believe their baby might be deaf. When parents are approached by an infant-hearing screener in the hospital, they should make sure the procedure is covered by insurance, patient advocates say. When the child fails the exam, parents should be aware it could be a fleeting result and ask for a follow-up before leaving a healthcare facility.
Surprise or mishandled bills from Pediatrix and Mednax have drawn complaints to the Better Business Bureau as well as on various online forums.
When a Mednax or Pediatrix clinician is outside a patient's insurance network, “we bill the balance towards the patient,” the company says in filings using the Filing. At least one hospital, Inova Alexandria Hospital in Northern Virginia, has warned parents-to-be that Pediatrix “may not be an approved provider” using their insurer.
From the beginning of 2022 to mid-November, 192 people filed complaints with the Bbb against Pediatrix and Mednax, according to data supplied by the BBB. The majority of the complaints are about billing and collections issues, based on the data.
“We need to do things that make things more seamless for our patients and much more seamless for the payers,” Hinson said. When Pediatrix has run out of network, the organization works together with families “to mitigate post-discharge surprise billing,” he explained.
It took at least a year, 24 telephone calls and the assistance of the greater Business Bureau to solve one incorrect $1,010 bill. It had been charged for any Pediatrix nurse practitioner who stood by while Sarah Tela's twins were delivered by an obstetrician in 2022.
After doing research, Tela, who lives near Seattle, remarked that “I wasn't the only one dealing with this struggle with them.” She added: “I might have easily paid the balance. But I knew I was right.”
The problem ended up being an incorrect date and services information around the bill, which caused the insurer's claims software to reject it, she said.
Mednax, which contacted Barhaghi and Malik after their cases were brought up by a reporter, is “confident their respective matters are being resolved to their satisfaction,” the organization said within an email.
Jay Hancock:
jhancock@kff.org,
@JayHancock1
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