Surprise health bills are not uncommon for anyone who has ever experienced a health emergency, and the amounts charged for these services – particularly if they were rendered outside of the patient’s health insurance network – can be enough to send some spiraling into bankruptcy.  Today’s Crain’s Health Pulse Extra highlights what health care providers in New York emergency rooms charge for their services versus what Medicare is willing to pay for those services.  The difference between the two amounts (i.e. the balance) which in some cases can be billed to the patient, is currently being evaluated by the New York State Department of Insurance and the Department of Health.  Topping out the Crain’s list with the largest discrepancy is a lesion removal from the scalp paid at $175.96 by Medicare but billed at $20,000 – amounting to 11,366.22% of the medicare payment.  Second on the list is a laproscopic gallbladder removal – a procedure which Medicare will pay out $641.00 for, but is billed at $25,000 by the emergency room – 3,900.16% of the Medicare amount.
 
To read the full Crain’s Health Pulse Extra, click here.

The State Department of Insurance and Department of Health held a joint public hearing on the subject of balance billing last October.  To read HCFANY’s blog post, or our testimony submitted, please click here.