Monday, March 11, 2019


Case 1: On March 1, ABC News reported the story of a Florida woman bitten by a stray cat she was trying to help. Having heard about rabies in stray animals, she went to the closest emergency room, where she got her first rabies vaccine and was also given an injection of rabies immune globulin, designed to protect the victim before the vaccine takes hold. She also later got a bill for $48,512, of which $46,422 was for the immune globulin. The product is not in particularly short supply and is available from three manufacturers and the average price paid by hospitals for the dose she got would been about $4334.
Case 2: A posting on Kaiser Health News back in November epitomized much of what is wrong with health care in today's America. An English professor in the California state university system went to Stanford University's outpatient clinic for help with a rash that she thought might be due to a cream she had been prescribed. She had 119 tiny plastic containers taped to her back and ultimately learned that she was allergic to a variety of things, including the ingredient in her cream. All well and good until she saw that Stanford had billed her insurance company for $48,329! This included $848 for the time she spent with the doctor and $399 for each of the 119 small samples taped to her skin. The "usual and customary" charge in the San Francisco Bay area for this is $35 per sample.
Case 3: There is also the story I recount in Prescription for Bankruptcy about a man who was mugged and taken to the emergency department for attention. He was aware (and concerned) enough to check before being transported that the hospital to which he was taken was “in network” for his insurance. He had suffered a broken jaw and was taken to the operating room for repair. Weeks later he got very large bills from the oral surgeon and anesthesiologist who cared for him who were not in his insurer’s network.
These three cases cover most of the causes for surprise medical bills. The Florida cat lover was at the mercy of price-gouging by the hospital she went to for help. The California professor and her insurance paid astronomical prices to the prestigious hospital system that knows it can overcharge because they are in the driver’s seat. It is hard to sell a health insurance package in northern California that does not include the perceived leading hospital in the area. The mugging victim was victimized a second time because even when a hospital has signed a contract with a health insurance company, many of its doctors may not. This practice is particularly common among specialties where the patient does not really have much choice in who sees them: emergency physicians, radiologists, pathologists and anesthesiologists.
Hospitals are now required to post their charges on-line, but to date they have (probably deliberately) done so in the most abstruse manner possible, using obscure terms that most non-medical people find hard to read or search. Hopefully some clever people will soon come up with an app to make the search more user-friendly.
What can you do about these nasty surprises? For diseases – like rabies – with obvious public health importance, you may be able to get treated at your local public health department for free. DO NOT POSTPONE TREATMENT to save money. If your problem occurs on a Saturday, go to the ED.
You must get in the habit of asking the doctors assigned to you if they take your insurance. Do not assume that they do because they are affiliated with a hospital that does. If you get an obviously-inflated charge compared to what others charge, you are entitled to, and should ask for, an itemized bill to see why the total is so high. First take your complaint to the hospital administration and offer to pay a more comparable charge. If that is rejected, and you have employer-paid insurance, take the bill to your HR department and ask them to intercede. If that does get an acceptable result, go to your local newspaper or television station. It gives them material for a human-interest story and just may get the hospital to offer a lower charge. Use social media to try to shame the over-charger.

Prescription for Bankruptcy. Buy the book on Amazon


  1. Some patients also take advantage of the health care system as well and, in many cases, physicians bear the burden financially. For example, hospitals may get reimbursed by the states for free care patients from the free care pool but doctors do not. Many Medicare patients get Part A but opt out of Part B. Hospitals get reimbursed through Part A and doctors through Part B. Free care and Part A Only patients claim ignorance of their responsibility or inability to pay for doctors' services even though they chose not to get insurance coverage for the doctors' portion.

  2. Very few of those with Medicare A only have much in the way of financial resources. While there may be a rare person "gaming" the system, in 45 years of practice I don't think I met one.

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