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Patients Being Hit With Monster “Balance Billing” from Hospitals


[DIGEST: HuffPost, Times-Picayune, Star-Telegram, Dallas News, Slate]

Going to the emergency room? Even with insurance, you may still get hit with shocker bills. A practice called balance billing allows hospitals to overcharge for services, leaving the patient to cover any amounts their insurance company considers excessive. Hospitals often contract with third-party staff or service providers, causing unsuspecting patients to be charged out-of-network prices for services at an in-network facility.  

Uninsured patients can expect even worse — hospitals typically charge uninsured emergency room patients four times what they charge Medicare for the same service, according to a nationwide study published in the JAMA Internal Medicine.

The study examined charges by 12,337 emergency medicine physicians and 57,607 internal medicine physicians based in the same 3,669 hospitals. “It points to the practice of price gouging by hospitals because patients often can’t pick their doctors in the emergency department,” said Dr. Tim Xu, lead author of the study, conducted at the Johns Hopkins School of Medicine.

Xu’s team found significant disparities in pricing, depending on the patient’s insurance status, location, economic status, and race.

  • Hospitals routinely charged patients twice as much as the Medicare allowance for the same internal medicine services procedures within the same hospital.
  • Charges for services performed in the emergency room were typically 4.2 times higher. Some hospitals charged up to 12.6 times more.
  • Uninsured patients or people treated outside their insurance company’s preferred network were charged seven times the Medicare payment to repair a cut, six times more for interpreting an electrocardiogram to check heart function, and 5.4 times more to insert an intravenous tube.
  • An uninsured patient could be expected to pay from 1.6 times more to as much as 27.7 times more to have an emergency department read a CT scan of the head.
  • For-profit hospitals charged the highest markup on emergency department services — an average of 5.7 times the Medicare allowance.
  • Hospitals in the southeastern United States charged prices that were 5.3-fold higher than the rest of the country.
  • Hospitals serving a large African-American population or a large proportion of uninsured patients charged more than average, at five times the Medicare rate.

Even when a patient has insurance, they could get stuck with the portion of the bill that their insurance company considers excessive. Some states have consumer protection laws that

To read more, please continue to page 2.

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