A while back I wrote about my experience being shaken down for over $4,000 when I had to take my daughter for a simple x-ray after she hurt her foot while we were vacationing. The x-ray was negative, but the charges — for a simple 3-view x-ray, an Ace bandage, and a pair of crutches — were over $4,300. Such charges are illegal under federal laws that limit charges for out-of-state emergency visits to what it would cost to stabilize the patient in her home state, but this hospital, as they say down in Texas, flat did not care. It plunged ahead, ignoring my insurer’s offered settlement and instead sending me threats that it would report me to collection agencies if I didn’t pay up. Someone familiar with such claims told me this is common in this situation; many hospitals simply routinely ignore this regulation, wave aside the insurer’s silly babbling about paying rates it considers too low, and harass the patients till they pay up what they can.

The hospital has now finally agreed — what d’ye know? — to actually file the claim with the insurer. In the meantime, however, they also sent the account to a collection agency because, they wrote, I had “failed to respond” to their attempts to collect. Apparently sending them your full insurance coverage information is a failure to respond. I’m now waiting to see whether they’ll accept the payment — and undo any damage they’ve done to my credit rating. All this over a sprained foot.

Apparently I’m not alone. A new study, small but clear, finds that patients who must seek care out-of-network regular face bills far larger than they should be.

Four themes characterize the perspective of individuals who experienced involuntary out-of-network physician charges: (1) responsibilities and mechanisms for determining network participation are not transparent; (2) physician procedures for billing and disclosure of physician out-of-network status are inconsistent; (3) serious illness requiring emergency care or hospitalization precludes ability to choose a physician or confirm network participation; and (4) resources for mediation of involuntary charges once they occur are not available.

In plain English, that means that the system is opaque, the billing procedures and prices are all over creation, and people who have no choice but to seek care are mercilessly dunned for the money.

via Patient Experiences with Involuntary Out-of-Network Charges.

Image: Dark Alley, by deryckh, via flickr. License Some rights reserved

See also:

Actually, Mr. Brill, Fixing Healthcare Is Kinda Simple

Bitter Pill: Why Medical Bills Are Killing Us – TIME

Ezra Klein – America spends way, way, way more on health care

Health-Care Secret Revealed, Again: More Is Not Better