When Standard Hospital Bills Aren’t So Standard


A recent study that looked at more than 19,000 operations found that the costs of medical care in the U.S. aren’t at all uniform–for example, you could be charged anywhere from $1,500 to $180,000 for the same type of surgery.

The study, carried out by researchers in California, compared the costs of treating appendicitis–which involves removing a person’s appendix through a surgical procedure called an “appendectomy.” The researchers looked at the cases of people between the ages of 18 and 59 who were hospitalized for three days or less and whose cases were classified as “uncomplicated..

The average bill for treatment was about $34,000, but researchers also came across a bill that totaled $182,955. Some of the differences in billing, the study found, happen because of the kind of hospital (public or for-profit, etc.) and how ill the patient is. For example, public hospitals tended to have lower costs on their bills than for-profit hospitals, the study found.

The biggest bill was for a woman undergoing cancer treatment who had her appendix removed–although her bill didn’t show any charges for cancer treatments. However, differences in hospital type and illness don’t explain all of the costs and differences in bills, researchers and medical experts say.

About 32 percent of the differences between bills remain unexplained, according to the study. Experts and patient advocates who commented on the study also pointed to the impact of insurance, saying that some well-insured patients are insulated from many kinds of charges, while under- or un-insured patients are given heftier bills–and often without understanding what hospitals expect them to pay for.

Even among insured patients, the type or brand of insurance can really affect the cost that ends up on your final bill. According to one healthcare advocate, costs within the same state, for the same type of procedure, can be three to six times as much–depending almost entirely upon insurance.

Along with questioning the impact of insurance companies, healthcare experts also say that expecting patients to comparison shop between hospitals is unrealistic–particularly for emergency care. Researchers also said their study looked at the amount that patients were charged, not at how hospitals were actually paid. Because hospitals can receive payments from insurance companies, employers, the government and other groups (like drug companies), some of the costs that get passed on to patients may have been affected by these other sources of income. But how this income affects a patient’s bill still isn’t clear.

Some advocates say that looking at how hospitals, insurance companies and other groups give doctors and administrators payments and other kinds of bonuses or “incentives” for certain kinds of medical care may help shed light on how a hospital bill actually gets made–and how costs get passed to patients.


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