New Study Finds Patients Regularly Mugged in the Dark


A while back I wrote about my experience being shaken down for over $4,000 when I had to take my daughter for a simple x-ray after she hurt her foot while we were vacationing. The x-ray was negative, but the charges — for a simple 3-view x-ray, an Ace bandage, and a pair of crutches — were over $4,300. Such charges are illegal under federal laws that limit charges for out-of-state emergency visits to what it would cost to stabilize the patient in her home state, but this hospital, as they say down in Texas, flat did not care. It plunged ahead, ignoring my insurer’s offered settlement and instead sending me threats that it would report me to collection agencies if I didn’t pay up. Someone familiar with such claims told me this is common in this situation; many hospitals simply routinely ignore this regulation, wave aside the insurer’s silly babbling about paying rates it considers too low, and harass the patients till they pay up what they can.

The hospital has now finally agreed — what d’ye know? — to actually file the claim with the insurer. In the meantime, however, they also sent the account to a collection agency because, they wrote, I had “failed to respond” to their attempts to collect. Apparently sending them your full insurance coverage information is a failure to respond. I’m now waiting to see whether they’ll accept the payment — and undo any damage they’ve done to my credit rating. All this over a sprained foot.

Apparently I’m not alone. A new study, small but clear, finds that patients who must seek care out-of-network regular face bills far larger than they should be.

Four themes characterize the perspective of individuals who experienced involuntary out-of-network physician charges: (1) responsibilities and mechanisms for determining network participation are not transparent; (2) physician procedures for billing and disclosure of physician out-of-network status are inconsistent; (3) serious illness requiring emergency care or hospitalization precludes ability to choose a physician or confirm network participation; and (4) resources for mediation of involuntary charges once they occur are not available.

In plain English, that means that the system is opaque, the billing procedures and prices are all over creation, and people who have no choice but to seek care are mercilessly dunned for the money.

via Patient Experiences with Involuntary Out-of-Network Charges.

Image: Dark Alley, by deryckh, via flickr. LicenseAttributionShare Alike Some rights reserved

See also:

Actually, Mr. Brill, Fixing Healthcare Is Kinda Simple

Bitter Pill: Why Medical Bills Are Killing Us – TIME

Ezra Klein – America spends way, way, way more on health care

Health-Care Secret Revealed, Again: More Is Not Better


10 responses

  1. “… when I had to take my daughter for a simple x-ray after she hurt her foot while we were vacationing. The x-ray was negative, but the charges — for a simple 3-view x-ray, an Ace bandage, and a pair of crutches — were over $4,300.”

    $4300 is certainly an excessive charge for an emergency room visit for a sprained foot. But your first sentence contains many clues that tell us why the cost of emergency care is so excessive.

    1. Why did you feel you were taking your daughter to the emergency room for an x-ray? Most people with closed injuries to the foot do not require an x-ray according to extensive medical research. Nevertheless, this research is ignored and most people coming to the emergency room for an injury to the foot do get an x-ray because that is their expectation. Patients no longer have the mentality that they are coming to the emergency room to be evaluated by a doctor. They have already made up their minds what their treatment will be.

    2. The charges were for an x-ray, an Ace bandage, and a pair of crutches. Did these items all miraculously appear and apply themselves without human intervention? No technician to place the bandage and provide crutch walking instructions? No nurse? No radiologist to read the x-ray? No emergency room physician? Believe it or not, these people do not work for free. They have all trained extensively and made many sacrifices to be in position to attend to your daughter’s sprained foot.

    3. Emergency departments need to aggressively pursue billing because they are legally compelled to provide services first without considering the ability of the patient to pay. Believe it or not, a large proportion of patients are uninsured and never pay their bills. Government insurances like Medicaid and Medicare pay pennies on the dollar. Private insurances negotiate for low cost care. The losers are uninsured patients who believe in paying their bills or have reason to maintain their credit ratings, and patients whose insurance isn’t covering their situation (out of network). Those situations aren’t the fault of the emergency departments, who have to charge high rates to paying customers in order to compensate for all of those who aren’t paying.

    If we prevent emergency departments from billing sufficiently to cover their expenses and maintain some degree of profitability, then you’re going to see private emergency departments start to disappear. State-run facilities can and will lose money indefinitely and their operational funds will come out of your taxes rather than your medical bills. Then you’ll have your choice between the local inner city county hospital ER or putting your injured foot up on a pillow overnight with an icepack, and taking Motrin for a few days.

    • Thanks for writing. My fuller account of this episode is at the link in the article, and it answers most of your questions. But the brief answers are:

      – Why did I take my daughter for an x-ray? We were out of town, and I took her to an urgent care facility that turned out to be an ER. I did so because she was in great pain, could not walk, had swelling — and my father, a retired surgeon with 40 years experience, advised I do so in case either foot or ankle was broken.

      – No the materials did not appear out of thin air. We occupied about 30 minutes total of staff time: 5 minutes at intake and outgo, 10 minutes with the very kind x-ray technician, and 10 minutes with an MD. That hardly justifies the sort of costs levied. And in fact, the MD’s time was billed separately, at just under $400. So the hospital’s bill was for … what? Their statements were indecipherable. For details, see the full story at I addresses many of your concerns.

  2. A child in need of emergency medical care is the text book example of a vertical demand curve. There is nothing you wouldn’t pay.

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