Gould, 78, a physicist who spent decades toiling for several Boston-area computer pioneers, has racked up more than a million dollars in medical expenses. He's met all his financial obligations through a combination of private insurance, Medicare, and savings.
He had asked Mass General during a presurgery consultation how much the tooth extractions would cost and was told several thousands of dollars, depending on how much anesthesia he required ($475 per 15-minute increment) and what medications he needed during and after surgery. When he decided to go forward, Mass General insisted on an $1,200 upfront payment.
The surgery took about 90 minutes. In total, he spent less than six hours in the hospital. He's deeply grateful for the high quality care he got there and, through the years, at Dana-Farber Cancer Institute.
But what shocked him was that the bill he received included $22,805 for the operating room and $979 for the recovery room. Neither was disclosed to him presurgery.
The total bill was for $26,954 (not counting the $1,200 he paid upfront). Medicare, which covers people age 65 and older, generally does not cover dental treatments. Gould nevertheless formally appealed his denial of coverage to Medicare, saying his surgery was a result of a medical condition -- cancer -- not a dental one. But it was rejected.
Gould was flummoxed by the gargantuan bill because he had carefully budgeted for what the hospital had led him to believe would be less than $5,000 in out-of-pocket costs.
Gould complained to Mass General that he had been misled on the cost, and that he would have gone elsewhere if he had known better. He asked the hospital to extend him "a little grace" under the circumstances. When the hospital instead insisted on payment a couple of months after his surgery, Gould emptied $8,000 from a retiree medical savings account and began paying $550 a month.
In early January, about a year after his surgery, Gould spotted one of my columns in The Boston Globe. It was about a Mass General-affiliated hospital charging a Newton family thousands of dollars more than it told them in advance would be the cost for their son's physical therapy.
Gould wrote to me: "Paying the $550 a month is a real strain for us, and . . . I have no funds left to maintain my upper teeth or get some kind of implant for the [extracted] lowers so I can chew again."
"We'll find a way to deal with this," he said of his hospital debt, adding there was a possibility that he or his wife would go back to work, and that he had mixed feelings about publicly airing his situation by contacting the Globe. (His wife, Christine, 74, is a retired public school administrator.)
"My real issue is how we got here. If [Mass General] had disclosed the full cost of the procedure to me, I would not have gone ahead [with it]. I could have searched for another doctor without the associated hospital overhead. I might have been able to negotiate with [Mass General] about the cost and got them to provide a discount.
"I feel like I was misled about what I was getting into. I truly thought I was aware of all the associated costs."
Months before contacting me, Gould had asked Mass General in a letter to accept payment of $10,000 and write off the remaining $17,000.
He said he did not get a response to his letter. But when he clicked on the financial tab of his patient portal, he saw an offer of a no-interest payment plan over 36 months -- thus his $550 monthly payments.
The resolution: In an email to Mass General on Feb. 28, I wrote that the hospital had apparently failed to inform Gould of the full cost "when it knew or should have known he had no insurance for what would be an enormous cost."
Mass General then acknowledged its failure to make full disclosure and said it regretted it. As a result, it almost immediately refunded Gould about $12,000 and waived the balance of about $15,000. Mass General kept only the upfront $1,200 payment he made.
Gould said he was "overjoyed" and said he and Christine will celebrate by going out to dinner at a favorite restaurant. He can now afford to obtain lower dentures or other means to be able to chew (he now uses his tongue to help chew soft foods).
Gould also had this word of advice for Mass General: "If you don't have a formal process for disclosing cost you will continue to get into trouble with patients."
The takeaway: Mass General told me it began taking steps to improve its cost-disclosing processes "several months ago."
"When a request for physician's fees is made, it should also include an estimate of the hospital cost," a Mass General spokesperson said in an email, adding that "the information is being offered in case the patient's coverage does not reimburse the entire cost."
I also asked the hospital if it planned to do a "look back" for any other cases of past patients getting billed for undisclosed expenses.
"We will be doing a review," it said.
My recommendation to consumers: Make sure you ask how much your treatment will cost -- but don't rely on anything you are told. You need to get it in writing (on paper, email or text). And when you do get something in writing, make sure to inform your provider that you are relying on it. Do that by simply saying so in a letter, email, or text. You still may be charged more, but now the burden will be on the provider to justify it.