Week 5: The Hospital Bill Arrives (A.K.A. Why You Can’t Shop for Health Care)
by Sharon Tjaden-Glass
One of the major talking points of Republicans about their plans for replacing the Affordable Care Act is that…
“It will encourage Americans to shop around for their health care.”
To which I say…
“Shopping around” for health care isn’t a thing in the United States.
You cannot shop around when you don’t know the prices ahead of time.
I mean… Duh.
(You also cannot shop around if there is only one hospital in your area, as is true for all Americans who live far from larger cities.)
If we’re “consumers” of health care, shouldn’t we have the same amount of information that we have when we are consumers of cars or computers, or even breakfast cereal?
But we don’t.
We often don’t know how much our health care costs until we tear open the bill that finally comes to our mailbox weeks later.
Before we had this baby, I tried to figure out about how much it was going to cost us out-of-pocket.
You know. For budgeting.
For planning our Flexible Spending Accounts.
You know. Because we want to be responsible. Because we want to make sure we’ve saved enough money to cover our health care costs.
We’re not in poor health. We don’t have pre-existing conditions. We’re fairly young. We’re gainfully employed.
Republicans should love us. Any plan put forth by them should definitely benefit us right? We’re kind of what they had in mind for good American health care “consumers.”
But the truth is you can’t blame “consumers” for the complicated mess that is the health insurance industry, nor can you blame them for the high costs of health care. You can’t tell Americans to just save their money and choose wisely.
I tried that approach and it didn’t work. Not because I didn’t try hard enough, but because the system is not designed to be transparent to patients.
The patients are an afterthought.
Our health insurance provider had some estimates for the costs of giving birth in the two main hospitals where I live. These costs were based on their negotiated rates for medical procedures with those hospitals.
But they were just estimates.
So I called the hospital’s pricing line, staffed by the billing department, for a more precise answer.
First, no one picked up the line. It went straight to voicemail. Over and over again.
So I left a message.
Someone called me back the next day.
When I asked the billing department’s representative about specific prices for having a baby at their hospital, he said that he couldn’t give me any prices.
The pricing line. Couldn’t give me any prices.
So I got specific. I told him that I would be giving birth in the birthing center that is attached to the hospital, where I would be rooming in with my baby 24/7. So we wouldn’t be using the nursery. Would we be charged a fee for the nursery? I asked.
“Yes,” he said.
“Why?” I asked.
“Because it’s available to you.”
“So how much will the nursery cost us?”
“I can’t quote you a price on that. It all depends on your insurance and how long you stay.”
“But don’t you have average prices for average stays? Anything?”
“We have a price sheet you can look at, but it’s not going to be inclusive of all of your expenses.”
“I’ll take whatever you have,” I said.
So he referred me to this pricing list, published on the hospital’s website. Why he didn’t give this to me at the beginning of the phone call, I’ll never know.
Indeed, these charges showed up on my insurance claim for the birth.
But so did this mysterious $3500 charge. And a boatload of other charges that are all labeled “Ancillaries” and have no identifying characteristics other than a medical code that only medical transcribers can interpret.
I mean, really. Don’t I deserve a little more information than this? If we’re going to pay $1800, I’d kind of like to know what it pays for.
So I wait for the hospital bill to show up. Maybe they have more information than my health insurance company.
From this bill, I can see that the ambiguous $1850 charge on my insurance claim is actually for the “Recovery Room.” But the other charges?
Who can tell?
The underlying message here is,
Please just accept this price. Your insurance company and the hospital have already decided on a negotiated rate and it’s really just best that you accept this price, pay it, and move on. See how expensive this birth was? You’re lucky that your insurance company is paying so much. So just suck it up and pay. There’s no free lunch, Friend.
I’m not the only one who has a problem with this.
“Childbirth is the number one reason why people go to the hospital,” reports Vox’s Johnny Harris in this well-researched video on this very topic. He finds that prices for uncomplicated deliveries in the United States vary from $1189 to $11,986.
I have to admit, I am slightly jealous that their out-of-pocket expenses were only $841.
But who am I kidding? Many, many Americans now have deductibles as high as $6000 now, making my $1000 deductible seem enviable.
The truth is that knowing the costs of this birth would have been helpful for me and my husband, but it didn’t break our bank. We earn enough money jointly that we can absorb a financial blow like this.
But what about the millions of Americans who can’t save $5000 to have a baby in a hospital?
What about those Americans who are “too rich” to qualify for Medicaid, but not rich enough to afford any kind of useful health insurance plan? One that doesn’t deter people from seeing the doctor simply because of the cost?
So politicians, quit telling people that they should learn how to make wise choices so they can save for their health care costs.
And quit telling people that they should “shop around” for their health care costs.
Not only is it demeaning, but often it is completely impossible.