Vox reporter Sarah Kliff spent the past 15 months analyzing more than 1,100 emergency room medical bills submitted by patients from across the U.S.
Ms. Kliff said her initial goal was to get a sense of how unpredictable and costly ER bills were across the country. While she will officially stop collecting medical bills on Dec. 31, she said the project has highlighted hospitals' lack of transparency regarding the cost of medical services and that the price of a certain medical service may not be fully guaranteed until a patient receives their bill.
Here are five things she learned from her research:
1. Hospitals often charge exorbitant prices, even for items typically available at a drugstore. Ms. Kliff noted the phenomenon was particularly high for patients who underwent pregnancy tests at a hospital. During her research, she received medical bills for patients who were charged more than $100 for a pregnancy test, including a $465 test given at an emergency room in a Georgia hospital.
2. In-network hospitals do not guarantee patients will see in-network physicians. Unless states have laws regulating out-of-network billing, patients often end up with expensive medical bills, as physicians are not obligated to inform patients they are out of network. Ms. Kliff said such surprise bills appear to be especially common in Texas, where as many as 34 percent of ER visits lead to out-of-network bills — 14 percent higher than the national average of 20 percent.
3. Sitting in an ER waiting room may come with a charge. Ms. Kliff found hospital's facility fees often end up leaving patients with hundreds of thousands of dollars in medical bills, even if they never receive actual treatment or a diagnosis during their visit. While hospital executives often argue that facility fees help institutions keep their ER doors open for patients, a 2017 Vox analysis of such fees indicated charges rose 89 percent between 2009 and 2015 — roughly twice as fast as overall healthcare prices.
4. Patients are at a disadvantage when advocating for themselves in an ER setting. Patients are typically at the mercy of hospitals and health systems when it comes to ER billing, Mr. Kliff found. While some patients who submitted bills to the publication's database were able to successfully negotiate down some charges, in most cases, it is at the hospital's discretion as to whether they will negotiate or reverse a bill.
5. Congress has taken interest in the issue. As more journalists shed light on hospital billing issues, elected officials have become more interested in the issue and are crafting legislation advocating for more transparency.
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