Do you have good health insurance? Pity. You could still get a $250,000 bill

Former United States Surgeon General Jerome Adams recently he tweeted his disbelief that he was charged $4,896 for an ER visit for dehydration after a hike—and that’s after his security had arranged its share. If he’s struggling to understand why his health care bills are so high, it doesn’t bode well for the rest of us.

As a professor of emergency medicine and health policy at the University of California, San Francisco, I have spent over a decade researching our health care system and documenting the Wild West of hospital billing. It started when a friend in my neighborhood was hospitalized for appendicitis and billed over $53,000. He asked me what the standard charge was for appendicitis and after doing a bit of research I found that the charges for uncomplicated appendicitis cases ranged from $1,500 to $180,000.

These ranges are not limited to surgical procedures. even routine cases such as normal vaginal delivery can be as low as $3,296 up to $37,227. These variations are still common in the most common blood labs, with one hospital charging more than $10,000 and another that charged $10 for the same blood cholesterol test.

Most of us who are lucky enough to have insurance hope and feel shielded from these absurdities. However, unfortunately this is not the case. None of us—even if we’re insured—is immune from the devastating financial consequences of the administrative monstrosity of the US health care system.

My friend Jack Emerson is an example of an educated, working, dually insured American in this exact situation. He has been paying into Medicare his entire working life, the last 40+ years, and he and his employer also pay monthly premiums for private insurance.

Work for him and his company after the pandemic has been remote for years, and last March, they decided to have an all-company gathering in anticipation of an upcoming 50th anniversary celebration. As Jack was on stage preparing for a presentation, he suddenly went into cardiac arrest. Fortunately for him, the very public nature of his medical event meant he received almost immediate CPR, and 911 brought him to the ER at Kaiser Redwood City, California, where he was admitted for six days and amazingly survived to tell his story. Unfortunately, his release from the hospital would be the beginning of significant mental anguish and stress for 10 months (and counting) due to the financial implications of the lack of communication between the hospital and his insurance companies.

Jack is fortunate to be covered by both Medicare Part A health insurance and employer health insurance through United Healthcare. His total hospitalization charges were over $250,000. Despite repeated inquiries to Kaiser, United Healthcare and Medicare, it appears that there are more than 30 outstanding claims that have somehow not been filed or processed. As so many of us who have touched the health care system know, multiple phone calls from Jack to each of these entities have yielded conflicting information with no definitive action.

A closer look at Jack’s hospital bills shows only the date of service, a general description like “inpatient visit,” and an even less descriptive provider disclosure (eg, “Permanente Medical”). In some cases, there is the name of an actual provider, but again, no further description of the service they provided, other than something like “Diagnostic Services.” This is like going to Safeway to buy bread, milk and eggs and the receipt we receive as “Food”. Except the fees, in this case, are astronomical.

In reviewing his summaries of claims, I created an Excel spreadsheet so I could see them in one place. There are 55 of these inpatient and poorly described services in categories such as “inpatient visits,” “inpatient services,” “medical services,” and “diagnostic services.” Under “inpatient services,” three of the same services are listed with the same claim number and dates of service, but have been billed separately as $18,323, $58,408, and $99,508. There is no further description of what these “internal services” entail.

Is this a billing error? Or charges for different services? There’s no way to know. Unfortunately, this lack of information about the statements does not particularly concern Kaiser. it’s just how things have become and accepted in health care in the United States. While the next step will be to request itemized bills so we can clarify what is actually being charged, the whole process—even for me as a health researcher who has devoted her career to studying these issues—is exhausting. Imagine the burden it would put on someone who almost died and is now recovering.

There is no other industry in the United States where we as Americans would tolerate such opacity in billing and inability to address it by service providers, whether it be hospitals or insurance companies.

How can we make sure we are not caught as powerless patients in this administrative web of complexity? On an individual level, each of us, upon receiving medical services, could begin an emotionally draining and time-consuming effort to obtain itemized bills and negotiate with the hospital and insurance company (or multiple, in some cases). But unfortunately, the probability of any success is low.

It’s time to put our collective powers to work to change the health care zone without arbitrators.

Recent policies have focused on price transparency, which 90% of Americans in favor, with examples such as Cents for Medicare and Medicaid Services Hospital Price Transparency rule and other current bills in Congress, such as S.3548 HR 4822 and HR 410, which would require cost transparency, including from insurers. There are legitimate concerns about potential unintended consequences of price disclosure, which could include price gouging (from hospitals raising their prices to match competitors rather than lowering them, as patients cannot act as true consumers ). However, while we do not have all the answers, it is clear that the current status quo of “secret rates” is not serving the public.

At a larger level, more fundamental reform is needed to address the fragmented delivery and financing of health care. This is happening across the country in many states. California SB770, for example, was signed by Gov. Gavin Newsom to begin the process of creating a statewide single-payer financing system. There are also more incremental approaches to a “public choice” that allow individuals to choose a government plan that competes with private plans. Washington and Colorado are operating public choice-style programs (albeit using a non-traditional private insurance company model), and of Nevada the program is scheduled to start in 2026.

While no program is perfect, we need to change the system so we don’t continue to be victims of an expensive and inefficient system. Additional billing and insurance costs are calculated 15% of US health care spending. These costs do not translate into the provision of health care services.

Overhauling our system would mean that the 350 billion dollars annually we spend on overcharging and the insurance administration could easily take care of it 195 billion dollars of the collective health care debt that 41% of Americans face.

As it stands, in the current system, if Jerome and Jack can’t figure out their health care bills and pay them, we’re all screwed.