When surprise hospital bills attack


Financial transparency may not solve the problem of escalating healthcare costs, but it can help patients make more informed and cost-efficient decisions about their care.

When it comes to medical care and cost, patients have a right to know. Yet, patients are still in the dark (or worse, left with indecipherable information) about how much they actually owe for care. Hospital billing gets even more complicated when in-network vs. out-of-network care comes into play.

Unfortunately, that's how the situation will stay for patients in Texas, as the state took a giant step back for healthcare price transparency when its insurance commissioner terminated rules that help patients avoid surprise hospital bills.

So as the saying goes, Texans should expect the unexpected--huge unexpected out-of-network medical bills, that is.

Without the regulations, more than four million Texans with preferred provider coverage won't get additional information or warnings about whether they'll be on the hook for more money if they are hospitalized at an in-network facility and seen by an out-of-network specialist, noted The Dallas Morning News.

A similar bill went up for debate in the New Jersey legislature in May. It would require healthcare organizations inform patients of the potential costs of choosing out-of-network care, according to NJ Spotlight. However, that bill's passage seems unlikely.

Until such legislation takes hold, the looming threat of surprise hospital bills could continue to push patients to put off needed care, jeopardizing their health, which can increase costs down the road. And whether price transparency regulations are instituted within hospitals and payers or mandated by states, patients need better information.

In a move forward for transparency advocates, patients in other states could be saying goodbye to surprise fees. For instance, Pennsylvania's  Rep. Dan Frankel (D) plans to propose a ban on hospital facility fees or a requirement that patients must be made aware of the fees before choosing a provider, The Morning Call reported.

Unfortunately, surprise hospital bills remain all too common among patients. Some hospitals, such as Tenet Healthcare's Saint Louis University Hospital and Des Peres Hospital, include sneaky "facility fees" in their bills, charging extra for non-hospital services provided at doctor's offices and outpatient clinics affiliated with the hospitals.

What's worse, some of these surprise hospital bills threaten to send patients back to the hospital. One man nearly suffered an asthma attack after receiving a erroneous $44 million medical bill from Bronx-Lebanon Hospita for services that actually cost $300. The patient is okay and, of course, he didn't have to pay the erroneous bill.

But hopefully it won't take a more serious reaction to get hospitals and policy-makers to rethink healthcare pricing and billing practices.  - Alicia (@FierceHealth)

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