The Anthem-MaineMed dispute highlights the complexity of our health system
by The Editorial Board - Bangor Daily News - April 25, 2022
Health care funding — hospital billing and insurance claims payments — is complex and often confusing. Both lack needed transparency for patients.
A dispute between Maine’s largest health care insurer and largest health care provider threatens to leave thousands of people without access to needed care. It also highlights the dysfunction of our health care industry and its finances.
Earlier this month, Maine Medical Center in Portland announced that it would essentially drop in-network coverage for patients with Anthem Blue Cross and Blue Shield insurance beginning in January. These patients may still be able to be treated at the hospital but they may need prior approval and would pay higher rates. Emergency room services for Anthem subscribers will still be covered.
Insurance companies and health care providers often negotiate rates and terms for services and treatments. It is unusual for the negotiations — and disagreements like these — to spill into public view, showcasing the discord between the two largest players in Maine’s health care system.
Discussions of patient care are largely lost in the debate.
MaineHealth, the parent company of Maine Medical Center, said that Anthem owes it more than $70 million for services over the last three years. Anthem has also been withholding payments totaling around $13 million a year, MaineHealth officials said. Other MaineHealth providers and offices will continue to accept Anthem insurance.
Anthem has faced similar complaints and disputes in several other states. Last month, the state of Georgia fined the company $5 million after officials there said Anthem misled patients about what hospitals and providers were available through its network.
Anthem has countered the Maine Medical Center claims by saying that the hospital is inflating prices, which raises insurance and health care costs for all patients. For example, the company told the Portland Press Herald that the hospital charged Anthem patients $136 for a bag of saline that should have cost $2, and overcharged for tissue used in breast reconstructive surgeries for cancer patients. The hospital said it needed more information to assess these claims.
Gov. Janet Mills has urged the hospital and Anthem to resolve the dispute. The governor’s sister is an executive at MaineHealth. Anthem provides insurance coverage to state employees.
This dispute comes as calls for more transparency around charges for hospital services and decisions about insurance coverage intensify. Under the Affordable Care Act, insurance companies must devote most of their premium charges to patient care, not administration, salaries and profit. The ACA, which has been codified into Maine law, also includes many procedures, such as mental health services, pregnancy care and preventative services, that must be covered by insurance.
Hospital billing, on the other hand, is not subject to similar government rules and lacks much transparency. New laws, and a new Office of Affordable Health Care, created last year by the Legislature, may help increase transparency. The office, which was created by legislation sponsored by Senate President Troy Jackson, is charged with reviewing the state’s health care system and developing proposals to “improve coordination, efficiency and quality of the health care system.”
In addition, the Legislature’s Health Coverage, Insurance and Financial Services Committee will soon hold a meeting with representatives from Maine Medical Center and Anthem to discuss this situation.
“These types of disputes and ongoing issues are why we need to continue the work to reform our health care system in Maine and across the country,” Jackson told the BDN editorial board. “The system is complicated from tricky insurance claims and difficult-to-read medical bills to the pricing of prescription drugs, all of which give industry players the cover to trade blame over outrageous prices while patients are left grappling with the cost of treatment and care.
“The Office of Affordable Health Care has a role to play to reform our system here in Maine in the long run,” the Senate president added. “However, in the meantime, the Legislature’s Health Coverage, Insurance and Financial Services will hold a hearing in the coming weeks to give both MaineHealth and Anthem a forum to present their side of the dispute. At the end of the day, the two parties must resolve the issue quickly for the sake of Maine people who are stuck in the crossfire.”
This dispute, and others that are likely to follow, lend support to the notion of a single payer healthcare system. Under such a system, one payer — often the government — would cover the cost of health care, typically for a large population. Medicare and Medicaid are single-payer systems. Both have much lower administrative costs than private insurance plans.
Health care funding — hospital billing and insurance claims payments — is complex and often confusing. Both lack needed transparency for patients.
We hope that Anthem and Maine Medical Center will reach an agreement before January so thousands of patients won’t have their medical care disrupted or delayed. But this standoff should prompt lawmakers to take a much harder look at making the entire health care system better, more transparent and centered on patients’ needs.Our health care system is broken and we need fundamental change
by Ted Sussman - Bangor Daily News - April 25, 2022
The BDN Opinion section operates independently and does not set newsroom policies or contribute to reporting or editing articles elsewhere in the newspaper or on bangordailynews.com.
