Various  medical and health policy blogs have already taken note of the latest study purporting to show that uninsured patients are being overcharged by hospitals. The political blogs won’t be far behind. There are two crucial and unassailable facts that must be absorbed in order to decode this “study? and the “news? articles it has spawned:

Fact # 1: Hospitals do not have separate price lists for patients based on insurance coverage or lack thereof.

Fact # 2: Most hospitals write off about 90% of the charges generated by uninsured patients.

Regarding the first fact, all hospitals bill their patients based on a single “charge master.? When a patient comes in, her account is charged according to the service rendered without regard to insurance. Thus, if an uninsured patient needs an appendectomy, she is charged exactly what she would be charged if she had Medicare, Blue Cross, Aetna, Medicaid, or any combination of these.

The Health Affairs “study? is deliberately misleading. It is actually about discounts rather than charges. When, for example, a Medicaid patient has an appendectomy, the hospital is paid a fixed rate based on a DRG. This rate averages about 25% of charges, and the hospital is required (by law) to write off the balance. The “study? disingenuously compares this 25% payment to the total charges applied to the account on an uninsured patient.

Which brings us to crucial fact number two: in most cases the charges for uninsured patients are mere exercises in bookkeeping—because very few of these patients ever pay anything at all. The Health Affairs “study? and related articles insinuate that uninsured patients are paying far more than insured patients for the same services. In fact, hospitals end up writing off most uninsured care to charity or bad debt. Hospitals receive an average of about ten cents on a dollar for uninsured care.

So, why do we keep seeing media reports claiming the uninsured are charged more? To put it bluntly, these articles emanate from ignorance and dishonesty. The journalists reporting on this issue, being too lazy to learn the facts, are ignorant. The “experts? who produce these “studies? are engaged in a deliberately misleading propaganda campaign whose goal is the imposition of socialized medicine on the country.

Comments 16

  1. RJS wrote:

    So, why do we keep seeing media reports claiming the uninsured are charged more?

    Because it’s true?

    I’m sure insurers put up with being charged $100 for a liter of normal saline, $47 for a vial of sublimaze, and $38 for IV promethazine.

    What insurers are charged versus what patients are charged are COMPLETELY different.

    Posted 10 May 2007 at 10:29 am
  2. Catron wrote:

    Nope. It’s “one price fits all” in the hospital biz. Moreover, no one actually pays the “list” price, including the uninsured. The self-pay patients who actually pay usually take advantage of our “prompt-pay” discount (exceeding 50%) or use our installment plan.

    Posted 10 May 2007 at 10:53 am
  3. mar cates wrote:

    It is not BS. If you have a PPO or HMO, then you are being charged pre-negotiated rates. This is certainly true for medicare patients! If you do not have the power of an insurance company or the government negotiating rates, you pay more.

    To say the article about the uninsured getting charged more is BS is BS. By the way, I am a licensed insurance agent.

    Posted 10 May 2007 at 12:13 pm
  4. Catron wrote:

    Most uninsured patients get a 100% discount. Others get large (50%) discounts for paying promptly (as most insurance companies do). Still others get no-interest installment plans for as little as ten bucks a month. It is a myth that hospitals are cleaning up on the uninsured.

    Posted 10 May 2007 at 1:27 pm
  5. John wrote:

    I keep hearing about how the uninsured don’t pay. does that mean i will be better off going to a hospital without health insurance or ID to get care? Why pay for something i can have for free? Something must be wrong with this picture, i can’t imagine the hospital not trying to bill me or collect. How do these people get free care?

    Posted 10 May 2007 at 3:44 pm
  6. BP Chaudhari wrote:


    The people getting a 100% write off are coming in through the ER. Because of EMTALA, everyone coming in the door of the ER gets treated. As for why hospitals aren’t hyper agressive about pursuing billing in this area, I can think of two factors at my own hospital:

    1) The people coming in through our ER could never pay the bill to begin with. I mean what are you possibly going to get from the guy who walked over from the homeless shelter down the street?

    2) We get money for indigent patients from the state ‘free care pool’ which insulates us from a lot of the cost of ER cases. If the state will pick up the tab, it is often more feasible to provide ‘free’ care and accept the state subsidy than to try and collect even a small fraction of the true bill from a patient who has no real prospect of paying.

    Posted 10 May 2007 at 6:22 pm
  7. Catron wrote:

    John, as Chaudhari says, EMTALA requires that (if you show up in our ER) you receive treatment whether you can pay or not. In fact, most hospitals don’t even ask ER patients about insurance until after they have been triaged. And many of the 47 million uninsured you keep hearing about in the media have deliberately stopped carrying insurance because of EMTALA.

    Posted 10 May 2007 at 9:15 pm
  8. Chuck wrote:

    What about the insured? They are actually overcharged because they have health insurance and the care provider takes advantage of this, robbing the insurance company and still leaving a large chunk for the consumer to pay. A person is better off going in stating they have no insurance and then turning the bill into the insurance company and having a smaller portion left to pay. When I see my insurance company not paying a portion because they say it is above and beyond customary, they are saying it is an overcharge. I’ve proven this in my case after a car accident.

    Posted 25 Oct 2007 at 5:40 am
  9. gladiator wrote:

    Brookhaven hospital in N.Y. Just charged me $7525 for a pelvic catscan. If I had known my bill would be 10,000 dollars for a kidney stone, I would have stayed home. Uninsured and screwed.

