A Johns Hopkins study of billing records for more than 12,000 emergency room doctors across the country showed a wide variance in prices. On average, adult patients are charged 340% more than the Medicare rate (amounts Medicare pays each facility for like services, plus the deductible and co-insurance). These rates are lower than in-network health insurance rates—which generally are contracted at 1.6-2.0 times the Medicare allowable rate. The study covered a wide variety of services from CT scans to simple stiches for a small cut.
A very distressing finding of the study was that most hospitals charged minorities and patients that are uninsured substantially higher rates, than commercial insurance and Medicare allowable rates. These huge disparities in emergency room prices poses a serious problem to millions in the U.S.
Surveys of both emergency room physicians and general internal medicine physicians’ charges were analyzed. The resulting service bills’ markup ratios were staggering: Emergency Room doctors had an average markup of 4.4 times Medicare allowable-while the Internists’ charges averaged 2.1 times Medicare allowable; less than half. However, due to a ubiquitous lack of patient-friendly regulation and unfettered and unrestrained greed—some emergency room physicians charged between 1.0-12.6 times what Medicare allows. ($1000-$12,600). This “gap” cannot be attributed solely to the quality of hospital or doctor performance (given the variations within each institution).Besides, who is thinking of that in the ambulance? This disparity cannot be explained by equipment used(a CT machine is a CT machine).Thus, presumably more so than any other hospital department, emergency rooms were guilty for charging up to 12 times more than what Medicare paid for the same services. There is a clear bias, however, toward for-profit hospitals charging more than non-profits.
The population affected most greatly by these practices are more likely to be located in the Southeastern and Midwestern U.S., serving a population of African-Americans and Hispanics that are uninsured. These uninsured patients are often charged FULL CHARGEMASTER rates. It gets worse. Once receiving a bill for services calculated at 12 times Medicare allowable, the billing departments are often aggressive about collecting amounts 8-12 times higher than from most other patients.
Often, the uninsured will receive no discount on their bill. (Several hospitals first seek to have the patient apply for financial assistance—and, if qualified, may receive discounts through that route). Some hospitals are terribly rigid, setting up roadblocks to negotiating reductions to this medical debt. Billing personnel will not even identify their last names. Managers are difficult to identify-generally not listed on the website. A more transparent, interactive approach could go a long way to addressing this problem. Some have a very “quick trigger” as to when to send a patient to collections. The effect that medical debt-particularly debt inflated to 10.0 times the pricing at a comparable facility can have negative life-changing repercussions. The uninsured bear the brunt of such practices –although certainly not alone. Forty-three (43%) percent of the population has medical debt listed on their credit report. Medical debt is the largest driver of individual bankruptcies in the U.S.
In 2003, the eighty (80) plus hospitals owned by Tenet was the subject of a lawsuit involving this precise topic—that was characterized as “Price-Gouging the Uninsured. To its credit, it softened its policy toward collections against those unable to pay; including discontinuing placing liens on the homes of such patients. Currently, it still offers automatic discounts for the uninsured in certain situations—with payment plans on discounted amounts (although its preference is to do so prior to the patient’s discharge).
The need for state and federal regulation to address hospital rates in order to protect patients becomes more pressing each day. If you have such an experience, write a letter to the hospital Administrator—copy its CEO and the state agency governing hospitals (despite that in some cases, it will not take jurisdiction of billing matters), call your congress person and senators(both state and Federal). Contact NPR and other news organizations. Silence will not result in change. Bringing this to the attention of those with decision-making authority might.
If you think you’ve been overcharged, or otherwise need help with your medical bills and health insurance matters– contact a Board Certified Patient Advocate at Human Health Advocates of Boca Raton, FL. WE ARE HERE TO HELP!