By Clifton Leaf
March 7, 2018

Hello Dailies. Happy Wednesday. STAT News has a good op-ed today from an ER doc who let her health insurance lapse between jobs. Then she got pneumonia.

The story—a quick one—details what happens next: a $10,282.34 bill for emergency treatment after she put off care for too long.

“Although I was previously aware of the many social circumstances affecting my patients’ access to care and the circumstances contributing to their overall health,” writes Jessica K. Willett, a California physician, “I’m now able to relate to it on a more personal level. Now when I ask the question, ‘Why did you wait so long to see a doctor?’ I can also say, ‘Yes, I absolutely understand why.’”

But as satisfying as the commentary is from a “Hey, now I get it,” point of view, it also raises another oft-raised issue: Why was that ER bill $10,282.34 to begin with?”

Among the detailed charges are a $30.13 expense for an “Ibuprofen 600 MG tablet” and a “routine venipuncture” (translation: blood draw) for $353.00. One of the more astounding charges is for a “Hydrate IV Infusion, Add-On” (an extra bag of saline solution), for which the hospital billed a ridiculous $342.00. For comparison, in the state of California, Medicare pays between $16 and $20 for the same exact thing (see billing code: 96361).

Hospitals often defend such outrageous charges with the equally outrageous argument that traditional payers (insurers and Medicare) don’t actually pay those prices. But some people do get stuck paying them. And tellingly, even insurers are fighting back.

This week, UnitedHealth Group, the country’s biggest health insurer, said it would review and, if necessary, adjust “facility claims for the most severe and costly ED visits for patients enrolled in the company’s commercial and Medicare Advantage plans,” the trade publication Modern Healthcare reported today. This follows the far more severe (and widely discussed) move by another insurer, Anthem, to deny claims (in certain states) for emergency room care that are later deemed not to be emergencies. That radical policy shift has been sharply criticized by many, including by physicians and some lawmakers.

Still, it’s not hard to see why insurers don’t feel somewhat aggrieved by such routinely sky-high medical bills, just as the rest of us do. No, the answer isn’t to deny care—or to adopt policies that discourage it.

But it also doesn’t make sense to talk about our runaway national healthcare bill…without mentioning the bill itself.

Clifton Leaf, Editor in Chief, FORTUNE


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