The document discusses trauma activation fees, which are charges billed when emergency services are alerted that a trauma patient is incoming. These fees can range from $837 to over $30,000 depending on the facility. The fees are meant to cover costs of preparing trauma staff and units, but some argue they are excessively high and not correlated to injury severity. Additionally, trauma patients still face other medical bills on top of the activation fee. Some level II trauma centers charge higher fees than level I centers, despite level I centers providing more comprehensive trauma care. Overall, the document questions the justification and variability of trauma activation fees.

1. Understanding the Trauma Activation Fee MBAA © 2014
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2. Understanding the Trauma Activation Fee MBAA © 2014
When a traumatic event occurs, you
want the best health care money can
buy. However, you expect the cost of
that care to be fair and reasonable.
Former trauma patients are seeing a
hefty fee on their medical bills simply
for coming through the medical facility
doors. This “trauma activation fee” is
not so new to the healthcare system
but is recently receiving much
warranted attention because it is
showing up with a higher frequency.
This alert allows the medical staff to prepare supplies and be ready in the trauma area to give
their particular concentration of care. A team of health care professionals will meet at a
previously designated location within the trauma area prepared with any necessary supplies,
such as pre-mixed IV solutions, oxygen and a crash cart, which contains emergency
medications and administration supplies.
Medical doctors, registered nurses, respiratory therapists and technicians, lab technicians,
operating room personnel, pharmacy staff and radiology technicians should be trained to “drop
everything” and respond to a trauma call. Additionally, the OR and ICU units must make sure
they are prepared to accommodate trauma victims. Sounds like every department in the
hospital, right? It should be. Trauma patients are a big deal and often, the emergency staff
does not know exactly what they are dealing with until the trauma patient arrives and is
assessed.
Like any other medical emergency, there are different levels of severity with trauma
patients, meaning each case is different and requires different levels of care. For
example, a patient with an injury to his arm, leg or foot might not be as severe as
someone with an injury to his head or chest. Regardless of the severity of injury of a
trauma patient, in many health care facilities, the trauma activation charge is the same.
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A trauma activation fee is a charge that is
billed when a medical third party (ambulance)
alerts a medical emergency facility or trauma
center that a trauma patient is on the way.
Severity of Trauma Not Taken Into Account
“

3. Understanding the Trauma Activation Fee MBAA © 2014
In addition to the activation fee, the
emergency facility is still able to bill
for additional emergency room costs
and charges from different hospital
departments. That means that not
only are you paying a fee for
representatives to be present from all
areas of the facility, you are also
paying a fee if you happen to use
their service. Read that last sentence
again.
"
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You are first being charged to let the facility know you
are coming and that you are experiencing some form of
trauma.
"
Second, you are being charged by the facility for
whatever costs they would normally charge (emergency
room fee, medications, IVs, supplies).
"
Third, you are charged by any doctors who see you.
"
And fourth, you are charged by any additional
departments from which you required assistance, such as
radiology for an x-ray or laboratory for blood drawn (plus
any supplies used by those departments).

4. Understanding the Trauma Activation Fee MBAA © 2014
"
Medical Recovery Services founder Pat Palmer is frequently seeing these charges in her
business, which audits excessive medical bills and often reclaims money for consumers,
companies, insurance providers and attorneys. Palmer is seeing trauma activation fees from
across the country in excess of $20,000 to $30,000.
The formula for creating these fees varies between hospitals and facilities, but there are
standards which must be met before a health care facility can charge for a trauma activation.
There must have been pre-hospital notification before the patient arrives and the trauma team
must have been activated and ready when the patient arrives.
According to the Arizona Department of
Health Services, a trauma center or medical
emergency facility bases its trauma
activation fee either on the actual cost (what
the trauma event costs the facility plus mark-
up) or on what other facilities are charging
their patients.
Palmer has seen a flat rate applied to
patients’ bills and she has seen rates based
on severity and treatment of trauma event.
Interestingly, she has seen vast differences in
charges for similar trauma events among
facilities in alarmingly close distances of one
another.
Why are there such vast differences in these trauma activation fees, especially in
facilities that are in the same area? A large problem is that many of the high-charging
facilities are owned by for-profit health care corporations, such as Hospital Corporation
of America, Community Health Systems and LifePoint Hospitals, who pack on hidden
fees to help pay hefty administration costs.
A 2012 article from USA Today shows a vast difference in trauma activation fees across
Florida. A medical center in Fort Pierce, FL, closer to the southern point of the state,
charges approximately $29,000 for a trauma activation fee. An Orange Park, FL facility
charges around $20,000 while a Jacksonville hospital charges a more reasonable
$7,000. What is very interesting about the charges from Orange Park and Jacksonville
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The $30,000 Trauma Activation Fee
Vast Differences in Activation Fees

