Why did you bring the firetruck? Is balancing billing why hospitals profits are billions while 20% of American have medical debt

Posted by Walter KeaneSep 21, 20210 Comments

This blog also discusses the profit hospitals make, the medical debt endured by Americans, and it asks if HCA Healthcare's road to billions in profit required surprise medical bills, balance bills, out-of-network bills, crazy ambulance bills, outrageous emergency room charges, and any other hospital billing shenanigans?

Or perhaps we American's are to blame because we've failed to set aside thousands of dollars to cover the deductible? And that dang out-of-network bill … and don't forget to budget hundreds of dollars for the ambulance ride.

Introduction: Why'd you bring the firetruck?

The physical pain was the worst I ever had.  So bad that I dialed 911 to be taken to the hospital, and Draper City answered the call.

As I was wheeled to the ambulance, I saw a huge fire truck parked in front of the ambulance.  "Uhhhggg," I moaned.  " Are you in pain? What is it?" the paramedic responded.  

"Why did you have to bring the ^%$#@! fire truck? You just needed the ambulance.  How much is that going to cost me?" I moaned.  "Shhhh, take it easy, buddy."

"Can you guys drive me to IHC because that's in-network?  Send the fire truck back, please," I pleaded.  "Shhhh, take it, easy, buddy."

"Hey, where are you taking me?" "Buddy, we're taking you to Lone Peak Hospital." 

"Uhhh, that's out of network. My out-of-network deductible is $7,500, and my in-network is $5,000. Is there another way?"  "Shhhh, take it easy, buddy."

The drive from Draper City Fire Station 21 to my home to Lone Peak Hospital is less than 2 miles total; my house is two city blocks from Lone Peak Hospital.  I got a bill from Draper City for $906.65.

My insurance paid nothing toward the ambulance and fire truck; Draper City's bill did not count toward my deductible.  I still don't know why they brought the *%}@&^! fire truck. 

After three days on the Covid floor, Lone Peak sent me a balance bill for $5,790.  My health insurance had a $5,000 in-network deductible and $7,500 out-of-network.  The price tag for the ambulance, fire truck, and three days on the Covid floor was shaping up to be well over $10,000. 

If you're reading this because you've got an insane medical bill, I feel your pain, and I want to fight for you.

There's evidence that balance bills result in higher costs for the same procedure or treatment according to the interim rules regarding the No Surprises Act.

Is there any evidence that hospitals or medical providers would take advantage of surprise medical billing, balance billing, or out-of-network billing for profit? Do hospitals make profits off of providing emergency medical care?

Congress did pass the No Surprises Act to fight surprise medical bills. More on point are the "interim final rules " published July 2021, which discuss balance bills, among many other things.

(Balance bills are a form of surprise medical bill.  Typically, the hospital receives some money from your insurance but then sends a bill for "the balance." Maybe you had to go out-of-network for medical care and a bill for thousands of dollars resulted.  Or perhaps you had a planned procedure, but a provider who treated you was out-of-network, so you got an unexpected monster medical bill. There are numerous scenarios, including emergency room visits, air ambulances, etc.)

The interim rules note, "the evidence suggests that the ability to balance bill is used as leverage by some providers to obtain higher … payments."  Was profit the motivation for my balance bill?  

HCA annual profit climbs to $3.8B

Lone Peak Hospital tried to stick me with a $5,790 balance bill.  When I got the bill, I looked up the hospital to see if it was a not-for-profit institution. Lone Peak is part of MountainStar Healthcare which is a division of HCA Healthcare.

Ayla Ellison wrote, "HCA annual profit climbs to $3.8B", Hospital CFO Report, 2 Feb. 2021.  Ellison provided a quote from HCA CEO Sam Hazen, "We are incredibly proud of our colleagues and our accomplishments in 2020, which included returning over $6 billion of CARES Act funds to the federal government."  (Can I get some of that federal money to pay for Draper City's fire truck bill? Nope.)

Here are thethe hospitals HCA has an interest in according to their website: Brigham City Community Hospital, Cache Valley Hospital, Lakeview Hospital, Lone Peak Hospital (my favorite), Mountain View Hospital, Ogden Regional Medical Center, St. Mark's Hospital, and Timpanogos Regional Hospital. 

HCA has just acquired five more hospitals according to KSL. Davis Hospital, Jordan Valley Medical Center, Jordan Valley Medical Center - West Valley Campus, Mountain Point Medical Center, and Salt Lake Regional Medical Center are now part of HCA.

If heading to these hospitals, remember they make billions in profit while Americans carry medical debt.

In April 2021, the United States Census Bureau reported that a shockingly high percentage of US households carry medical debt.

Over 20% of householders Ages 35 to 64 years have medical debt.

Share of U.S. Households with Medical Debt by Householder Age

It seems odd that Sam Hazen returned $6 billion in federal money while so many people are in debt due to medical bills.  Couldn't that money have been used to care for the needy?  Or at least not send me a balance bill after my insurance paid them $23,000?

A study published July 2020 in JAMA, Medical Debt in the U.S., 2009-2020, noted that the largest source of debt owed to collection agencies was unpaid medical bills!  How much of that billing was deliberately out-of-network to garner a profit?

Conclusion - I speculate that Surprise Medical Bills and Balance are a significant part of HCA's profit.

I guess that HCA issues balance bills, out-of-network bills, and all types of surprise medical bills to earn as much profit as they can. 

No one ever knows how much their planned medical procedure will cost, and everyone thinks their exposure is just the deductible. See Jennifer Finney Boylan's article, "My $145,000 Surprise Medical Bill", New York Times, 19 Feb. 2020.

If your medical bill resulted from an unplanned event (like mine), there's no way to anticipate the cost. Based on my experience, I will try and set aside at least $10,000 to cover the deductible, ambulance ride, and litigation costs.  (Did I mention I have to serve Lone Peak Hospital to get rid of that $5,790 balance bill?)

It's a nightmare out there. If you have a surprise medical bill or you've been sued for outstanding medical bills, reach out and let's talk for free.