This man will help you get out of expensive medical bills

As the father of four sports-playing children, David Silverstein has long grappled with the high cost of hospital care. “There’s always a bill for something,” he said, laughing.

But something changed years ago when he received an emergency room bill for his then-high school-aged daughter, Kailey. The total came to $12,000, but Silverstein’s portion came in just under $1,000.

Despite a background in health care — Silverstein has worked with hospitals and insurance companies for years through his management consulting business — he was flummoxed by the math. The 92% discount may have benefited him, but it also seemed arbitrary and confusing, he said.

But after he paid the bill, he couldn’t get the hospital to respond to his questions. So he decided not to make that mistake again.

Related: This expensive risk lurks in nearly every medical experience you have

He has been challenging hospital bills ever since, and started doing it for non-family in early 2016, through his Colorado-based nonprofit Broken Healthcare. Silverstein estimates that he’s reached a couple of hundred people since, including those who have used his techniques on their own. None of the roughly 40 patients he’s given direct help to have paid a cent, he said.

Providence Saint Joseph Health, where Silverstein has challenged his daughter’s emergency room bills, told MarketWatch that it’s worked to simplify its medical billing for a number of years.

“We work to help patients navigate what is an overly complicated process, but the industry has to do better,” said , Providence Saint Joseph Health’s Kathleen Dowling. “The fix will take advances in technology, coordination among the government, providers and the health insurance industry and a tremendous investment.”

Silverstein’s strategy is an unusual one, and possibly even unique. Plenty of non-profits and for-profit businesses aim to help consumers with expensive medical bills. But while these groups may dispute or negotiate bills, there’s an assumption that patients will ultimately pay any legitimate charges, for fear of eventually damaging their credit.

But more and more people are now affected by high out-of-pocket costs, thanks to the rise of cost sharing, lending Silverstein’s efforts a new urgency.

“The problem I’m trying to address is that nobody has figured out how to do anything about it. We know the problem is there, but we have a broken political system that is incapable of fixing it,” he said. “I know it sounds crazy that one guy can take on the health care system but… I have no choice not to act.”

Read: American health care is so messed up that a whole industry has been created to help navigate it

Challenging hospital bills

After a few days of extreme pain last year, Jamesia Shutt realized what she thought was back spasms was probably something worse. She knew she had to go to the emergency room.

Four hours, several tests, some morphine and IV saline later, the 34-year-old received a diagnosis of pneumonia and was sent home.

Then the bill came, two weeks later.

“Oh my gosh, yeah, I freaked out,” she said. “I went in there expecting it to be expensive — it’s an emergency room. But I didn’t expect after their adjustments and everything to spend $8,000 for a four-hour visit.”

The bill was technically $16,800, not including the roughly $1,000 cost of the emergency room doctor. After uninsured discounts, the total came to about $9,000 — still too much for Shutt, an art student, who’s lived in Colorado her whole life.

That’s where Silverstein came in. Together, they reached out to the hospital, asking it to explain its billing. In return, Shutt said, the hospital simply insisted that she pay, offering her payment plans.

David Silverstein began challenging hospital bills for non-family members in 2016, and says the roughly 40 people he’s worked directly with haven’t had to pay a cent.
Parker Adventist Hospital, which is part of Centura Health, wouldn’t comment on Shutt’s particular case. But it did note that Centura Health has offered an online price tool — which includes regional pricing for the top 65 procedures for those who self-pay — since May 2015, and patients can request a custom price quote.

“We are committed to evolving our transparency strategies and sharing resources to help patients navigate and better understand where to go for care,” a Parker Adventist Hospital spokeswoman said.

Shutt and Silverstein continued to press for more information. Though medical providers will give out a more detailed bill upon request, those don’t provide a rationale for the listed cost.

So bills appear confusing at best, indecipherable at worst. One of Shutt’s charges, for the emergency room, totaled around $9,000. Then she was charged separately for a number of other tests, medical imaging and pharmacy services.

She wondered, was the $9,000 charge simply for the room itself? Should anything else have been included in that? But there was nothing to refer to, she said: no public pricing list, just the hospital’s word that the prices were correct.

“How do you know you’re not just getting raked over the coals, which you probably are?” Shutt asked. She and Silverstein wanted “to clarify what is being charged, how do you come up with billing, how are your prices charged. Do you pull them out of thin air?”

Advocates like Silverstein say this is part and parcel of a larger problem: U.S. patients have long been unable to find out the price of a medical procedure until after it occurred.

In this, the U.S. health care system is unlike any other customer experience. Imagine sitting down to a meal, going on a flight, or sending your kids off to school, all without knowing the cost or outcome until later, health care advocates say.

“There’s no other market in the world where we ask this much of the consumer and give them this little information about what they can expect from us upfront,” said David Vivero, chief executive of health care transparency company Amino.

Read full story at MarketWatch

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