Houston Chronicle by Jenny Deam April 17, 2019
Six months after the fact, Christine Jaschinski was still fighting a $4,223 charge for seven stitches. During the phone call, a billing clerk casually let something slip:
“Yes, I know it’s expensive,†Jaschinski said she was told, “but if you pay up-front it would be less.â€
As it turned out, the difference may have been as much as 20 times.
Jaschinski had just fallen into the black hole of medical pricing, where billed charges make little sense and the true cost of treatment remains unknowable to the public and even to doctors who provide it.
Hospitals, out-patient centers, medical practices and free-standing emergency rooms spit out a number —the initial billed charge— which is often many times more than what they expect to collect, say health policy experts. What facilities eventually get paid often bears little resemblance to the original charges, varying wildly from patient to patient and venue to venue for the exact same treatment.
Hospitals and other health care facilities acknowledge wide price differences, but say there are too many variables —from market forces to ever-changing insurance contracts — to make apples-to-apples comparisons of medical charges. “You can’t have a discussion in binary terms,†said Lance Lunsford, the chief marketing/business development officer for the Texas Hospital Association.
Still, the lack of price consistency can trap unsuspecting patients into paying too much — if they ever find out. It also hinders efforts to lower the nation’s health care costs since the system is shrouded in secrecy.
“We don’t have a particularly unified or rational way of finding out what the value of health care is in this country,†said Christen Linke Young, a fellow with the USC-Brookings Schaeffer Initiative for Health Policy, a research partnership between the Brookings Institution and the University of Southern California. “Billed charges are effectively just made up.â€
$600 a stitch
In Jaschinski’s case, The Woodlands woman thought she was so careful in picking a place for the couple’s medical care. She liked America’s ER because it was near her home, seemed efficient and, best of all, offered both urgent care for routine treatment and emergency room service for more serious care. It also accepted their insurance.
When her husband, Wolfgang Faust, sliced his thumb while cutting drywall in November 2016, she double-checked insurance coverage and asked for urgent care because the wound was not serious. The doctor closed the cut with seven stitches, gave Faust a Tetanus shot and told him to come back later to remove the stitches.
There were four separate bills from the facility and doctor — the initial visit designated an emergency — totaling $4,223, which was charged to the couple’s Cigna plan. The insurer paid about half, leaving them to pick up the rest, she said.
After the billing clerk’s remark about paying upfront, Jaschinski went to the facility and asked the staff. She said she was told if she had paid cash and not used her insurance, the price for urgent care would have started at $200. For emergency treatment, the cash price would have started at around $700.
America’s ER said in an email Friday it could not comment on this specific case due to privacy laws, but it “does not have a policy of charging insurance companies drastically more than either uninsured patients or patients that opt to pay for the services rendered in cash, by credit or any other means other than their chosen insurance plans.†Further, the company said it does not balance bill patients, strives for price transparency, and determines its fees using Fair Health, a national pricing benchmark based on treatment and location.
To this day, Jaschinski has no idea what those seven stitches were worth. “The prices are just fiction,†she said. After fighting for more than a year, she finally paid about $1,500 to settle the bill.
More:
https://www.houstonchronicle.com/business/article/It-cost-what-Medical-pricing-shrouded-in-13781730.php