Ted Sussman has been a physician in Houlton for more than 40 years and joined the Maine AllCare board in 2021. He is a past governor of the Maine chapter of the American College of Physicians, and also served on the Maine Health Access Foundation board.
As a Mainer, a physician and a Maine AllCare board member, I was disappointed to learn that Maine Health Care Action will be unable to gather the needed signatures to get a universal health care Resolve on the ballot in 2023, as reported by the BDN on April 13.
Maine AllCare has advocated for universal, publicly funded health care for Maine since 2010. We hoped that the effort would give Maine voters the chance to send a clear message: Our health care system is broken, and we need fundamental change.
I believe that Maine Health Care Action may have succeeded if not for the COVID-19 pandemic, which all but eliminated in-person events and made it very difficult to gather signatures, despite the valiant efforts of dozens of volunteers. And I share their belief that this effort is not finished.
It’s true that campaigns in other states to establish universal health care, through ballot initiatives and legislation, have so far been unsuccessful — the April 13 article mentions Vermont. But the real failure is not a lack of resources, as is often stated. In the U.S., we already spend far more on health care than other developed countries — 16.8 percent of GDP compared with Germany’s 11.7 percent, the next highest — yet have worse outcomes.
Nor is it lack of a workable model. A 2019 fiscal study by the Maine Center for Economic Policy shows one model for how universal health care in Maine would cover everyone and save money.
The April 13 article notes that health care reform is a “perennial subject” in the Legislature, and this is true. But I believe this indicates the need for fundamental reform, not an argument against it. Fixing our dysfunctional health care system requires big changes, not tinkering around the edges, and mustering the political will to make those changes is a steep climb.
The article misses other parts of the picture as well. Describing the consensus report of a 2018 legislative task force on health care reform as “tepid,” for one.
One of the outcomes of this task force was the formation of a Joint Standing Committee on Health Care, Insurance and Financial Services, which has been instrumental in keeping a legislative focus on health care reform. Among the reforms considered by the Legislature was LD 1045, An Act to Support Universal Health Care, which was passed and became law in 2021. This new law provides one pathway to achieving universal health care in Maine, contingent on action by Congress.
At Maine AllCare, we know there is strong public support for remaking our health care system to be fair, affordable and economically sound. Our tens of thousands of supporters and the countless stories of people struggling to get health care without suffering financial hardship show us how deeply Mainers understand this need.
Look at any movement for social or political change, and you’ll see that it takes years, sometimes decades, for a sound idea to gain traction and become reality. I believe that universal, publicly funded health care is one of those ideas, and that we are gaining traction, bit by bit. Maine Health Care Action’s suspension of signature-gathering is far from the end of the story.
Anthem president: We’re working to protect health care affordability
The insurer is committed to coming back to the negotiating table, and it hopes MaineHealth will join them, Denise McDonough says.
by Denise McDonough - Portland Press Herald - April 26, 2022The reality is, health care costs in Maine are high – some of the highest in the country – and if we are not vigilant, they’ll continue to climb higher. An objective 2019 study by the University of Pennsylvania ranked Maine as having the fourth highest health care cost burden for working families in America, and a 2020 study by the Rand Corp. showed prices paid to hospitals in Maine by private insurers are 252 percent of what Medicare would have paid for the same services at the same facilities.
The result? Maine can be such an expensive state for health care that some employers find it more cost-effective to send their employees to Boston for certain surgeries or care.
The findings of these studies and others do not come as a surprise to me, nor to Maine employers and consumers. The majority of our members in Maine work for companies that are self-funded, which means an insurer like Anthem administers the plan, but the employer pays for health care costs directly; any increases health systems charge for medical expenses is a direct increase in the expenses they pay. Employers with “traditional” plans, where the insurer assumes the risks and the costs, see their premiums increase as costs go up.
Simply put, the prices health systems charge for services is the primary driver of health care spending. If the cost of services continues to rise unchecked, all Mainers will pay more for health care through higher premiums and higher out-of-pocket costs. If that sounds unsustainable, that’s because it is.
At Anthem, our role is to protect our customers from increased costs and to protect affordability for the businesses and people we serve. That’s the whole reason why we enter into contractual relationships with providers and health systems: to be stewards of our customers’ money.
Our work is as important now as ever. Through routine audits, we discovered MaineHealth has overcharged our members. In 2018, we discovered overbilling by Maine Medical Center in Portland for anesthesia and operating room services. As a result of an investigation, MaineHealth eventually acknowledged the overcharging and issued refunds amounting to nearly $20 million. If it were not for our internal audits – a system of checks and balances to protect our members – these overcharges may never have been discovered.
