According to the triage notes, “Patient went to swim” — “patient” is me, by the way — and “after getting out of the pool, his hands were flushed and felt generalized itching…felt light headed … his vision ‘seemed pixilated,’ felt his speech was slurred.”
I felt like I was having an allergic reaction and the next thing I knew, I was in an ambulance, on my way to the emergency room. The good news, that my symptoms were apparently a false alarm, was mitigated by the series of invoices I received over the next nine months.
First, there was one for that 2-mile ride to the hospital, for which the ambulance company charged my insurance carrier $2,750. Even after that, I still owed $251. But when I emailed the ambulance company’s CFO to suggest they might have already received enough compensation for 29 minutes of service, the bill I received mysteriously disappeared.
The hospital I visited agreed to accept just over $2,500 from my insurance company — on an initial bill of $4,500 — but, to my surprise, it wanted another $701 from me. This size of charge isn’t unusual: The national average out-of-pocket cost that insured patients paid for an ER visit was $646, according to a 2022 report from Peterson-KFF Health System Tracker.
While the hospital agreed to waive more than 40 percent of the initial bill for my insurance company, I was told my personal bill was nonnegotiable.
There are plenty of unknowns related to health care, but the financial ones take a toll. I knew my insurance plan covered 80 percent, but in the emergency room there’s no way of knowing what procedures will be required — so the remaining 20 percent that I’m responsible for could be almost any amount.
In effect, when an insured patient enters the ER, they are agreeing to write a blank check. I talked over my experience with Ashley Blackburn, senior director of policy and government relations at Health Care For All, a nonprofit that advocates to ensure access. “I think the way you describe it is, yes,” she tells me, “you are in some circumstances leaving it up to chance.”
The federal law known as the No Surprises Act, which took effect in 2022, requires a “good faith estimate” of care costs, but that provision doesn’t apply to patients using insurance, or to some emergency services. And in 2012, Massachusetts enacted Chapter 224, the health care cost containment law, which requires both insurers and providers to disclose the cost of a procedure upon request. But, of course, this isn’t particularly applicable when you’re in an ambulance, speeding to the ER.
“Hello, Aetna? I know it’s 3 a.m. but could you please check and see if the hospital we’re going to and the ER physician on duty are in-network or if we should keep driving?”
Trying to wrap your arms around what you owe is another challenge, especially since medical procedures are often billed piecemeal and the invoices continue to roll in long after patients receive care. Nearly nine months from the date of my ER visit, having paid what I assumed were all my bills, I received another one from the physician — he’d stopped by that night for what I estimate was 40 seconds, before discharging me without a diagnosis. The cost of his services, which worked out to roughly $16.75 a second, seemed a little excessive. But the hospital wouldn’t budge; I owed $78.50 toward my portion of his bill.
I know, it’s difficult to sympathize with a haggler like me, who at least has health insurance. There are many lower-income patients who are uninsured or underinsured, and who would be happy to have the problems I do. But suppose the uncertainty we face on pricing deters us from making a needed visit? The consequences of waiting may result in increased costs for insurance companies, hospitals, and consumers — assuming they’re not deadly.
“Skipping or delaying care is a huge concern and it’s absolutely happening here in Massachusetts,” Blackburn says. She cites the 2023 Massachusetts Health Insurance Survey, by the Center for Health Information and Analysis, that found nearly 29 percent of state residents reported they or a relative have gone without necessary health care services due to the cost.
It would have been nice if my hospital discounted my bill by 40 percent, to match the discount afforded my insurance company. But I’ve learned it’s important to question your charges, and to raise your hand — early and often — if you suspect you’ve been billed too much or you can’t afford the price. A Kaiser Health News analysis in 2019 found 45 percent of nonprofit hospitals were routinely sending bills to people who actually qualified for the hospitals’ own free or discounted care programs. And, according to one recent survey by JAMA Health Forum, asking after a bill can get an error corrected (that worked for about 26 percent of respondents), a price reduction (15 percent), and/or get the bill canceled outright (7 percent). If you don’t ask, you don’t know what’s possible.
And finally, how about a statute of limitations governing how long hospitals have to issue their bills? Thirty days seems reasonable. By the time my final invoice arrived after nine months, I had finally, mercifully, almost successfully put the experience behind me.
“Customer service, it’s me, again. Last question, I promise: Before I accept this gown from the nurse, am I covered?”
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