Posted on 08/14/2025 8:42:42 PM PDT by SeekAndFind
When leftists attack our health care system for its supposedly market-driven forces, they fail to grasp a key fact. American health care has rarely functioned like a market because few, if any, patients know the price of their care in advance. A recent personal experience illustrated this problem and reinforced the rules the Trump administration must finally implement to make prices transparent.
Last April, I went to the Surgery Center of Chevy Chase just outside Washington for outpatient foot surgery. Staff informed me in advance that my estimated financial responsibility would total $574.12 — an amount I dutifully paid the morning of the procedure. The surgery proceeded with no complications until the Surgery Center sent me an additional bill for $752.52 — more than the original estimated cost — weeks afterwards.
In theory, I never should have faced such a sizable after-the-fact bill. Section 111 of the No Surprises Act, signed into law in December 2020, contained a new Advanced Explanation of Benefits requirement that gives patients the right to a written estimate of total out-of-pocket costs before receiving care. In my case, this “all-in” Advanced EOB would have encompassed not just the Surgery Center’s charges, but those of my surgeon, anesthesiologist, and any other anticipated out-of-pocket costs.
The No Surprises Act provided an implementation date of Jan. 1, 2022, for the Advanced EOB requirement — more than two years before my surgery. But the Biden administration delayed implementation while insurers and health care providers reconfigure their billing systems. As a result, a requirement passed in the waning days of the first Trump administration lacks a firm implementation date more than six months into the second Trump administration.
Because the statutory requirement to receive a written, itemized estimate in advance has not yet taken effect, I had to fight for information about my after-the-fact bill. Staff offered to “explain” the bill, but never answered my specific questions, even though a line on the statement — “Wrong Contract Selected” — clearly meant some type of error had occurred. The Surgery Center likewise failed to provide a substantive response to the Maryland Attorney General’s Office when I asked them to mediate.
Only after I threatened legal action did the truth finally emerge. Surgery Center staff made two separate errors in calculating my estimated responsibility, concluding that I was in an HMO rather than a PPO and that I was near to meeting my annual deductible. Billing staff disclosed the first error, but concealed the second for more than a year, sending my bill to collections rather than admitting a mistake that led to an inaccurate estimate of my out-of-pocket costs and the post-procedure bill I disputed.
While I eventually had my balance forgiven, I couldn’t help considering the matter a Pyrrhic victory. The time, hassle, and frustration I invested to get to that point far exceeded the $752.52 balance at issue, and providers like the Surgery Center know it. They also recognize that, when threatened with collection actions, most people will attempt to pay any balance a provider claims they owe — even if they can’t afford to do so, and even if, as in my case, the purported balance stems from the provider’s own mistakes.
But the American people deserve better. In no other field would customers accept businesses failing to tell buyers a price in advance — or attempting to change that price after the fact. Vulnerable patients should expect no less. The Trump administration should accelerate implementation of the Advanced EOB requirements to the earliest possible date so that all patients receive an accurate, written estimate of their out-of-pocket health care costs before receiving care.
Dystopian medical care.
I just paid the latest bill after date of service was January 5th.
In the future, every time a medical care employee enters the room, my phone is on constant recording for sure. The radiologist review bill made me realize you have to threaten them with fraudulent billing to get it to stop, if in fact they are "maximizing allowed or customary charges" yet those were not performed. They have billing algorithms that data comb your insurance plans (even old ones) for any charge customary to a procedure. They will automatically bill for those services with each run through an algorithm (program).
I’ve had it happen to me too, six months after surgery, a sudden bill for over $6,000 after I assumed everything was paid!
Yea, he has little else to do.
Our PCP office (30,000 square feet) will no longer treat any patient with any need for an IV to be given. So, when the urgent care facility is slow on business, they bounce patients to that facility to keep it profitable.
Truth is that healthcare providers have almost no ability to tell you what something will cost, because they’ve outsourced billing to companies that specialize in gaming the complicated insurance systems.
An estimate is an estimate not an exact contractual agreement. You get it in writing you’re good.
yep, same here
it should be illegal
Many don’t know that if the law is broken, they don’t have to pay the “surprises”...the estimates are supposed to come from insurers and providers that accept are bound to not charge for items the insurer disallows...if you get it in writing - they can’t charge you extra.
It’s easy if you’re needing outpatient care to visit the billing office and get written estimates for what you’re going to have done.
Medical coding actually makes that easier because it gets really specific.
Then it’s up to you to make sure you’re not screwed silly.
Not fun, an aggravating PITA.
Just do it.
Chances are your health system won’t try to deliberately overcharge someone savvy enough to trust but verify.
And if there’s an oopsie, we’ll, you’ve still got your paperwork.
Sucks to be them.
Back in 2008 I had a gallbladder removed and the bill was about 3X of what was expected. There are accountants who specialize in forensic analysis of medical bills. I hired one whose fee was 10% of what he saved me off the bill. We were on the phone and was looking at my bill and started laughing. Saying. “If they shot as much Morphine in you as they’re charging you for you’d be dead.” He shaved over $35,000 off the bill. One egregious practice he noticed, the hospital put these sort of compression leggings on me. On the bill the sold them to me at a huge markup. Then whenever I went anywhere in the hospital (e.g. MRI) they removed them. When they put them back on they charged me again for a new pair! I gladly paid his fee. I later saw the same guy on CNBC talking about medical bill fraud. Hospitals live in terror of guys like him.
And yes, I'm aware that my brains are right behind my eyes.
“When leftists attack [*insert any perceived injustice here*] fail to grasp a key fact.”
Fixed! :)
My last trip to the ER (I am rarely ill or injured, thank goodness!) was $8,000.00 for a 4-hour visit to pass a kidney stone. The VA picked up the tab and I hope to h#ll they got a better rate than what they wanted to charge me!
And I had already passed it by the time they got me the MRI. Granted, they gave me some gooooood drugs to help me through it, though. ;)
I saw the Doc for all of 2 minutes; nurses took care of me the whole time. He was just ‘checking on me’ at the end of the visit. I said - ‘Where have YOU been? I did all the heavy listing here, today!’
I just got the bill for my kidney stone adventure...$31K...
Aren’t all of these ‘surprise’ bills for people who signed up for 0bamacare?
Anyone know? I’m covered under the VA and also Medicare now that I turned 65; the VA recommended I sigh up for it so I won’t have any problems getting care later if I need something BIG - like someone’s used heart. Or just a heart to begin with, LOL!
They are SO much fun, aren’t they? Ugh! I have never felt so close to death before. The pain was unbelievable - and I’m no wuss!
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.