Unfortunately, we find ourselves in a similar situation, where through a routine audit, it was discovered that MaineHealth has once again overcharged Maine consumers and charged them for services they shouldn’t have, which we believe totals millions of dollars. Disputing such charges is at the heart of the current dispute with MaineHealth.
Anthem has been partners with MaineHealth for decades, and in order for all Mainers to have access to high-quality, outcomes-driven health care, we believe strongly that this partnership must continue. To help resolve these matters with MaineHealth, we have engaged an independent mediator.
As, respectively, the largest payer and provider in the state, Anthem and MaineHealth have a responsibility to address the challenges of rising health care costs on behalf of the people we mutually serve. We at Anthem Blue Cross and Blue Shield agree with the governor that it is in the best interests of consumers to come back to the negotiating table and hash out our differences. I am committed to doing so, as are the hundreds of Mainers I work with every day. We are hopeful MaineHealth will join us.
Letter to the editor: MaineHealth-Anthem conflict symbol of something bigger
The dispute between MaineHealth and Anthem is a perfect illustration of why for-profit health care is a bad idea.
Philip Moss
Cape Elizabeth
Covid Drugs Save Lives, but Americans Can’t Get The Them
Almost two months after President Biden promised to make lifesaving drugs against Covid widely available to Americans, the medications remain hard to get for many, despite supplies, leaving large numbers of Americans to face increased risks of avoidable death and serious illness.
That’s largely because, once again, a dysfunctional health care system that costs more and often delivers less than that of any other developed country has hindered our pandemic response.
As was the case with vaccines, the United States quickly snapped up these therapeutics and accumulated vastly more supply than any other country. These drugs do not replace vaccines but provide crucial extra protections for vulnerable people who number in the millions and who face increased risks as the few remaining public health protections are rolled back.
Paxlovid, an antiviral treatment developed by Pfizer, an American pharmaceutical company, is highly effective for reducing hospitalizations and deaths in high-risk patients, as long as it is started early. This is especially important for elderly or immunocompromised people, since their immune systems are not as robust as others’ against viruses, even when vaccinated. In his State of the Union address, Biden announced a “test to treat” initiative to provide such pills on the spot in pharmacies when someone tests positive.
Reality is much less rosy.
The national map of participating pharmacies in test to treat shows large parts of the country with none. Even in areas where treatment is supposed to be available, it can be hard to get. A Kaiser Health News reporter spent three hours driving around Washington, D.C., before finding a pharmacy where testing was available and the drug was in stock — something we should not expect sick people to do. When trying to book appointments online in several states, the reporter was sometimes denied an in-person appointment after listing upper-respiratory symptoms and a positive coronavirus test, even though the point of the program is to treat people with respiratory illness so they don’t get sicker. Many places did not have any same-day appointments, a big obstacle for a drug that should be given as quickly as possible.
The greater difficulty is that the drug can be prescribed only by a medical doctor, advanced practice registered nurse or physician assistant, especially because it can interact harmfully with many other drugs. It cannot be prescribed by a pharmacist. Many pharmacies aren’t participating in the national program because they don’t have a clinic on site where a health practitioner can assess a person’s eligibility. Even if they have one, managing prescriptions for high-risk people is best done by a patient’s regular doctor, not in a one-off encounter at a pharmacy. Patients who successfully wangle an appointment are asked to bring a list of all their drugs and, I suppose, resolve all the complexities in one sitting.
As further congressional funding has not been approved, the funds used for reimbursement for coronavirus testing have begun to be depleted, so people without insurance or whose insurance doesn’t cover such clinics have to pay for the health appointment out of pocket.
So it’s not hard to predict that many people will be left behind.
What about those with proper health insurance and a primary care physician? Fine, as long as your doctor is aware of the drug and you can get an appointment quickly and then locate the drug.
Several physicians have told me they had to intervene on behalf of their elderly or high-risk relatives who tested positive, calling their health care providers directly to persuade them to prescribe the antiviral. These may be anecdotal, but even Dr. Anthony S. Fauci, the president’s chief medical adviser, noted last week that the drug was “being underutilized.”
If many doctors are unaware of these therapeutics or unsure how patients qualify for them, where’s the effective awareness and education campaign for health care providers?
