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Huge Hospital Markups
Burden Patients
For profit and public facilities are rapidly hiking prices;
nonprofits are limited by law
By M.B. Pell with The Atlanta Journal-Constitution
Atlanta Business News
Wednesday, April 20, 2011
This article points out the incredible mark-ups hospitals, profit or non-profit, are commonly adding to their bills. Anywhere from 157% to 702% markup for procedures is commonplace. It doesn’t matter if you are an insured or underinsured patient or an insurance company, you have to fight with the hospital to get the bill reduced to something much more fair and reasonable. We have the tools to help you get results you can afford.
Markups for hospitals in metro Atlanta ranged from 157 to 702 percent in 2009, according to an analysis by The Atlanta Journal-Constitution of the most recent hospital financial disclosure data collected by the Georgia Department of Community Health.
The highest markups for Atlanta area hospitals have more than doubled since 1999, when averages ranged from 124 to 319 percent, according to the AJC’s analysis of state data.
Tenet Healthcare Corp.’s North Fulton Regional Hospital marks up its prices an average of 702 percent over cost and South Fulton Medical Center, another Tenet facility, charges an average markup of 618 percent, giving the two hospitals the highest markups in a 10-county metro area.
Tenet operates for-profit hospitals, but tax-exempt, non-profit hospitals also mark up their services.
Southern Regional Medical Center’s average full charge is 332 percent above costs and Saint Joseph’s Hospital of Atlanta’s full charge is 314 percent more. Both are nonprofit.
Even with discounts the bills are severely overinflated. Holly Lang, the hospital accountability project director for Georgia Watch, a consumer advocacy organization, explains the paradigm well. She says“To put a discount of 50 percent on a procedure that’s been marked up 700 percent, that’s still a markup of 350 percent and that’s still a problem for many patients, especially when the average markup across the state is about 240 percent”
Of course, our clients do not typically know how to navigate medical financial systems, know what other hospitals are charging for like services, or have relationships with the accounts receivable executives of hospitals. That is where our services become very valuable to our clients.
Uninsured Patients: Unfortunately insurance coverage is just too expensive for self employed or unemployed individuals and a medical procedure can cause financial devastation.
But thousands of uninsured patients are charged the full amount either because they do not qualify for assistance or they are unaware of assistance programs and do not apply.
Underinsured Patients: Insured patients have the benefit of the coverage offered through their insurance company, but many times due to high deductibles and unexpected out-of-network charges, the patient cannot pay their inflated bill either.
Insured patients pay far less, but they are not completely shielded from high markups. Patients with large deductibles or those who receive a service from an out-of-network provider can be buried under in debt or forced into bankruptcy, said Mark Rukavina, executive director of the Boston-based Access Project, a nonprofit group that helps patients resolve medical debt problems.
“The higher the bill and the higher the markup, the more likely people are going to have a problem paying the bill,” Rukavina said. “The problem is huge and millions of Americans are struggling to pay their medical bills.”
A study published in the American Journal of Medicine in 2009 found more than 60 percent of bankruptcies were related to medical issues.
An unexpectedly high medical bill can be especially frustrating for patients who have insurance, took the time to assure their doctors and hospital were in their insurer’s network, but are billed for portions of a procedure, for example, anesthesiology, performed by an out of network provider.
This can create a bill that includes the hospital’s full charge for the out-of-network services, Rukavina said.
Federal rules prohibit hospitals from passing the rest of the cost to the patient.
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