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A collection agency sinks its teeth in you like a pitbull. Nothing makes it go away - until you feed it your hard-earned cash.

So let me tell you the amazing story of a St. Louis man. He wrote one letter, and the collection agency gave up.He's a medical man who got an outrageous hospital bill. At least, he thought it was high.

I'll call him Dr. Bigbill.

The hospital collection agency went after Dr. Bigbill. He asked for an itemized bill. What he saw made him sick.

In one case, the hospital charged him more than 35 times the wholesale price for an item. Another time, they nicked him for 12 times the wholesale rate.

He wrote the hospital this letter. It's so good, you should read it.

"First, I don't think there should be a $9 charge for a venipuncture, nor should there be a $20 charge for transportation of a specimen," Dr. Bigbill wrote.

I interrupted. What's a venipuncture?

"They have to stick you for a blood test," Dr. Bigbill said. "In this case they stuck me for $9. Then they stuck me again for $20 to carry my blood to the lab. Then they stuck me again for the tests."

Dr. Bigbill gave the hospital a second opinion on that practice:

"The venipuncture took less than five minutes," he said, "and I can't see being charged for this, especially if you figure out that the venipuncturist would earn over $100 per hour for her efforts.

"Transportation of a specimen is an in-hospital issue, and I should not have to pay for this. The movement of specimens is not dissimilar to the movement of an X-ray from one place to another, and there are no transportation charges in those instances.

"When my internist did a chemical profile that had 19 or more chemistries for me, the charge was $15.

"The chemical profile for six tests that your hospital ordered was for $52. Four electrolytes and two other blood chemistries were done. I can't see why I should pay $52 for these six tests, when my internist provides a profile of 19-plus chemistry tests for $15."

Another test made his blood boil.

His internist charged him $15 for a blood count. "The hospital expects to be paid $34.

"It is hard for me to understand how my internist, who does not have the economies of volume that your hospital laboratories have, is able to make a profit charging a lower fee for doing more."

Next, Dr. Bigbill told the collection agency what he thought of the hospital's charges for the fluids and medicine he was given during his outpatient surgery.

"When I purchase medications for myself and my family, I use a drug wholesaler." Dr. Bigbill thoughtfully provided the wholesaler's name and 800 number for the hospital.

Then he did some price comparisons.

The hospital charged him $40 for 15 ml. of atropine sulfate.

The wholesaler charged $1.12 for 20 ml.

The hospital charged him $36.80 for pilocarpine.

The wholesaler charged $5.50.

The hospital billed him $45 for 1,000 cc's of lactated Ringer's solution. The wholesaler charged $2.55.

The hospital wanted him to pay $40 for 5 percent dextrose in water. That's sugar water.

He could get it at the wholesaler for $3.20.

There's more, but it would only depress you.

Now Dr. Bigbill began to cut up the $820 operating room charge.

"I was in the operating room for 55 minutes. Am I to assume that $820 is the hourly rate for the operating room, or are the charges not by the hour, but some other way?

"I also don't understand the $38 charges for the `recovery room set up.' Since I was fully awake and conscious when I entered the recovery room, I am not sure exactly what sort of set up was done. There was charting and there was taking of my vital signs, and then some morphine administered for pain relief. I don't know what needed to be set up.

"I find it hard to understand a recovery room charge of $262. Is the recovery room on the basis of an hourly charge? If so, it should be stated."

Dr. Bigbill was also charged a breathtaking $38 for respiratory services.

"These were not received, not done, and with spinal anesthesia would not be necessary.

"Further, I don't understand the $191 charge for the `treatment-observe room.'

"I think I am a person who generally pays my bills promptly and fully," he said. "However, these charges require a review by either you or the hospital.

"I am looking forward to your speedy reply, since I would like to have this issue resolved and finished."

That was January.

It could be the hospital had good reasons for all its charges. I don't know what they are. The hospital said it would need the patient's name to audit the bill. I was on deadline and needed a quick answer. The hospital said it needed more time to look into the problem.

Dr. Bigbill certainly gave them plenty of time. He hasn't heard from the hospital or the collection agency in more than four months.

In his case, silence is golden. He received no more bills.