I’m a doctor and even I fell for this cunning medical bill trap every American should know about before going to urgent care
A doctor with almost 40 years of experience has raised the alarm after falling victim to a healthcare trend that is causing a tenfold increase in medical bills for some people.
Danielle Ofri, a family physician at Bellevue Hospital in New York, took her daughter to what she thought was an urgent care center in Chicago, hoping to get a quick X-ray after a bicycle accident.
Weeks later, she received a bill for $1,168 and discovered the clinic was owned by a hospital that paid hundreds of dollars in “facility fees.”
“It turned out that I had ended up in a lucrative corner of health care, the hospital outpatient clinics, or HOPDs,” she told the newspaper. New York times.
‘Because these facilities don’t necessarily look like hospitals, patients can easily be misled and face major financial surprises.
“I’m a doctor who works in a hospital every day, and I was fooled.”
Dr. Danielle Ofri was shocked when she had to pay $1,168 for a pair of $100 x-rays before discovering that the ‘urgent care center’ was in fact a hospital outpatient clinic
The share of medical practices in hospitals has increased from 29% to 41% in ten years
The hospital-owned clinics perform the same routine procedures as independent clinics, but are allowed to charge higher prices.
The average cost for a colonoscopy is $1,383 at a HOPD, compared to $625 at a doctor’s office, according to a National Institute for Health Care Reform study.
A knee MRI cost 50% more, chemotherapy twice as much, echocardiograms three times as much and prostate biopsies more than six times as much.
“Because they are considered part of a hospital, they are allowed to charge hospital-level prices for these outpatient procedures even though the patients are not as sick as inpatients,” Dr. Ofri wrote.
The cash cow has been eagerly jumped on by hospital groups who have mounted an aggressive buying campaign against previously independent clinics.
The share of medical clinics affiliated with hospitals has increased from 29% to 41% in the ten years to 2022.
In Maine and Ohio, four out of five medical bills for heart tests now sent to each state’s largest insurer include a facility fee, and a March report shows that many hospital systems now generate at least half of their revenue from patients that are not included.
Dr. Ofri cited the case of an elderly patient in Ohio whose bill increased 10 times for the same treatment by the same doctor after a hospital was allowed to charge for it.
“It’s one of the most egregious examples of hospital financing at the expense of consumers,” said Liz Hagan of the advocacy group United States of Care, which has investigated the trend.
HOPDs add hefty facility fees that charge an individual for use of the room in which he meets his doctor, to offset the costs of running a hospital
Some states have taken matters into their own hands. In Indiana, clinics outside hospital campuses affiliated with the largest nonprofit health care systems cannot charge fees
‘Hospitals are at the center of a large-scale market failure.
‘Ultimately, consumers have to pay the price – either through higher premiums, because hospital costs are built into the premium costs, or at the point of service delivery.’
Efforts to address this inequity have failed in Congress, despite fierce lobbying from the health care industry, which claims reimbursements are the only thing protecting hospitals from “substantial and unprecedented cuts.”
Dr. Ofri has almost 40 years of experience as a practitioner and warned that if she can get caught, so can anyone
“The cost of care provided in hospitals and health care systems – and any associated hospital-operated sites of care – takes into account the many unique services that only they provide to their communities,” the American Hospital Association shared. the guard.
“This includes the costs of maintaining standby capacity for traumatic events and providing 24/7 care to anyone who comes through the emergency department, regardless of payment options or insurance status.”
Some states have acted on their own initiative, including Indiana, which has rules that prevent clinics outside hospital campuses affiliated with the largest nonprofit health systems from charging fees.
Colorado hospitals, like those in 15 other states, will have to disclose their fees in advance to potential patients starting next month.
“It is time for Congress to protect patients from both unfair pricing schemes and healthcare fraud,” said Dr. Ofri.
“I was so outraged by having to pay hospital charges for two simple x-rays that I filed a formal complaint with the Illinois Attorney General’s office, which concluded that the billing was legal under federal law.
When I asked for official comment about my claim that the charges seemed outrageous and that the system felt deceptive, a representative from NorthShore University HealthSystem (now Endeavor Health) provided only a general statement.
Liz Hagan of the nonprofit United States of Care said hospitals are ‘at the center of a massive market failure’
“That read in part, ‘We understand that navigating the healthcare landscape, including billing, can be complex.’
‘After six months of fighting the costs, the hospital quietly canceled our bill.
‘I’m sure it calculated that this was the easiest way to get rid of an annoying patient, but that wasn’t what I was looking for.
“I wanted to untangle this loophole that catches patients unaware and saddles them with exorbitant bills.”