Last summer, Matt Anderson cut his finger on a knife while doing dishes. He’s a college student, and his roommate, a biology major, suggested that he go to the emergency room. He had recently used the same knife to cut raw meat and thought Anderson’s finger might get infected.
Anderson estimates he got to the emergency room around 11 pm. A nurse saw him shortly after midnight and cleaned his wound. A doctor came by a little later to apply liquid stitches to his finger. Anderson went home around 1 am.
“I saw a nurse for maybe five to 10 minutes and a doctor for maybe five minutes tops,” he says.
A few months later, the bills arrived at his parents’ house: $2,782 in total.
One reason the fees were so high? Because the clock ticked past midnight as Anderson waited to see a doctor, Tri-County Emergency Physicians (the doctor group that appears to staff the emergency room) billed his insurance for two days rather than one. The rest of the bill came from Chestnut Hill Hospital, which owns the emergency department.
Neither provider responded to repeated emails and phone calls requesting comment.
The hospital bill has gone into collection, as Matt’s father, Todd Anderson, attempts to negotiate for a lower price. Their insurance plan has a $4,000-per-person deductible, which means the family is responsible for the entire thing.
“My son is 19, he’s trying to do everything right and build his credit, and now I’m worried this will go against [him],” Todd says. “He still feels very guilty right now. He told me he has 25 meals on his card for the semester, and maybe he could use those to get some money to pay for it.”
Many Republican health care plans to replace Obamacare emphasize the role of consumers’ shopping for the best health care deals as a way to rein in health care spending.
“People will tell you Americans won’t shop for health care. We’re the best shoppers in the world,” Rep. Phil Roe (R-TN), co-chair of the GOP Doctors Caucus, says. “We’ll drive across five lanes of interstate to get cheaper gas. I’ve learned how to shop, and people will learn how to do that.”
The Andersons’ story is a cautionary tale in how difficult it is for patients to shop for care in a health care system that rarely reveals its prices. It shows that significant reforms in price transparency would be absolutely crucial to making such a plan work.
A $2,782 bill for a 20-minute emergency room visit, explained
The Anderson family has received two separate bills for Matt’s emergency room trip. One was from the hospital itself, Chestnut Hill Hospital. That one was initially $1,036, but their health insurer negotiated a discount, bringing the price down to $772.
That first item — a $704 charge for a “limited ED visit” — appears to be what hospitals typically refer to as a facility fee, essentially the price of walking in the door of an emergency department.
Hospitals charge facility fees to cover the cost of keeping an emergency room open at all hours. Hospitals need to be ready “every day of the year, and stand ready to treat whoever walks through our door, be it a gunshot victim or a patient with a stroke,” John Murphy, chief executive of the Western Connecticut Health Network, wrote in defense of his hospital’s $622 facility fee, which Vox reported on previously.
But facility fees can often be quite hefty, as in these cases — and rarely provided to patients before they receive medical care.
“I called the walk-in clinics in the area after, who said they would have charged $150 or $225 for something like this,” Todd Anderson says. “I wish they would have said, ‘You can get treatment elsewhere,’ [and] explained how much it was going to cost.”
An extra $873 charge because the clock ticked past midnight
The Chestnut Hill Hospital bill was high, but on its own, Todd Anderson says he wouldn’t have been as angry — he probably would have paid it and moved on. What baffled him the most was a separate bill his insurance received from Tri-County Emergency Physicians, a group the hospital appears to contract with.
This group sent the Andersons’ insurance a bill for $1,746, which includes two $873 fees. Anderson says when he asked Tri-County why it was billed twice, the group said it was because the visit stretched over two days. There was the hour between 11 pm and midnight on one day, and the hour between midnight and 1 am on the second day.
The group did not respond to my phone calls, but the claim that Tri-County Emergency Physicians filed with the Andersons’ health insurance backs this up.
“I called them and said, ‘You double-billed me for one day, and the hospital already charged me for that day,’” Todd Anderson remembers. “It was a three-minute procedure. That can’t possibly be correct.”
So far, he says, he has had no luck getting the price lowered.
Obamacare tackled some problems in the health care system — but not this one
The Affordable Care Act largely focused on expanding access to coverage, and on that measure, it has been successful. About 20 million more people have health insurance as a result of the health overhaul.
But the law stayed away from any sort of price regulation — or even price transparency — that would have prevented a situation such as the one the Andersons experienced. These types of bills are still completely legal in the American health care system. This is very different from international hospitals, where how much they can charge for specific procedures is regulated by government.
“The ACA did a great many things, but it didn’t do anything with costs,” says Renee Hsia, an expert in emergency medical billing at the University of California San Francisco. “You can imagine the hospital associations lobbying against that. It’s not in their interest to change the system even though it’s dysfunctional.”
High prices are at the core of one of the main critiques of the Affordable Care Act: that the premiums and deductibles are so high. It’s big bills like these that drive up the cost of insurance, encouraging insurers to shift more of the costs onto patients.
Recently, some experts have begun to argue that any health care effort from Republicans or Democrats will struggle to succeed if it doesn’t take steps to eliminate bills like these.
“You cannot do this without focusing on price,” Bill Hoagland, who spent decades working for the Senate Budget Committee, said at a recent event hosted by the Kaiser Family Foundation. “It is the cost issue that drives us crazy. I don’t know how Republicans put together a package that reduces the deficit that doesn’t focus on price. Doctor costs, hospital costs — that is where we have to focus our attention.”