hospital bills

Florida Legislature

 After an emergency trip to the hospital, some patients find a nasty surprise in their mailbox -- bills their insurer didn't pay. Florida law protects some patients from this but not others.

Those in an HMO would see all their bills covered: ambulance, hospital, and doctors. But those who have another type of health insurance could be slapped with astronomical bills. They could have collection agents calling to get whatever their plan didn't pay.

Almost a year and a half ago, Mt. Sinai Medical Center CEO Steve Sonenreich pledged on WLRN to make public what insurance companies pay his hospital.

But he learned that non-disclosure agreements between the hospital and the region’s insurance companies, kept him from legally sharing that information after all.

It turns out these secrecy agreements are standard practice between South Florida insurers and hospitals, WLRN and the Miami Herald reveal in its comprehensive series the “Power of Price.”

Showing once again that hospitals' charges bear no relation to what a stay actually costs for most patients, Medicare officials on Monday released data showing sticker prices soared by four times the rate of inflation.

There are worrisome signs that actual spending is being forced up, as well, because of hospital systems' growing size. The bigger the hospital system, the more clout it tends to have in negotiating contracts with health plans.

A nurses' union says some hospitals are charging exorbitant rates, in certain cases more than 10 times more than what they need to cover costs, according to its analysis of Medicare Cost Reports.

Florida Orange Park Medical Center tops the list for Florida, the Florida Times-Union reports.

Responding to changes in the Medicare auditing system, which gave a bonus payment to audit teams that found questionable admissions, hospitals started holding patients in "observation" status even though the patients thought they had been admitted.

It leaves patients owing a lot more for their hospital stay, and -- worst case -- the entire nursing home bill if they are transferred to one. A number of Medicare patients and consumer groups are suing to get the problem solved, but so far it hasn't been.

One of the most common operations in Florida -- joint replacement -- is the focus of the New York Times’ continuing series on how health-care pricing defies all the laws of economics. In other fields, as patents expire and technology matures, competition takes hold and prices fall, but not in health care.

Jason Redmond / AP

It isn't exactly news that hospital bills bear no relation to what products and services actually cost, or the amount that is paid. 

What IS new is the pressure on the  hospital industry to defend its pricing system. On Wednesday, the Obama administration released data showing how much each hospital charges for various types of treatment and contrasts that with how much Medicare actually pays for it.