In the United States, such doctor outreach is often, sadly, left to pharmaceutical companies, which spend tens of billions of dollars each year marketing their drugs to physicians. This has led to heavily promoted drugs getting prescribed even when cheaper, effective alternatives exist. However, Paxlovid received an emergency use authorization, which means that legally, Pfizer cannot directly market it yet, so physicians don’t get even this sort of outreach. This leaves individual doctors on their own for keeping up with new drugs and treatments, even in a pandemic and even when the drug is potentially lifesaving.
Also, it’s not that easy to get a same-day appointment with one’s regular physician, even for those who have great insurance. This makes catching the early treatment window harder. In most places, emergency rooms are always open, but besides being overloaded and understaffed, they are the last places where infected people should congregate or where the elderly or those at high risk should spend hours merely to get access to a crucial drug.
A similar situation is underway for Evusheld, a Covid drug approved in December for the millions of immunocompromised people, like transplant patients and those on medications that can suppress the immune system for conditions like rheumatoid arthritis. In trials, the drug reduced symptomatic infections by about 83 percent. This drug provides them with extra protection for six months as a prophylactic. It’s been approved for months, and Biden also mentioned treatments for the immunocompromised in his State of the Union address. The federal government bought 1,700,000 doses, to be distributed free.
So I guess this is where I should say, “Stop me if you heard this before.”
In March, The New York Times reported that a whopping 80 percent of the doses were sitting unused as the Omicron wave washed over the country. A CNN investigation found desperate patients unable to find the drug, doctors unaware that it even exists and some pharmacies with hundreds of unused doses while others had none. Hospitals like the Mayo Clinic told CNN that they had only a few thousand boxes for the more than 10,000 patients who could benefit from it, while boxes were delivered to medical spas offering Botox or eyelash extensions (and sitting unused). The Detroit Free Press found supplies of Paxlovid and Evusheld unused because physicians weren’t prescribing them. A Kaiser Health News investigation found that government maps of supplies were missing many locations that had doses. This happened even as desperate patients waited for lotteries to allocate some to them. Social media is also replete with stories of despondent patients unable to locate doses or managing to do so after much effort and paying extra when they ended up out of their insurance networks. Meanwhile, at least one infusion center had so many unused doses that it ran out of refrigerator space and declined new shipments.
What makes this all more troubling is that conditions like diabetes and uncontrolled high blood pressure increase the dangers of Covid and the United States has had a worse record on such health indicators than many other wealthy nations.
Not having a regular relationship with a medical provider — too common in the United States — leaves these high-risk people open to confusion and misinformation, especially in the current political environment. People without insurance lagged in being vaccinated at all and will face more obstacles in getting antivirals.
In Britain, which has a national health system, 58 percent of people have received a third vaccine dose. In the United States the number is a measly 30 percent. Well, I should say we think it is; without a national health system, the United States has difficulty keeping track of the numbers. The failure to reach more people with a third dose, shown by the data to greatly help with outcomes, cannot be blamed solely on anti-vaccination attitudes, as 66 percent of the U.S. population had received two doses.
In October 2019, a Johns Hopkins study found the United States more prepared than any other country for a pandemic. Obviously, that prediction did not age well. But taking a look at how the study got it wrong is instructive.
On many of the indicators the researchers examined, the United States ranked high, often in the top five, with one conspicuous exception: access to health care. On that measure, the researchers placed the United States 183rd out of 195 countries. In retrospect, maybe they should have made that the primary criterion.
What is the point of talking about health care access and outlining how it manifests itself in failure after failure, given that the Republican Party seems determined to block progress and even roll back what little improvement we have had with the Affordable Care Act, or Obamacare?
The most important reason is that to do otherwise would restrict the possibilities for change and our political imagination even further. Lowering the eligibility age for Medicare to 60 and then to 55 and expanding the Veterans Health Administration, the largest integrated health care system in the country, to include firefighters, social workers, teachers and others who serve their communities are among the options that should become part of the political conversation.
And any obstacles on the federal level should inspire states to overcome these problems themselves and even build their own systems.
New York City, for example, has created a hotline to provide Covid information, including how to get Paxlovid free, with home delivery, and how those without a doctor can reach one quickly through a telehealth appointment. In the earlier waves, the hotline also connected people with free hotel rooms if they needed to isolate away from their homes. It will also allow people to request delivery of basic supplies like masks and thermometers to their homes. And I’ve seen all this advertised a lot, including on local TV stations. We need more such efforts.
