NPR and Kaiser: Exposing Overcharged Medical Bills

business-care-clinic-1282308.jpg

As they should be, Nobel laureates are revered as the absolute best minds our planet has to offer, weaving together their achievements at the frontiers of human learning. However, as with all humans, they are not immune to those symptoms of life that manifest themselves through sickness and disease. That should come as no surprise. What should be surprising, however, is the notion that even such an illustrious group of individuals is plagued with the unruly costs of medical bills. One such laureate, luminary physicist Leon Lederman, even had to go so far as to auction off his coveted price for $765,000 in an effort to pay back a number of surprisingly hefty medical bills. When such problems arise within these groups, they are generally representative of a deeper issue that affects millions of others. As a matter of fact, more and more cases of suspicious issuing of surprisingly large and disproportionate health bills are beginning to surface. NPR, long a voice for the voiceless, is spearheading a campaign oriented toward investigating suspiciously wrongful billing, unmasking its underlying errors, and exposing those who benefit from a system that has proven itself immensely corrupt and inefficient. 

Back in August, Drew Calver, a high school history teacher in Austin, Texas, suffered a serious heart attack that kept him in the hospital a total of five days. Through this time, he underwent one surgery, implanting stents within the walls of a clogged artery. Drew, an avid swimmer, reportedly asked the staff multiple times whether his insurance would be accepted, as the hospital lay just out-of-network of the school district’s health plan. After four days, and after being repeatedly told not to worry, Drew returned home, only to find, a few days later, that, his insurance had paid $55,840, but that St. David’s HealthCare Center had charged him for the unpaid balance of $108,951, roughly two times his annual salary as a high school teacher. This form of billing, known in the U.S. insurance industry as “balance billing,” represents the discrepancy between what an insurance provider deems an operation worth, and what the same is worth to the hospital. When the costs the hospital claim it incurs exceed those insurance providers are willing to pay (when, of course, they are not in-network), the difference is billed to the patient directly. Mr. Calver was charged with this exact kind of bill, a practice that has been under immense scrutiny since NPR and Kaiser news broke the story at the end of August. 

Though many states have passed laws to prevent such malpractice (including Texas), as NPR’s own Chad Therune reports, such protections do not apply to people “who get their health coverage from employers that are self-insured.” As the figures from a Henry Kaiser Family Foundation study tell us, In the United States, about 60 percent of people with health benefits from their employer are covered in this form, they just do not know it. The problem, then, goes far beyond the costs of health care for the uninsured. Rather, these costs seem to always arise as surprise issue for those who are actually insured, feeling protected by the Blue Cross Shield logo on their insurance card, but who are admitted into care at an out-of-network hospital. The problem becomes particularly difficult to deal with, in fact, when the patients arrive at an emergency room with no input towards the choice of location. When out of network, there seems to exist a viciously well-established practice to pump exorbitantly high prices into balance billings. It should come as no surprise then, that, at least initially, St. David’s HealthCare facilities blamed the incredibly high costs Mr. Calver incurred on the school’s narrow network of services, rendering them “unable to offer any better.” 

However, Mr. Calver’s story would have perhaps been swept under the rug along with countless other exorbitant balance bills, if it wasn’t for NPR’s storytelling. As a matter of fact, after National Public Radio told his story, St. David’s Healthcare slashed the bill down, from the six-digit figure they had asked before, to a mere $332. Here is where the novelty arises. How can a hospital charge a bill that could potentially bankrupt a patient behind closed doors, but renders the cost affordable when brought under the light of public discussion? Certainly, it was no accident, given the immense amount of cases like it, and further given no St. David’s official deemed it so. The procedure Mr. Calver underwent, though relatively common, is generally priced at $36,800, a sum a few thousand dollars lower than that which his insurance agreed to dish out. The stents themselves, necessary for the procedure, run about $1,153 each when bought by hospitals. Drew Calver was charged $19,708 a piece. Though emblematic of a privatized healthcare system, St. David’s is an integral part of HCA’s (America’s number one private hospital company) vast chain of a for-profit hospital. Though their officials have continued to call the balance bill fair, a climb in prices this steep is absolutely unethical and goes well past the concept of privatizing and monetizing on health care.

Slashing a bill by almost 100 percent as soon as a story goes viral casts a veil of doubt and shame upon the system that administers it. Industry analysts have long deemed Saint David’s, and other hospitals in its network as problematic out-of-network providers, grossly (and arbitrarily) inflating their prices with relative constancy in cases where the legal loopholes require them to. Casting a light on this malpractice, especially when shined on from the NPR’s moral high ground, unimaginatively causes the entities to weevil and adjust, to abide and hush down the story. The reason, once more, is that so many individuals might feel they are covered far better than they actually are. There will always be room for this type of exploitation, and so long as it considered the standard, the majority of individuals will quietly pay. As a matter of fact, recent figures from a research group at the University of Chicago show that as many as 57 percent of interviewed subjects had been surprised by the size of a medical bill. When the numbers get as hefty as Mr. Calver’s story show they can, an NY Times inquiry shows that as many as 60 percent of American citizens turn to use the majority of their savings, while as many as 42 percent take on secondary jobs in order to make financial room for these unwarranted debts. 

Such treatment of public health debt is not only unfair but emblematic of a predatory system that is flawed at the core. In the shade of general ignorance, for-profit healthcare industry giants can exploit the most obscure legal loopholes and practices to maximize revenue, unfazed by the near bankruptcy conditions they place many of their patients in. However, when these shifty malpractices are cast light upon, a domino-effect of back-pedaling and face-saving must occur. As such, NPR acts as a brilliant communicator, studying and becoming well read in the subject matter far better than a single individual ever could. For one, it may seem a mountain far too tall to climb, due to sheer ignorance, lack of funds, or lack of time. However, when a well-informed giant takes the challenge head-on, things begin to move. For that exact reason, National Public Radio, and Kaiser with it started the brilliant “Bill of the Month” segment, where patrons can send in their most exorbitant health care bills, hoping for the same treatment received by Mr. Calver. Once more, information becomes power, in a fight that no man, woman, teacher, or Nobel laureate should ever have to endure.