A year into our “Show Us Your Bills” campaign, 9Wants to Know continues to collect a paper trail of horror stories documenting the ongoing struggle Coloradans have with medical billing practices.
(We’re still interested in hearing from you at firstname.lastname@example.org)
It’s a struggle one Colorado businessman feels he can remedy one bill complaint at a time. He sees it as the first shot at a health care pricing transparency revolution. More on that in a moment.
Denton Anderson has known for a long time his body and mosquito bites don’t always play well together.
Sometimes, he admits, the reactions can be downright frightening. That’s what happened shortly before a friend of his convinced him to go to an emergency room.
“The swelling went from my wrist to my elbow,” he said.
So, yes, it was big.
But it didn’t take long for a doctor at an Aurora ER to tell him it really wasn’t going to be that big of a deal.
“Doctor said, yeah, that’s an allergic reaction to a mosquito bite. Take some Benadryl,” Anderson told 9Wants to Know.
Five minutes after the doctor walked in the room, Anderson was on his way out of the hospital.
A few weeks later, Anderson opened up the bill thinking he’d be responsible for a few hundred bucks. He was wrong.
“It said $2,160,” Anderson said. “So, yeah, that prediction of mine was not correct.”
More than $1,200 of it was his responsibility.
“Yeah, there’s something wrong there,” he said.
And Anderson isn’t the only one with a story to tell.
David Silverstein, founder of BrokenHealthcare.org, says the idea came to him upon examining an emergency room bill for his daughter.
It didn’t make much sense. The numbers seemed inflated. The lingo appeared indecipherable.
The more bills he examined, the more inquisitive he became.
Why would the hospital bill an ER patient at a Level III as opposed to a Level II or Level IV (There are five levels of care when it comes to billing practices inside American emergency rooms)?
Why are the negotiated rates so different? One bill he looked at showed a 95 percent in-network discount for a patient. Others showed discounts of less than 40 percent.
He even received a bill for another child of his, with one line simply reading, “TOES.”
“That people would pay a bill that just says, ‘TOES,’ is beyond me,” he said.
So a few years ago, he and his daughter decided to start fighting each and every bill they received.
It’s not that he believes the costs are too high.
“Medicine can be expensive,” he said. “But the fact that we have to wonder what the price is and get surprised after the fact is just crazy.”
Think of it like going to a grocery store in search of a loaf of bread. In the real world, you know how much any loaf might cost you, because there’s a price tag right under each one.
It doesn’t work that way in health care.
To take the bread analogy a step further, in health care the grocery store allows you to go in, take a loaf of bread, and often leave without paying a dime.
A month later, you open the bill. Maybe they want you to pay $3 for that loaf. Or maybe they want you to pay $300.
Silverstein calls that ridiculous.
So he’s now starting to tell people to question everything on their bills.
“That’s it. Deny payment. No negotiation. No middle ground. Either we’re going to get answers to our questions, or the bill isn’t going to get paid,” he said.
“We just have to say we’re not going to play by the rules of the system,” he added.
We consulted Colorado attorney and former employee with the Consumer Protection Bureau, Sarah Auchterlonie, on Silverstein’s idea.
“You have to realize there are repercussions,” she said.
Unpaid medical bills don’t just disappear.
“If you’re not paying, you’re technically in breach of contract,” she said.
You can be sent to collections. Unpaid bills will go on your credit report and could harm your credit score.
That’s not something to be taken lightly. “The cleaner credit you have, the better you are financially,” she said.
It’s also not unusual for people with unpaid bills to be taken to court.
Auchterlonie said she finds Silverstein’s idea intriguing, but says patients can better protect themselves without taking such drastic measures.
“The first thing you need to do is check your bill and look for anything the hospital didn’t do,” she said. Errors are not uncommon in bills. Estimates from various consumer groups vary widely from 10 percent to far more than half of all bills contain errors.
Auchterlonie said it’s up to the patient to ask questions.
“I think you need to be assertive. You have to press and ask for more and more detail to make sure you actually received the things they’re charging you for,” she said.
Silverstein admits he likes the idea of being a pain in the a--.
“I don’t think we have any other choice,” he said.
“I’m saying enough is enough. We’re saying we’re not going to compromise. We’re not going to take no for an answer,” he said.
In fact, Silverstein said he actually wants a hospital or provider to sue him.
“They’re going to have two choices. Walk away from the bill or file a lawsuit,” he said.
Why wouldn’t he be worried about a lawsuit?
Silverstein said a court just might give him access, through discovery, to the hospital’s chargemaster. Think of it like a pay sheet for every service or product a hospital offers.
Typically, no one pays the chargemaster rates as they simply represent, in rough terms, a list price. Insurance typically negotiates lower rates – sometimes much lower rates -- for patients.
Hospitals typically like to keep their chargemaster private.
“I want full transparency into pricing,” Silverstein contends.
The Colorado Hospital Association sent a statement to 9Wants to Know saying the association and its member hospitals “have long supported billing transparency.”
“A number of Colorado hospitals and health systems currently display pricing information on their websites and have fully supported other transparency efforts like the All Payer Claims Database and the Hospital Price Report,” the statement said.
To read the Colorado Hospital Association’s full statement, click here.
Patients like Zdenek Novak agree. Last year, he made sure everyone involved in an ACL reconstructive surgery was in-network with his insurance company.
He simply didn’t want any unexpected bills from the anesthesiologist, for example.
A month later, a bill came in the mail for $695 for a knee brace. When he asked why he was receiving the bill, the company that provided it to him explained it was out-of-network with his insurance.
Novak ended up wearing the out-of-network brace for a day.
“Nobody warned me about the cost. If it wasn’t going to be covered,” Novak said.
Not long after and out of curiosity, Novak went online to see how much the brace might actually cost.
He found it… for $195.
At that point, he asked the company if he could pay the market rate for the brace.
The response was immediate.
Shortly after that, he received a notice from collections.
He still owed $695.