There’s more the federal government can do now, like start a robust physician and patient outreach program and work to clarify and balance the supply of therapeutics for Covid so that millions of immunocompromised people can better protect themselves and high-risk people who get infected can avoid severe disease.
However, states should be aware that this may not be coming and should begin their own programs and maybe even cooperate to build shared infrastructure. Under these political conditions, rescue may not be on its way for a long time, if ever. We can at least try to build better lifeboats, locally, wherever possible.
https://www.nytimes.com/2022/04/22/opinion/covid-pandemic-drugs-treatment.html
Hit with $7,146 for two hospital bills, a family sought health care in Mexico
by Paula Andalo - Kaiser Health News - April 27, 2022
The Fierro family of Yuma, Ariz., had a string of bad medical luck that started in December 2020.
That's when Jesús Fierro Sr. was admitted to the hospital with a serious case of COVID-19. He spent 18 days at Yuma Regional Medical Center, where he lost 60 pounds. He came home weak and dependent on an oxygen tank.
Then, in June 2021, his wife, Claudia Fierro, fainted while waiting for a table at the local Olive Garden restaurant. She felt dizzy one minute and was in an ambulance on her way to the same medical center the next. She was told her magnesium levels were low and was sent home within 24 hours.
The family has health insurance through Jesús Sr.'s job, but it didn't protect the Fierros from owing thousands of dollars. So when their son Jesús Fierro Jr. dislocated his shoulder, the Fierros — who hadn't yet paid the bills for their own care — opted out of U.S. health care and headed south to the U.S.-Mexico border.
And no other bills came for at least one member of the family.
The patients: Jesús Fierro Sr., 48; Claudia Fierro, 51; and Jesús Fierro Jr., 17. The family has Blue Cross and Blue Shield of Texas health insurance through Jesús Sr.'s employment with NOV, formerly National Oilwell Varco, an American multinational oil company based in Houston.
Medical services: For Jesús Sr., 18 days of inpatient care for a severe case of COVID-19. For Claudia, fewer than 24 hours of emergency care after fainting. For Jesús Jr., a walk-in appointment for a dislocated shoulder.
Total bills: Jesús Sr. was charged $3,894.86. The total bill was $107,905.80 for COVID-19 treatment. Claudia was charged $3,252.74, including $202.36 for treatment from an out-of-network physician. The total bill was $13,429.50 for less than one day of treatment. Jesús Jr. was charged $5 (70 pesos) for an outpatient visit that the family paid in cash.
Service providers: Yuma Regional Medical Center, a 406-bed nonprofit hospital in Yuma, Ariz. It's in the Fierros' insurance network. And a private doctor's office in Mexicali, Mexico, which is not.
What gives: The Fierros were trapped in a situation in which more and more Americans find themselves. They are what some experts term "functionally uninsured." They have insurance — in this case, through Jesús Sr.'s job, which pays $72,000 a year. But their health plan is expensive, and they don't have the liquid savings to pay their share of the bill. The Fierros' plan says their out-of-pocket maximum is $8,500 a year for the family. And in a country where even a short stay in an emergency room is billed at a staggering sum, that means minor encounters with the medical system can take virtually all the family's disposable savings, year after year. And that's why the Fierros opted out of U.S. health care for their son.
According to the terms of the insurance plan, which has a $2,000 family deductible and 20% coinsurance, Jesús Sr. owed $3,894.86 out of a total bill of nearly $110,000 for his COVID-19 care in late 2020.
The Fierros are paying off that bill — $140 a month — and still owe more than $2,500. In 2020, most insurers agreed to waive cost-sharing payments for COVID-19 treatment after the passage of federal coronavirus relief packages that provided emergency funding to hospitals. But waiving treatment costs was optional under the law. And although Blue Cross and Blue Shield of Texas has a posted policy saying it would waive cost-sharing through the end of 2020, the insurer didn't do that for Jesús Sr.'s bill. Carrie Kraft, a spokesperson for the insurer, wouldn't discuss why his bill was not waived.
(More than two years into the coronavirus pandemic and with vaccines now widely available to reduce the risk of hospitalization and death, most insurers again charge patients their cost-sharing portion.)
