In case you missed it, a new analysis of U.S. medical bills has found hospitals typically charge uninsured emergency room patients four times as much as they’d take from Medicare for the same service.
What’s more, the study published in JAMA Internal Medicine found that ER patients routinely pay more than twice as much for healthcare services as they would be charged had they been performed in other parts of the hospital.
The research, by the Johns Hopkins School of Medicine, involved an analysis of charges by 12,337 ER physicians and 57,607 internal medicine physicians at 3,669 hospitals. Among the key findings:
- For a $100 treatment in the ER, some hospitals were charging patients up to $1,260.
- Internal medicine services for ER patients without insurance were typically charged 4.2 times more than what Medicare would pay, with some hospitals charging 12.6 times more.
- Patients treated at facilities outside their insurance company's preferred network were charged seven times the Medicare payment to repair a cut, six times more for an electrocardiogram to check heart function, and 5.4 times more to insert an intravenous tube.
- An uninsured patient could be charged up to 27.7 times more than a Medicare recipient to have an emergency department read a CT scan of the head.
- Costs for services can vary widely, depending on the doctor providing the service. For instance, hospitals typically charged patients $62 to read an electrocardiogram if it was read by an internal medicine physician and $96 if it was read by an emergency department physician. (For comparison, Medicare would pay $34 for a healthcare provider to read an electrocardiogram.)
- Even when a person has insurance, the patient is responsible for at least part of the bill that carriers won’t cover — a practice known as balance billing. Only a few states, such as New York, ban the practice of issuing these "surprise medical bills."
The researchers noted medical bills are the leading cause of bankruptcy in the U.S. and that hospital ERs may take advantage of the fact that Americans usually can't plan for an emergency.
Bill Kampine, co-founder and senior vice president of Healthcare Bluebook, which provides healthcare price and quality comparison tools for consumers, tells Newsmax Health the study findings are troubling but hardly surprising.
“No, the difference [in ER charges] is not surprising — and the impact on patients is not limited to ER visits,” he says. “The difference between Medicare rates and the amount that uninsured patients are billed for services like MRIs or outpatient surgeries can vary by well over 10 times.”
But the reasons for such charge variations are many, Kampine explains.
One factor: “cost shifting” — where paying or insured ER customers are charged more for services to cover for those who lack insurance, or pay less or nothing.
Another: Huge differences in what various healthcare facilities charge for their services — most of them without disclosing those costs upfront, leaving consumers in the dark until they receive the bill, sometimes weeks or months later.
“The reason is in partially cost shifting — but a more significant factor is the historic lack of price transparency, and consumers not knowing that they should ask the price before receiving care,” says Kampine.
“Hospitals and other providers have an amount they charge for a service. This amount is called the billed charge, and it is almost always a very large amount — and frequently an amount that is unrelated to the actual cost of providing the service.”
Patients who are covered by Medicare or commercial insurance, and use a preferred in-network provider, usually pay an amount significantly less than the billed charges.
This is because Medicare and Blue Cross Blue Shield negotiate large discounts off the billed charges on behalf of their members.
“Because Medicare is the largest insurer in the U.S., they get the best (lowest) rates with providers,” says Kampine.
But Americans without insurance are at the other end of the spectrum.
“Uninsured consumers, who many times don’t stop to ask the price before receiving care, are frequently asked to pay the high billed charges,” he notes.
So what can you do to combat an inflated ER bill? Kampine offers the following tips and advice:
Negotiate costs before receiving care. Savvy consumers can avoid large or unexpected charges by asking ahead of time what they will pay for ER, and haggling for a lower price.
Compare prices. Healthcare Bluebook’s Website posts customary and fair prices providers accept from commercial payers for hundreds of healthcare services by region of the U.S. “Uninsured consumers can look up the fair price on Bluebook and offer to pay that amount to the provider,” he says. “[Or] if the bill is significantly higher than the fair price, then they should consider negotiating the bill with the provider.”
Offer cash. “Many providers offer additional discounts for consumers who pay cash at the time of service,” he says.
Don’t pay for ER care right away. “Not automatically,” he advises. “As a first step, an uninsured consumer should carefully review their bill to make sure the services are accurate.”
Ask about insurance rates. “Consumers can … ask the provider what Medicare or Blue Cross Blue Shield typically pays for the same service,” he suggests, advising patients use that information to negotiate a lower price.
For more information: Healthcare Bluebook provides price and quality transparency tools for consumers, provider organizations, and self-insured employers in all 50 states. Consumers access the organization’s Website, or download the free app for iPhone and Android.
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