    Posted 15 Mar 2009 at 2:01 pm
  10. Joe wrote:

    YOU are splitting hairs! I am still paying off my UNdiscounted hosptial bill because I had no insurance after an accident. The hospital refuses to write off or discount anything. So YES, there is a double penalty for not having insurance. 1. You are reposible for the entire bill. 2. You get no discount like the insurance companies. I would call that a double hit. What kind of moron do you have to be to not see a problem with that?

    Posted 13 Jul 2009 at 9:21 pm
  11. Tina in Florida wrote:

    I was in the hospital for less than 48 hours for a GI bleed. I have no insurance. I was billed $22171.70. I had a colonoscopy and and EGD and was told I had a hemmorage in my colong but they didn’t know why. I received some IV antibiotics, IV fluids and medication for Ulcers. I had an EKG and Chest x-ray and a few ohter labs. I was charged for things that I did not receive and double charged for other things. I agreed to make small monthly payments and asked that the errors on my bill be corrected. This was two years ago! To this date the errors have not been corrected, I was told my payments were not sufficient and was turned over to a collection agency. I stopped making payments and told them until my bill was corrected that I would not pay them anything else. I have a court date next week in front of the Judge for a summary judgment. That’s right, the hospital is suing me for the total bill! I work for a small physician’s office and have documentation from some of my patients who have insurance and had the same procedures done that I had done and difference is what I was charged and what someone with insurance was charged is astounding. Just for instance: I was charged $409.00 for an EKG, the patient with BC/BS was charged $16.00! You say all hospitals charge the same no matter what the payor status is and that most hopitals write off or never get paid for the uninsured. Think again! Did you know that by sueing me for this hospital bill, if approved by the judge my paycheck can be garnished, my checking account frozen all all monies taken? Please forgive me, but you need to do a little more research on what is actually occuring in the real world before you claim that something is “BS”!!!

    Posted 20 Sep 2009 at 1:12 pm
  12. fred wrote:

    hospital do overcharge the uninsured, i had to get 3 stitches after i got cut during a basketball game, getting the stitches took less then 10 min, before i got anything done i specificlly asked how much will it cost and they refused to answer. after that i recieved 2 bills one for $585 for the hospital and one for $1251 from the emergency room physician. a total of more then $1800 for 10 min. and your telling me they dont charge the uninsured????

    Posted 28 Dec 2010 at 5:15 pm
  13. Janice Storey wrote:

    In Houston, went to ER of well known hospital. Told them I was uninsured and filled out paperwork. Waited 6 hours to see doctor. I had appendicitis attack four days before and finally went to ER due to excruciating pain. Bent over and in pain on right side. Doctor listened that I had claimed appendix. One ultrasound and two cat scans later….Doctor says”Want the good news first or the bad news?” I state good news. He told me it was NOT my appendix and go see my OBYGN. I did that – had vaginal ultrasound and pelvic ultrasound – clean bill of health. Inspection by OBYGN – clean bill of health CA125 test-clean bill of health. THE ER HOSPITAL made mistake and billed me $1200 on first bill…then promptly rebilled me for $5600.00 for the ultra sound and two catscans and they said they gave me discount to boot. I sent letter to CEO complaining I had been misdiagnosed twice (found out the ER Doctor thought it was gallbladder and had them analyze the catscans for that and NEVER even brought that fact to my attention….until I saw it in medical records I pulled). YES, THEY OVER BILL THE UNINSURED…..THEIR WAY OF DOING BUSINESS TO MAKE UP FOR THE LACK OF FUNDS THEY GET FROM MEDICARE/MEDICAID AND PRIVATE INSURANCE. I could afford to pay the $1200…but not the $5600….so now I am forced to try and hire an attorney to fight against them. My first and only experience with any hospital and it was not a good one. I also read that each hospital marks things up with specific percentages…some less and some more. The doctors make from $800 to $1200 for a appendectimy. So the average cost of an appendectimy ranges from $17,000 to $50,000 depending on what hospital in the USA… tell me why any hospital deserves to make that much money when the doctor is doing the work yet they make the most money and you are in and our within three days. I went to board certified doctor in a surgical group in Maryland and got appendectimy for $2600.00……so tell me now that the hospitals do not OVER CHARGE the uninsured…..I just backed it up with facts!

    Posted 13 Jan 2011 at 3:26 am
  14. brad wrote:

    hospital charged me 5200 for an innebriation stay. basically u lie in a gurney in the hallway for 3 hours while the staff does other things then u get a bill for 5200 which they oh so generously cut 40% off taking it down to ~3000. so the rate charged is 1000/hr

    Posted 09 Jul 2011 at 7:45 am
  15. John wrote:

    I went to Marin General Hospital and was charged 12,000 for a CT scan, 1,000 dollars per liter for IV fluids, 4,500 for a brief ER doc visit. Over 25,000 for a 6 hour long stint to let me know I had a kidney stone! This is the worst and highest bill I’ve ever heard of.

    Posted 28 Feb 2012 at 12:11 am
  16. Catron wrote:

    John, my friend, if you’re going to tell these whoppers, you need to keep them plausible. Marin didn’t charge you those amounts and you know it.

    If you did indeed have a CT done, the list price was priobably 1,000 to 2,000. And, if you’re uninsured, Marin would have given you a discount.

    Before you make up any more of these tales, you might want to check the average prices at public websites like the one at this link.

    Posted 28 Feb 2012 at 12:49 am

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