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Why there are shocking costs on your emergency room bill

The cost of health care remains a big concern, even for people with insurance. A new analysis found the cost of emergency care has nearly doubled in the last eight years even as the total number of visits has stayed about the same. William Brangham talks with Sarah Kliff of Vox about a special reporting project that's chronicling the impact of ER prices on individuals and families.

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    Now- the rising cost of visiting an emergency room.

    Health care costs remain a big issue for many Americans, and E.R. prices are one part of that problem.

    A new analysis found the cost of going to an emergency care Has nearly doubled in the last eight years.

    William Brangham is back with a look at a special reporting project that's chronicling the effect of E.R. prices on individuals and families.


    The stories surrounding some of these E.R. bills are stunning. A man in Texas with a broken jaw ends up in an E.R. He's stuck with a nearly $8,000 bill, even though he was in a hospital that is in his insurance network.

    Parents in Virginia take their 1-year-old daughter in for a cut on her toe. Thirty minutes later, she's out, treated just antibacterial ointment. Their bill? Over $900.

    Or how about a $629 hospital bill for a Band-Aid for a baby girl in Connecticut?

    These are just some of the 1,300 anecdotes that Vox is collecting. It's part of a big reporting project that is looking at the 140 million E.R. visits Americans make each year and why they cost so much money.

    Sarah Kliff, is the journalist behind this project, and she joins me now.

    Welcome back to the NewsHour.


    Thanks for having me.


    So, you collect 1,300 so far, maybe more than that now, E.R. bills from people all over the country. And you're trying to, I guess, discern a pattern in all of these bills.

    What, broadly speaking, have you found thus far?


    Yes, so I would say there's three big findings from this reporting project.

    The first is that, basically, every emergency room visit has something called a facility fee. This is the price of walking through the door, seeking care. And most people don't know about this. I didn't know about this until I started this reporting project.

    We know that those facility fees are really high. They're usually the majority of the bill in those cases that you were mentioning, and we also know they vary a lot. One hospital across the street from another hospital, they may have facility fees that look nothing like each other.

    But it's really hard to find information about them. You usually don't know what your facility fee is until before you receive a bill from the hospital.


    You can't call ahead and ask what theirs is?


    No, no, you can't ahead and ask. These are privately negotiated between hospitals and insurance companies.

    So it's a difficult market to be a patient in, to actually know how much you're going to pay when you do go to the emergency room.


    So, that's one of the big findings. What were some of the others?


    We have seen a lot of issues with out-of-network billing at in-network emergency rooms.

    One of our stories looked at this man in Texas who wakes up after being unconscious, left in a Texas emergency…


    This is the broken jaw story.


    This is the broken jaw.

    So, he wakes up with a broken jaw, starts Googling, is my hospital I woke up in in-network? He finds out it is. He feels relieved. But then it turns out that the surgeon who does his jaw surgery is not in-network.

    And he receives an $8,000 bill. And it turns out this is pretty common, especially in Texas, to have out-of-network providers workings at in-network emergency rooms. And, again, it's really difficult for patients to find that information.

    You might think you're safe, like this patient did, and then get a bill a few months later which shows you really weren't safe.


    Have these costs been the same all along? Is it just now we're just now paying attention to it, or have they been changing over time?


    They have been going up much faster than general inflation in the economy.

    But I think one key factor here is that deductibles are rising very, very quickly. So, a lot of us, most of us who have insurance at work now have a deductible above $1,000. And that means we actually see our health care costs, instead of the insurance just kicking in everything. We're expected to pay for more.

    So, I think we hear from more patients who are paying that facility fee vs. who might have had their insurance cover it in the past.


    In one of the stories in this series, you feature several analysts who argue that E.R.s are acting like monopolies, that they are monopolies, and that they act that way.

    What does that actually mean?


    So, it means that patients often have often little choice when they go to the emergency room.

    A lot of the cases I write about are people who, you know, it's late at night, it's the weekend, it's the holiday, everything else is closed, and the emergency room is their only option. So they're kind of held, you know, hostage a little bit to whatever prices the emergency room wants to charge for the care.

    They don't really even have another option. The — one of the cases you mentioned earlier about this little girl who got some ointment on her toe and ended up with a $900 bill, that was a case that happened on the weekend, when the pediatrician was closed, urgent care said it wouldn't see a pediatric patient. So the E.R. essentially becomes the only place you could go. You can't really shop at all when there's just one option.


    And with all of these different types of costs, obviously, knowing what your insurance does and doesn't cover and what your deductible is, is part of it, but are there other things that consumers can do to try to protect themselves from having this incredible surprise when the bill shows up in the mail?


    I think certainly asking a lot of questions. It can be pretty intimidating to be in these situations, but asking, what is the facility fee, how much am I going to expect?


    When you're in — sitting in the emergency room?


    When you're — if you're capable of it.

    And, granted, like, there are people who are unconscious or people dealing with severe medical situations, so it is not always possible. But if it possible to ask those questions, I would say not to be afraid to do so.

    Reaching out to the hospital after you receive the bill to ask questions about, well, why was it coded this way, why am I having these fees, to protest the bills. Doing a lot in writing can be helpful, so you actually have a record of those interactions.

    But I think one of the frustrating things I have seen for a lot of the patients I have covered, a lot of times, there just aren't good ways to protect yourself, that it is very, very hard to put this on the consumer, as their responsibility to kind of be a good shopper in this case.


    In your series, you also quote some people who argue that this is largely hospitals profit-seeking, that this is why the costs are going up.

    What do the hospitals arguing in return? I assume they're saying, no, no, no, we're not just trying to make more money for ourselves.



    So, the thing I hear the most often from hospital executives is that it's expensive to run an emergency room. They have to be open 24/7, ready for stroke victims, for gunshot victims. And they are required by federal law to see everybody. They're required to get everybody to stable condition. They can't have someone die at their doorstep.

    So, they argue, we have lots of unpaid bills. We have to keep the lights on, we have to keep things running in case of those emergencies. And I certainly do think there is some truth to that argument, that emergency rooms are expensive places to run.

    But the place where the experts I have talked to become skeptical of that argument is that all the fees are really high, that they're charging this facility fee to come in the door. Then they're charging $800 for the eardrops. They're charging $8,000 for the oral surgery, that doctors are — you know, it's not that you pay this fee and that you're in, but that there's really high charges even after you pay this fee that's supposedly there to keep the emergency room up and running.


    Sarah Kliff of Vox, thank you so much.


    Thank you.

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