(Updated 2022) A friend writes:
“This year I underwent surgery to have my gall bladder removed. As a recent retiree, I decided to pay a little more attention to both the services I received and their cost. I am fortunate to have great insurance that I receive through my last employer. And I confess, that when I had open-heart surgery 6 years ago, I barely glanced at the bills that came in. I was gainfully employed and frankly, my co-pays were a pittance compared to the overall costs of the mitral and tricuspid valve repairs I received.
“Generally, I approach health care from the perspective of first acquiring the best care I can. I want doctors I am comfortable with, who listen to me, don’t order unnecessary tests, are proficient and who listen to me. I try to stay as local as I can because as a single woman living alone, travel for health care has complications. Though I confess, I went to the best mitral valve surgeon in the country when I had my OHS, regardless of where he was located.
“Anyway, back to the cholecystectomy. The whole thing, preliminary exams and test, surgery and post-op care cost about $15,000. Insurance paid about $8,000 and I paid $1,200. What surprised me the most is how much the insurance company adjustments amount to. They represent the discount to the negotiated prices the service providers agree to with the insurance company. The fact that they do this tells me that the initial charges have nothing to do with the actual costs to the providers. In essence the negotiated amount is about half the charges. So if I didn’t have insurance and was required to pay the entire amount, what would I be paying for? Someone else’s Cholecystectomy in addition to mine? Why is the charge more than the expected payment? What do these differences represent?
“It’s a mystery to me. But I think Clear Health Costs will unravel some of the tangles of these healthcare conundrums. I for one have learned that I need to shop around for my radiological procedures.”
My friend’s bills, represented here in the spreadsheet, occasioned a number of questions, especially the one about the abdominal ultrasound. She was charged $737, and insurance paid $318 — leaving her responsible for $285.43. We happen to know, though, that in New York the cost of an abdominal ultrasound can be around $150 many places (though it’s sometimes a lot higher), so this New Jersey charge seems high. We’re also confused that the insurer paid $318, more than many providers charge in the city, and she had to pay another $285.43. Not to mention the extra charge for reading. Truly, another $149.66?
Furthermore, the accounting is odd and kind of loosey-goosey. Take a look yourself, and tell us what you think.
Here’s a full post about how to argue over a bill.
Also, if you have a bill you’d like to send, drop us a line at email@example.com. Thanks!
(Update, February 2016: Here’s another post about gall bladder removal prices.)
Jeanne Pinder is the founder and CEO of ClearHealthCosts. She worked at The New York Times for almost 25 years as a reporter, editor and human resources executive, then volunteered for a buyout and founded ClearHealthCosts.
She was previously a fellow at the Tow Center for Digital Journalism at the Columbia University School of Journalism. ClearHealthCosts has won grants from the Tow-Knight Center for Entrepreneurial Journalism at the Craig Newmark Graduate School of Journalism at the City University of New York; the International Women’s Media Foundation; the John S. and James L. Knight Foundation with KQED public radio in San Francisco and KPCC in Los Angeles; the Lenfest Foundation in Philadelphia for a partnership with The Philadelphia Inquirer; and the New York State Health Foundation for a partnership with WNYC public radio/Gothamist in New York; and other honors.
Her TED talk about fixing health costs has surpassed 2 million views.