Introduction to Medical Price Roulette
Nobody really knows what costs in the healthcare system, and too many people get surprising medical bills for thousands of dollars. In a new series, CBS News will examine the reasons and work with journalists at Clear Healthcosts to bring transparency to the health markets.
A Personal Story of Surprise Medical Bills
Frank Esposito says it started with relentless back pain last March. He could hardly move, and an MRI soon showed a herniation in his spine. A specialist asked him to go to the closest hospital immediately. Doctors in the emergency room said that he had to operate. The herniation was so serious that it could cut his nerve, said Esposito, and paralyze him. The operation was a success, but then the bills came: a total of over $650,000. His insurance company said that his back surgery was not qualified as an emergency and was not medically necessary.
The Lack of Transparency in Healthcare
According to a survey by Kaiser Health from 2018, half of the people who received a surprise medical bill last year were charged over $500. Dr. Aaron Carroll, a pediatrician and healthcare expert, says that there is no transparency in healthcare. "This is someone who has pain that is immobile, and now it has been said: ‘Ok, they could be paralyzed unless they run to the hospital.’ How should you become good buyers and make complex, rational decisions?"
Variations in Medical Procedure Costs
Even if it is not an emergency, CBS News and Clear Healthcosts have found that there are surprising swings in what a procedure or test can cost. A simple blood test in the Dallas-Fort Worth area was between $10 and $176, and between $15 and $126 in San Francisco. An ultrasound of the abdomen in Dallas was between $115 and an estimate of $2,459. The same procedure was between $100 and $2,800 in the Bay Area.
Cash Prices and Insurance
While not everyone pays a cash price, especially those with good insurance, cash prices reflect what the provider will accept. "Plans will have different deductibles, different co-insurance, different numbers of additional payments," said Carroll. "And of course, it also depends on what you calculate – what the price is and how much you are responsible for this price. This number has become much higher than people would think. It can be an essential part of people’s income."
The Consequences of Surprise Medical Bills
Carroll added: "I think people have an assumption, right or wrong, that the insurance will protect them. Therefore, if we pay so much, we think we are covered and we will not see this surprise calculation. So if they do, people are shocked." Esposito has already drafted $49,000 from his retirement provision. He commissioned a company to negotiate some of his bills. According to an appeal, the insurer of Esposito, Oxford United Healthcare, paid some invoices from his doctors. But he still owes $220,000.
The Need for Transparency and Affordability
Esposito said, "You work all your life. You are working on buying a house. You are working on having a house. You have to save for everything. We want to know that we can go to the doctor, that we can get well, that we can deal with it without losing everything we have." The issue of surprise medical bills highlights the need for transparency and affordability in the healthcare system. Patients should be able to make informed decisions about their care without facing financial ruin.
