Back surgery saved him from paralysis. Then the bills arrived: over $650,000
No one really knows what anything costs in health care — and too many people are getting surprise medical bills for thousands of dollars. In a new series, “Medical Price Roulette,” CBS News will explore the reasons, and we’re collaborating with journalists at ClearHealthCosts to bring transparency to health care markets.
Frank Esposito says it started last March with unrelenting back pain. He could barely move, and an MRI soon showed a bulge in his spine. A specialist told him to go to the closest hospital — immediately.
Doctors at the emergency room said he needed surgery. The herniation was so severe it could cut his nerve, Esposito said, and render him paralyzed.
The surgery was a success, but then the bills started coming: over $650,000 in all.
His insurance company said his back surgery didn’t qualify as an emergency and wasn’t medically necessary.
“What was my choice? Just be paralyzed for the rest of my life?” asks Esposito, a tool and die maker from Long Island, New York. “Then to get these bills that were so overwhelming. You say, this can’t be real, I mean, I really don’t have to pay this. How am I gonna pay this? And you sit there. And you start cryin’ ’cause you don’t know what you’re gonna do.”
Four in 10 consumers said they’d received a surprise medical bill in the previous year, according to a 2018 poll by Kaiser Health. Half of those bills were over $500.
Dr. Aaron Carroll is a pediatrician and health services researcher who says there is no transparency in health care.
“This is somebody who’s in pain, who is, you know, immobile. And now has been told, ‘OK, you might be paralyzed unless you run to the hospital.’ How are they supposed to become good shoppers, and make complex, rational decisions? They’re going to say, ‘Please tell me what to do, because that’s your job,'” Carroll said.
Even if it’s not an emergency, CBS News and ClearHealthCosts found there can be surprising swings in what a procedure or test can cost.
We surveyed cash prices in two major metro areas: Dallas-Fort Worth and San Francisco.
A simple blood test in the Dallas-Fort Worth area ranged from $10 to $176, and from $15 to $126 around San Francisco.
An ultrasound of the abdomen in Dallas ranged from $115 to an estimate of $2,459. In the Bay Area, the same procedure ranged from $100 to $2,800.
While not everyone pays a cash price — especially those with good insurance — the cash prices reflect what the provider will accept.
“Plans will have different deductibles, different amount of co-insurance, different amount of co-payments,” Carroll said. “And it also depends of course, what they’re charging — what the price is, and then how much you are responsible for that price. That number has gotten much higher than people would think. It can be a significant part of people’s incomes.”
Carroll added: “I think people have an assumption, right or wrong, that insurance is going to protect them. That’s why if we pay that much, we think we’re going to be covered, and we’re not going to see that surprise bill. So, when you do, people are shocked.”
Esposito has already taken $49,000 from his retirement savings. He hired a company to negotiate down some of his bills. After appeals, Esposito’s insurer, Oxford United Healthcare, did pay some of his doctors’ bills. But he still owes $220,000 — CBS News is still waiting for a response to questions about that balance.
“You work all your life. You work to buy a house. You work to have a house,” he said. “You have to save up for everything. We would like to be able to know that we can go to the doctor, that we can get healthy, that we can get taken care of without losing everything we have.”
We’d like to know what you paid for medical procedures. Share your story and learn how you can search ClearHealthCosts’ database of prices in our sample markets. You can also email us at firstname.lastname@example.org.
This content was originally published here.