Total healthcare spending in the U.S. hit $3.5 trillion in 2017 and about 32% of the total, or $1.1 trillion, was spent on hospital services. Patients around the country are getting stuck with enormous medical bills as hospitals continue to mark up the cost of their services, including those for routine medical procedures and advanced surgeries. Costs range widely from facility to facility, but one thing remains clear: Getting care isn’t cheap.
For many patients and families, rising medical bills can be a nightmare. 79 million Americans have medical bill or debt problems. A small mistake or a tragic accident can result in thousands of dollars or even hundreds of thousands of dollars in medical debt.
Let’s explore some of the craziest medical bills over the last few years and why so many hospitals continue to inflate the costs of their services.
$14,018 for Stitching a Hand Wound
After accidentally cutting his hand while chopping vegetables, Owen Davis received a $14,000 bill for getting stitches. The hospital charged United Healthcare $3,523 for “rearranging skin tissue” and $4,560 to repair Davis’ skin tendon, even though his tendon wasn’t harmed. The hospital also charged United Healthcare $5,935 for a skin graft from his face and neck, which Davis claims never happened.
In the end, United Healthcare paid the bill after negotiating it down to a modest $4,500.
$108,951 for a 4-Day Hospital Stay
Drew Calver, a schoolteacher from Austin, TX, suffered a heart attack in 2017. He ended up staying in the hospital for four days and came out with a bill for over $100,000. Even though he had insurance at the time, he was forced to pay the bill out-of-pocket, thanks to a practice known as “balance billing,” which is when healthcare providers and insurers fail to come to an agreement on how much they should pay for the hospital’s services. In the end, the patient is forced to make up the difference.
Currently, six states have comprehensive laws that protect consumers from balance billing, while 15 states have partial protections in place. 29 states have no balance billing protections in place, which could spell disaster for patients in these areas.
$454,000 for Heart Bypass Surgery
Debbie Moehnke of Washington went to see a doctor for her swollen feet when she suffered a massive heart attack. She was immediately rushed to the hospital for stabilization, and then, the next day, to Oregon Health & Science University for urgent cardiac care. She soon underwent heart bypass surgery. One valve needed to be replaced and one repaired. Overall, she spent a month in the hospital recovering from surgery.
When she was finally discharged, her medical bills totaled nearly half a million dollars. While her insurance company paid around half of the total, she was on the hook for $227,000, another example of balance billing.
Afterward, she commented on the ordeal, “I wish I would have known. I would have said ‘no’ to life support. We’ll lose everything.” Washington continues to try to pass a bill protecting consumers from balance billing, but banning the practice has proved elusive.
$4,300 for an Inner Ear Infection
In 2017, Kimberly Fister-Mesch woke up with a pounding head, and OTC painkillers weren’t helping. With her blood pressure spiking, she thought she was having a stroke and immediately rushed to the closest hospital. As it turned out, she was suffering from bacterial mastoiditis, an inner ear infection. With more painkillers and a prescription for antibiotics, Fister-Mesch was on her way home.
Weeks later she received a bill for $4,300. Her insurer, Anthem, refused to pay the bill because her condition failed to meet their standards of an emergency. The company told her she should’ve called the insurer’s 24/7 online doctor service, gone to her local doctor’s office, or used an urgent care center instead.
Fister-Mesch wasn’t aware that Anthem had changed its emergency care policies when she went to the ER. She also had no idea what was causing her pain, which made it essentially impossible for her to know whether her condition qualified as an “emergency.”
Why Are Medical Bills So High?
Costs tend to vary dramatically from facility to facility and from patient to patient. If a patient visits a facility that’s out-of-network, their insurer may not cover the bill. Yet, if a hospital uses an out-of-network doctor, patients may have to pay the bill out of pocket, but knowing which doctor or surgeon is in which network isn’t exactly realistic for many patients, especially when they’re in the middle of a medical emergency.
On average, all U.S. hospitals charge patients (or their insurers) 3.4 times what the federal government thinks these procedures cost. Some facilities mark up their prices more than others. For example, North Okaloosa Medical Center in Crestview, FL charges 12.6 times, or 1,260 percent, more than what it costs the hospital to treat patients.
Hospitals tend to inflate costs as a way of making up for other expenses, such as branded medications, administrative salaries and fees, medical equipment, and even marketing costs.
Patients can use the following strategies to reduce their medical bills or avoid being denied coverage:
- Use price comparison tools to avoid overpaying for care.
- Avoid going to the ER unless someone is unconscious, bleeding heavily, not breathing, or they have what looks like a broken bone. Patients should avoid going to the ER if they’re not sure what’s wrong with them or their injuries don’t appear to be life-threatening.
- Spend time asking questions before agreeing to treatment, such as, “Is this procedure covered by my insurance?” “Are there any alternatives?” “What are the risks of going without?” and “How will I pay the bills if the price is higher than expected?”
- Appeal the claim denial from the insurance company. Patients can talk to their doctors and those who treated them to learn whether the procedure was medically necessary.
- If the appeal is denied, patients can negotiate with the facility’s billing department to get a lower price. They can also use price comparison tools to negotiate down the price of care.
Everyone deserves access to healthcare without spending a fortune out of pocket, but the American healthcare system remains complex and opaque for many patients. Everyone should understand what’s covered by their insurance policy and what isn’t before seeking care.