On Jan. 1, 2021, the Fierros' deductible and out-of-pocket maximum reset. So when Claudia fainted — a fairly common occurrence and rarely indicative of a serious problem — she was sent by ambulance to the emergency room, leaving the Fierros with another bill of more than $3,000. That kind of bill is a huge stress on many American families; fewer than half of U.S. adults have enough savings to cover a surprise $1,000 expense. In recent polling by the Kaiser Family Foundation, "unexpected medical bills" ranked second among family budget worries, behind gas prices and other transportation costs.
The new bill for the fainting spell destabilized the Fierros' household budget. "We thought about taking a second loan on our house," said Jesús Sr., a Los Angeles native. When he called the hospital to ask for financial assistance, he said, people he spoke with strongly discouraged him from applying. "They told me that I could apply but that it would only lower Claudia's bill by $100," he said.
So when Jesús Jr. dislocated his shoulder when boxing with his brother, the family headed south.
Jesús Sr. asked his son, "Can you bear the pain for an hour?" The teen replied, "Yes."
Father and son took the hourlong trip to Mexicali, Mexico, to Dr. Alfredo Acosta's office.
The Fierros don't consider themselves "health tourists." Jesús Sr. crosses the border into Mexicali every day for his work, and Mexicali is Claudia's hometown. They've been traveling to the neighborhood known as La Chinesca (Chinatown) for years to see Acosta, a general practitioner, who treats the asthma of their youngest son, Fernando, 15. Treatment for Jesús Jr.'s dislocated shoulder was the first time they had sought emergency care from the physician. The price was right, and the treatment effective.
A visit to a U.S. emergency room likely would have involved a facility fee, expensive X-rays and perhaps a specialist's evaluation — which would have generated thousands of dollars in bills. Acosta adjusted Jesús Jr.'s shoulder so that the bones aligned in the socket and prescribed him ibuprofen for soreness. The family paid cash on the spot.
Although the Centers for Disease Control and Prevention doesn't endorse traveling to another country for medical care, the Fierros are among millions of Americans each year who do. Many of them are fleeing expensive care in the U.S., even with health insurance.
Acosta, who is from the Mexican state of Sinaloa and is a graduate of the Autonomous University of Sinaloa, moved to Mexicali 20 years ago. He witnessed firsthand the growth of the medical tourism industry.
He sees about 14 patients a day (no appointment necessary), and 30% to 40% of them are from the United States. He charges $8 for typical visits.
In Mexicali, a mile from La Chinesca, where the family doctors have their modest offices, there are medical facilities that rival those in the United States. The facilities have international certification and are considered expensive, but they are still cheaper than hospitals in the United States.
Resolution: Both Blue Cross and Blue Shield of Texas and Yuma Regional Medical Center declined to discuss the Fierros' bills with KHN, even though Jesús Sr. and Claudia gave written permission for them to do so.
In a statement, Yuma Regional Medical Center spokesperson Machele Headington said, "Applying for financial support starts with an application — a service we extended, and still extend, to these patients."
In an email, Kraft, the Blue Cross and Blue Shield of Texas spokesperson, said: "We understand the frustration our members experience when they receive a bill containing COVID-19 charges that they do not understand, or feel may be inappropriate."
The Fierros are planning to apply to the hospital for financial support for their outstanding debts. But Claudia said never again: "I told Jesús, 'If I faint again, please drive me home,' " rather than call an ambulance.
"We pay $1,000 premium monthly for our employment-based insurance," added Jesús. "We should not have to live with this stress."
The takeaway: Be aware that your deductible "meter" starts over every year and that virtually any emergency care can generate a bill in the thousands of dollars and may leave you owing your deductible and most of your out-of-pocket maximum.
Also be aware that even if you seem not to qualify for financial assistance based on a hospital's policy, you can apply and explain your circumstances. Because of the high cost of care in the U.S., even many middle-income people qualify. And many hospitals give their finance departments leeway to adjust bills. Some patients discover that if they offer to pay cash on the spot, the bill can be reduced dramatically.
All nonprofit hospitals have a legal obligation to help patients: They pay no tax in exchange for providing "community benefit." Make a case for yourself, and ask for a supervisor if you get an initial no.
For elective procedures, patients can follow the Fierros' example, becoming savvy health care shoppers. Recently, Claudia needed an endoscopy to evaluate an ulcer. The family called different facilities and discovered a $500 difference in the cost of an endoscopy. They will soon drive to a medical center in Central Valley, California, two hours from home, for the procedure.
The Fierros didn't even consider going back to their local hospital. "I don't want to say, 'Hello' and receive a $3,000 bill," joked Jesús Sr.
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