5. Understanding the Trauma Activation Fee MBAA © 2014
is that these two facilities are located approximately 20 miles apart, yet one facility only
charges a third what the other charges. None of these facilities are classified as a level I
or even a level II ACS-verified trauma center, according to data provided by the
American College of Surgeons.
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For an updated list of ACS-verified trauma centers in
the U.S., listed by state, please visit this link:
http://www.facs.org/trauma/verified.html
Level 2 Charge More than Level 1 Facilities
The Arkansas Trauma Education and Research
Foundation states that their cost-based
activation fees pay for overhead and for all
staff that respond to the trauma call for their
time spent, including extra trauma call pay for
some physician staff. Extra charges incur
based on the number of patients in the trauma
call.
The U.S. National Library of Medicine and
National Institutes of Health released the
results and details of a study performed on 57
U.S. trauma centers evaluating charges for
severely injured patients. The report found a
vast difference in the cost of trauma activation
charges across the country. The fee for a full
trauma activation ranged from $837 to
$24,963. The report also revealed that level II
trauma centers tended to charge more than
level I trauma centers.
A level I trauma center has more to offer a
trauma patient than a level II trauma facility,
such as a wide range of various in-house
specialists. Not only would this type of facility
offer general surgeons, orthopedic surgeons
and neurosurgeons, but might also offer
plastic surgeons and oral and maxillofacial
specialists. Their trauma team participates in
ongoing continuing education opportunities
and provides prevention education to the
public. They are able to see a trauma patient
through from the moment they enter the facility
with an injury all the way through rehabilitation.
This type of facility is trained and updated on
every aspect of trauma care for every type of
injury possible and because the volume and
variation of injuries which come through their
doors is so great, they would have the most
experience in trauma care, meaning they
would likely have the best surgeons, doctors,
nurses and staff in the region. So, how can a
level II trauma center justify higher charges for
trauma activation, since they supposedly base
this charge on the cost of facility operations,
which includes physician pay? Are these
highly-skilled surgeons really making less
money than their colleagues who work for
lesser ranked facilities? This report just further
validates that there is no rhyme or reason to
these fees charged to trauma patients.

6. Understanding the Trauma Activation Fee MBAA © 2014
"
There is no doubt trauma centers are costly
to operate. The cost of surgical coverage
and equipment and expenses of medical
staff can be extremely high. Specialty staff
must be available 24/7. Keeping the OR and
ICU available for new traumas costs money
(not just the staff, but equipment as well).
However, what can justify charging a patient
tens of thousands of dollars in addition to
regular fees and charges just to walk through
the door because their arrival was
announced ahead of time, regardless of type
or severity of injury?
Unfortunately, there doesn’t seem to be an end in sight to fees created in hospitals and other
healthcare facilities to offset the costs of running that facility, according to data from the long-
term budget from the U.S. Congressional Budget provided by the Arkansas Trauma Education
and Research Foundation. A 2010 report projects the federal cost of health care will double by
2035.
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Surcharge for Pre Arrival Announcement
Call 855-203-7058 or Click the Button to Visit BillAdvocates.com
Looking to Dispute Medical Bills?

7. Sources:
"
"Trauma Finance 101." Arizona Department of Health Services, n.d. Web. 25 Feb.
2014. <http://www.azdhs.gov/bems/documents/trauma/workshop/131115-
trauma-finance-101.pdf>.
Arkansas. Arkansas Trauma Education and Research Foundation. By Deb Brown,
RN, BSN, MHA. N.p., Aug. 2013. Web. 25 Feb. 2014. <www.aterf.org/wp-content/
uploads/2013/08/The-Nuts-and-Bolts-of-Trauma-Activation-Fees-by-Deb-
Brown.pdf>.
Crain, W., SM Fakhry, R. Maier, and C. Potter. “Survey of National Usage of
Trauma Response Charge Codes: An Opportunity for Enhanced Trauma Center
Understanding the Trauma Activation Fee MBAA © 2014
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