Hospitals Often Charge Uninsured People the Highest Prices, New Data Shows
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From [HERE] Raul Macias was rushed to an emergency room last November, with pain shooting from his back to his legs. His breathing was shallow.
Doctors at Avera St. Luke’s Hospital in Aberdeen, S.D., discovered a potentially life-threatening tear in the lining of his largest artery. They moved him to Avera Health’s heart hospital, where he stayed for three days.
Avera then billed Mr. Macias, who was uninsured, some of the highest prices the hospitals charge to any payer, the Wall Street Journal found in an analysis of Avera’s previously confidential hospital price data.
A Journal study of thousands of prices at hundreds of hospitals revealed that many charge top prices to patients like Mr. Macias, who must pay cash out of pocket, compared with the prices the hospitals have negotiated with insurance companies.
The 32-year-old’s abdominal and pelvic scan at Avera St. Luke’s cost $6,422, the highest out of a wide range of rates the Avera hospital charges for that service based on the new data. The price billed to Mr. Macias was roughly three times the best deal negotiated by an insurance company.
Another scan of his chest came to $4,194, approximately $280 to $2,800 more than any prices negotiated between St. Luke’s and an insurer. The prices for identical scans performed at Avera’s heart hospital were also among the highest that the hospital charged.
His total hospital bills came to $59,800.
Hospitals typically charge different customers different prices for the exact same service, with big discounts for some but not others.
The newly public prices allow for the first time a comparison of what deep-pocketed insurers pay hospitals versus rates that hospitals set for patients who pay cash. Time and time again, the Journal’s analysis revealed, cash payers are charged among the highest prices.
Patients typically pay these cash prices either because they are uninsured or because some services aren’t covered by their health plans. Hospitals generally offer financial aid, but policies vary widely and can be poorly promoted, leaving many uninsured, who are often also low-income, to struggle with unmanageable bills.
