A bike accident, a $20 000 ER visit and an American scandal

2019-01-26 09:16

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After a bicycle accident last year, an ambulance transported Nina Dang to the emergency room at a public hospital in San Francisco. A few months later, the bill arrived: $20 243.

The news site Vox, which has been investigating high US medical bills for the past year, learned of her case, and wrote about it. The media coverage ignited a nationwide frenzy that lasted weeks. Now, the hospital has finally agreed to reduce the bill to $200, Vox reported on Thursday.

The story illustrates the complexity of the American health system, and its tangled web of public and private hospitals, local and federal laws, insurance that pays differently if a hospital is "in" or "out" of network, and no central authority that manages prices and coverage levels, despite the health care reform passed during Barack Obama's presidency.

In the United States, having health insurance does not guarantee peace of mind.

Patients must constantly figure out whether their insurance will cover certain procedures, or if they can see certain doctors or be admitted to specific hospitals according to their coverage. Coverage is often incomplete, and patients are left guessing what amount they will be asked to pay in the end.

In Dang's case, her insurance only covered a fraction of the bill from the emergency room, about $3 800 of the total $24 000.

That's because the insurance company did not have a coverage contract with the hospital, which was named Zuckerberg San Francisco General Hospital, after Facebook founder Mark Zuckerberg made a $75m donation.

In fact, the hospital was considered "out-of-network" for all private insurers, a policy Vox described as "surprising", and which resulted in vastly higher bills for many patients.

Vox, which has built a database from some 2 000 bills that readers sent in, showing exorbitant medical bills, also found that a baby's visit to the ER at the same hospital resulted in an $18 000 bill.

Elsewhere, a woman in Kentucky was billed $12 000 after her insurance company refused to pay for her ER visit, saying her stomach pain did not merit an emergency.

Such stories have begun to mobilise lawmakers, and some bills have been proposed, and hearing dates set in an effort to change current practices.

Zuckerberg Hospital, in the meantime, has not announced any change of policy, beyond adjusting bills for certain patients, like Dang.

"It's great that things worked out for this patient! But, having journalists investigate medical bills is a pretty terrible way to run a health care system," tweeted Sarah Kliff, the Vox journalist assigned to the project.

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