With most purchases, whether it’s groceries, a new car or a house, the price is clear up front. Not so for medical services, which can produce massive, mysterious bills to insurers and patients long after a hospital visit. An ongoing series by National Public Radio and Kaiser Health News has documented bills of $142,000 for a young girl’s snake-bite treatment, $94,000 as part of a woman’s spinal surgery and $48,000 for allergy testing, to note just a few examples.
Such insane bills often remain stubbornly unexplained by the hospitals and insurers involved; all are wildly out of whack with expected costs. Legislation moving through Congress with strong bipartisan support would offer new protections to patients. Its passage is urgent. Its logic is clear: People should be able to know up front what the cost of specific procedures and treatments would be.
Seeking medical treatment isn’t generally a matter of choice. Even with insurance, costs can be significant to patients because of deductibles, co-pays and — especially — procedures that insurance doesn’t cover, sometimes to the surprise of the patient. Add to that unexplained variations in the costs of procedures. Just setting foot in an emergency room can become a financial crapshoot.
The ongoing Kaiser-NPR series presents a shocking study in the excessive, confusing, seemingly random world of medical billing, through the eyes of bewildered patients. The well-documented stories are appalling to the point of being almost unbelievable:
• A Florida woman bitten by a stray cat sought rabies treatment in an emergency room. After receiving two injections and an antibiotic, she was sent home, having not even been seen by a doctor. She later got a bill for more than $48,000 — most of it from a roughly $4,300 rabies treatment that the hospital had marked up by a factor of more than 10.
• A Montana man who was suffering kidney failure was billed more than $524,000 for 14 weeks of dialysis — more than the typical cost of a kidney transplant — at a per-session cost roughly 59 times higher than what Medicare pays for the treatment. The astronomical bill was in part because there were no in-network dialysis clinics available in his region.
• A three-year-old Nevada girl got a tiny toy shoe from a doll stuck up her nostril. An emergency room doctor pulled it out with forceps. The family subsequently got a bill for more than $2,600 — for a procedure that, according to Medicare data, generally costs less than $50 to perform. The family is still trying, so far unsuccessfully, to get an explanation as to how the astronomical bill was calculated.
• A Michigan woman’s routine biopsy, which found a cyst to be benign, resulted in a bill for more than $3,350 — the bulk of it consisting of a $2,170 “facility fee” that one reform advocate likened to a “cover charge” at a nightclub.
• An Illinois woman suffering from depression spent five nights in a hospital psychiatric unit and was billed almost $30,000. The bill was largely attributable to her insurance plan, which offers the kind of shortchanged coverage that was not allowed under Obama-era rules, but has been allowed back into the market by the Trump administration.
These kinds of bills are surprises that hit the patients later — up to a year later, in some cases. Patients are often able to negotiate-down the bills after the initial sticker shock, and in some cases (including the above-mentioned half-million dialysis), the embarrassing media attention alone has caused medical facilities to cancel the bills altogether.
But even those happy endings don’t indicate the system is healthy — not if it takes fighting with hospitals and insurers, or the blind luck of bad publicity, to force reasonableness from the system. Patients should know going in what these procedures cost. As it stands now, they often can’t get a straight answer even afterward as to how the unexpectedly high bills were calculated.
Polls show nearly half of Americans have been hit with surprise medical bills. That helps explain the overwhelming public support for legislation to address the issue. In a divided nation and a divided Washington, it’s one thing Democrats, Republicans and President Donald Trump all appear to agree upon.
The pending legislation would prohibit doctors from sending unexpected bills to patients who were treated at hospitals that accept their insurance. It would also create a system to resolve billing disputes between insurance companies and doctors, often a key factor in surprise billing.
Not surprisingly, the legislation has prompted a full-court press of opposition from the medical industry — including a truly Orwellian multimillion-dollar media campaign by shadowy private-equity-backed firms that own physician practices around the country, selling the specious argument that reform would somehow hurt patients.
Doctors, hospitals and insurers are, of course, all blaming each other for the outrageous bills. And, certainly, there’s plenty of blame to go around. But Congress mustn’t let the finger-pointing, the complexity of the issue or the big-money lobbying campaigns derail reform.
America doesn’t agree on much these days. But anyone who might need medical attention at some point — which is to say every single one of us — has an interest in ending this shell game.