RACHEL MARTIN, HOST:
Listeners have sent us thousands of medical bills over the last three years, and every month we take a close look at one of them. Dr. Elisabeth Rosenthal is editor-in-chief of Kaiser Health News, and she is here to tell us about the latest. Elisabeth, welcome back.
ELISABETH ROSENTHAL: Great to be here again.
MARTIN: Who are we meeting today?
ROSENTHAL: Today we meet Jen and Claire Lang-Ree. Claire's a college student who needed some care in an emergency room, and Jen is her mom.
MARTIN: And as it goes in this series, I'm imagining that the emergency room bill was way more expensive than they thought it was going to be.
ROSENTHAL: Yeah, you got it. But there were some really, really surprising charges on this one.
MARTIN: All right. Reporter Rae Ellen Bichell of Kaiser Health News spoke to them. Let's listen.
RAE ELLEN BICHELL, BYLINE: Claire Lang-Ree was in the kitchen of her Colorado Springs group home in a lab coat doing a college chemistry class when a profound pain twisted into the right side of her abdomen.
CLAIRE LANG-REE: And so I had to do the quiz. And I remember being in so much pain sitting there, like, doubled over and trying to answer these questions, but I, like, could barely read it.
BICHELL: She called her mom, Jen, a pediatric nurse practitioner in California whose hobbies include shooting rifles while skiing and also fighting medical bills.
JEN LANG-REE: I just think it's wrong in the U.S. to charge so much. And so I'm always - it's just a little side passion of mine to look at those and make sure I'm not being scammed.
BICHELL: The pair had butted heads in the past, but the pandemic brought them closer. They even went backpacking in the wilderness together.
J LANG-REE: It was really wonderful to see her in action because that's where she's comfortable is out in the woods.
BICHELL: Now her daughter needed help. It seemed like appendicitis.
C LANG-REE: It was just, like, constant pain. And so eventually we were like, all right, let's find an ER that, like, is in our insurance.
BICHELL: And the ER staff gave her an IV and squeezed in some morphine to help with the pain. They also gave her some antinausea medication.
C LANG-REE: And I was like, OK. That seems normal.
BICHELL: After a CT scan, the physician assistant came back in.
C LANG-REE: He was like, good news. You don't have appendicitis. And it looks like you have an ovarian cyst that burst. And those are really painful.
BICHELL: So they sent Claire home to wait it out - four long, painful days. Eventually, the bill came. The hospital was trying to charge a grand total of more than $18,000.
C LANG-REE: And I called my mom. And I was like, what's the deal with this bill? It's so much money.
J LANG-REE: I said to Claire, are you willing to fight it? And she said, yeah.
BICHELL: The first stop was to get an itemized bill. It showed the hospital wanted nearly $10,000 just for the CT scan. That's about four times what Medicare would allow. But what really drove them nuts was this - two IV pushes. That was not for the medications themselves. Nope. They had their own lines on the bill. The act of squeezing the syringe costs $722 each.
C LANG-REE: I was like, this just sucks because I could have just stayed home and been totally fine.
BICHELL: To make matters worse, Claire later learned from another doctor that, yeah, she did have an ovarian cyst, but it was on the other side of her abdomen, so it didn't cause that pain.
C LANG-REE: I still have no idea what was going on.
BICHELL: Still, that winter, the mother-daughter duo were united again. Summer had been for steep mountains. The winter would be for steep medical bills.
C LANG-REE: We, like, tried to do it like at least once a week, do a call, if not multiple times.
BICHELL: They wrote letters. They did research online. They made it fun with pretzel chips and fancy cocktails. Unfortunately, though, they hit a dead end. The hospital said...
C LANG-REE: We've reviewed your bill, and we found all charges to be correct. It felt like we were having two different arguments. One was like, is it incorrect charging? And ours was like, how is this ethical?
BICHELL: I'm Rae Ellen Bichell in Colorado.
MARTIN: This is crazy. I feel like I say this every time we talk, Elisabeth, but help us understand how it costs $722 to push - the act of pushing medicine through an IV syringe.
ROSENTHAL: Well, this is an act that just takes seconds, but they call it unbundling in the field. It's where hospitals have separate fees for ever-smaller components of care - in this case, an IV push fee. It's really out of control. It's similar to what's happening on airlines where they charge you, you know, for an extra bag or an exit row seat. But it's even worse in health care.
MARTIN: So is this particular hospital an outlier, or is this sort of common?
ROSENTHAL: Well, unfortunately, it's common. Colorado's one of 18 states that have some transparency around pay. So we could see that this charge is close to the norm for an IV push in Colorado. It seems to be an example of what some medical economists call sticky pricing. One hospital sees that the other is getting away with that kind of charge, so they say, oh, we should start charging it, too.
MARTIN: So how did it all work out for Claire and her mom, Jen?
C LANG-REE: Well, they learned a lot with their fight, but they ultimately hit a wall. Their insurance negotiated rate for the ER visit was $7,000. Their share was $1,600. And they went ahead and paid it because Claire didn't want to graduate from college with a dinged credit rating.
MARTIN: Right. That makes sense. So when you think about this example, what's the main takeaway from this bill of the month?
ROSENTHAL: One point is that transparency and prices alone isn't enough to keep prices in check. You know, just knowing that the charge is absurd doesn't help you avoid it. Now, as we saw here, insurers pay a negotiated rate, and they won't pay that $722 for a push of medicine. But sadly, the un- and underinsured or if you go out of network, they do get dinged with that kind of charge. In our system, the deck is tragically stacked against patients.
MARTIN: Which is why we want to hear from you all, from patients. If you have a baffling or simply outrageous medical bill, go to NPR's Shots blog and tell us about it. We want to hear.
Dr. Elisabeth Rosenthal, thank you so much, as always.
ROSENTHAL: Thanks for having me.
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