Surprise bills, billing errors and vast swings in average prices for similar tests and procedures underscore the need for transparency and reform in hospital pricing.
Hospital care is the single largest component of national health care spending. We expect that our health care premiums will cover most of our hospital costs, but over half of us have received a surprise medical bill in the past year for a cost we thought was covered by our health insurance. Too many consumers are finding out that prices for hospital services vary widely making it more difficult than ever to figure out what you might have to pay.
Many surprise hospital bills result from “balance billing” for treatment at in-network facilities by out-of-network providers. Others result from a lack of customer understanding of complex health benefits and opaque pricing and still others are a result of billing errors.
A Virginia family received a $34,000 surprise bill after their teenage son was rushed to an in-network hospital after being hit in the nose by a baseball. The “plastic surgeon on call” who treated Zack was out-of-network, which they learned only when they received the huge bill.
A Florida man received two CT scans ordered by his doctor only a few weeks apart. The first one was performed at a local imaging center for $268, while the second was done at a hospital at a cost of $8,897. In another instance, a New Jersey woman received an ice pack and bandage, but quickly left the emergency room after learning it was not in her insurance network. She was still billed nearly $5,000 for the visit.
What you can do:
Recent research shows that four in five medical bills contain at least minor mistakes, so it’s important to review bills and insurance “Explanation of Benefits” closely to ensure you received the specific services, procedures and supplies charged. You can visit www.consumers4qualitycare.org/healthliteracy for a tutorial on how to read a medical bill.
It’s also very important to watch out for out-of-network providers serving at in-network facilities. Hospitals aren’t under any obligation to tell consumers what insurance an ER doctor accepts.
Consumers should also do their best to understand pricing and what they are responsible for in advance of having procedures performed. Unless it is an emergency situation, do as much research into pricing ahead of time and determine your share of the bill. By demanding this transparency prior to your procedure, you’ll be able to make a more informed decision about how you will cover your costs.
77: Percent of American consumers who believe hospitals, health insurers and pharmaceutical companies should be more transparent about the cost and access to health care.