Two patients with the same symptoms receive the same treatment at the same hospital.
Same bill, right?
Patient Patti Joiner learned the hard way that insurance isn’t health care when she visited a Texas emergency room along with her mother experiencing the same flu symptoms.
“Same doctor, same exam, same diagnosis, even the same room,” the Houston Chronicle reports. Patti had insurance. Her mother didn’t.
“My mom’s bill was only $300,” she recalled. “Why am I being charged $1,200?”
Yes, you read that correctly: the patient with health insurance paid a medical bill 4x higher than the uninsured patient. It gets worse: Patti’s mother had one extra test – a chest x-ray – while still receiving a bill that was just a fraction of hers.
Insured Double Whammy: High Premiums, Higher Medical Bills
Sky-high monthly premiums aren’t the only insurance burden on patients. Millions of patients with good insurance are discovering they’re paying more in out-of-pocket costs BECAUSE they’re insured.
Rather than lowering patient out-of-pocket costs, health insurance can increase a patient’s out-of-pocket costs whenever they visit a doctor, go to the emergency room, or fill a prescription.
“The whole point of health insurance is to reduce the financial burden on patients,” says Terry Wilcox, executive director of Patients Rising, a national patient advocacy non-profit that helps patients overcome insurance barriers to access. “Patients with great insurance are being charged more — just because they’re insured.”
Patti Joiner’s medical bill horror story isn’t an outlier. The Chronicle shares the story of Wolfgang Faust. After seven stitches, he received an outrageous $4,223 medical bill from his insurance company, Cigna.
His wife, Christine, did some investigating. If they’d paid cash – without going through insurance, the bill would have been about $700.
2017 Study: Insured Receive Medical Bills 10.7% Higher than Uninsured
Patient stories are supported by an independent analysis of medical bill data for millions of patient hospitalizations.
A 2017 study published in Applied Health Economics and Health Policy, which analyzed more than 4.7 million hospitalizations, found that patients with private insurance paid hospital bills that were, on average, 8.9 percent higher than medical bills for patients with coverage through Medicare.
The disparity was even greater when compared to patients without insurance. Patients with private insurance received hospital bills that were an average of 10.7 percent higher compared to those without insurance.
Again, it bears repeating: patients with insurance pay medical bills that are higher than Medicare and nearly 11 percent higher than patients without insurance.
Insurance Schemes: Secret Pricing, Kickbacks and Rebates
How is it possible? It all comes back to one core problem in health care: a lack of transparency.
“Billed charges are effectively just made up,” says Christen Linke Young, a fellow with the USC-Brookings Schaeffer Initiative for Health Policy.
Whether it’s hospital bills or prescription drugs, insurance companies and pharmacy benefit managers cut massive deals to receive kickbacks, write-offs, and rebates from health care providers.
“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,” writes Houston Chronicle reporter Jenny Deam. “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.”
Insurance companies, pharmacy benefit managers and other health care power players also go to great lengths to keep their pricing structures secret.
Of course, health care secrecy is one-sided – health insurance companies know exactly how much patients pay towards premiums, insurance deductibles and other out-of-pocket costs.
“The only way to bring down health care costs is to impose transparency in health care,” argues Wilcox of Patients Rising. “If your insurance company knows how much you’re paying for a procedure or treatment, doesn’t the patient deserve to know how much the insurance company is paying?”