UVA Doctors Decry Aggressive Billing Practices By Their Own Hospital | Kaiser Health News

Debt is debt, right? No, it’s not.

When people don’t pay health care bills, we assume they can’t afford to. While that may be the case, it’s not always the case, but it’s nearly always assumed to be the case. And when health care bills are not paid, do we ask what other non essential bills are unpaid or paid for that matter?

Hey, if you have no insurance and end up with a $50,000 hospital bill, you’re in trouble. But we also need to ask is that person being billed at a rate higher than would be accepted by an insurer and if so, why. If the bill is $5,000, how does that fit with other bills and spending?

In other words, should health care bills be handled differently than any other financial obligation an individual incurs? Nobody wants to answer that question.

Doctors are realizing that financial barriers to treatment and budget squeezes from bills can be as harmful to patients as disease, said Dr. Marty Makary, a surgeon and researcher at Johns Hopkins Medicine who studies hospital debt collection and is urging UVA alumni to press for further change. “I have not talked to a single patient or student of UVA or faculty member or alumni who thinks it is reasonable for the hospital to sue patients who cannot afford their bill,” he said.

Source: UVA Doctors Decry Aggressive Billing Practices By Their Own Hospital | Kaiser Health News


  1. One of the real problems here is something which hospitals use called the chargemaster which is essentially the list price which is not based on reality. Each hospital develops its own different chargemaster. (Medical offices, labs, clinics, use similar billing systems) Say someone with no insurance is in the is in a hospital and has pain. As part of the hospital stay, over a day or two the patient receives 10 generic pain killer tablets such as ibuprofen and has an x-ray and an mri. The hospital chargemaster bills each ibuprofen tablet at $5, the xray at $100, and the mri at $800. If you have insurance, (or medicare/medicaid) the insurance company negotiates with the hospital to pay 50 cents for each ibuprofen, $10 for the xray, and $100 for the mri. With no insurance the bill is $950. With insurance the insurance company negotiated payment is $115 which is probably a reasonable estimate of actual costs. With no insurance the patient is billed and expected to pay $950 and if you can’t pay, the hospital may send your bill to collections and/or sue you. Now multiply this example by someone being in the hospital for several days with multiple tests and maybe surgery. The chargemaster list price comes to $50,000 but the insurance company or medicare pays a negotiated price of $7,500. Is it morally and ethically right to expect an uninsured patient to pay $50,000 or be sued? This can result in bankruptcy for an uninsured patient. A better way would be for the uninsured patient–or indeed for everyone including insurance companies–to be billed $7,500 and then if the patient still can’t or won’t pay, then maybe sue them for $7,500 but not for 50,000! But as Dwayne points out, how do we know if the patient really can’t afford to pay or is just trying to scam the system by pleading poverty? Furthermore, how can we get rid of the totally opaque and unreal chargemaster billing system?


    1. Excellent summary that most people don’t understand. I’m going to use your comment in a future post. Another question, how do we explained to the insured population their costs and premiums are going up to accomplish this?


  2. I’m sure they didn’t ask the doctors how much they were will to cut their salary and/or benefits to enact a policy of non-collection of these debts.

    Richard hits the nail on the head. If these debts are to be forgiven – we need a deep dive into the finances of the individuals involved. They can afford iPhones, luxury cars, etc., but not their medical bills. He’s hit on this before with the bogus statistics about bankruptcy “caused” by medical bills. They count any medical bills as having contributed or caused the bankruptcy.


  3. Interesting article. While I do think that deadbeats should be sued, after all healthcare is not free, this is not the right approach. Sounds like they need to come up with a way to force people into a sliding scale payment plans based on the lowest fee that the hospital will accept from any insurer and their income. This plan should be based on all medical bills from all providers, since often you get multiple bills from labs, doctors, hospitals over weeks or months depending on the illness. Maybe have an annual review to rework the total payment plan. Then if they fail to meet the a payment plan which they agreed to, the hospital could go to collections.

    The question who can run such a plan? Hospital and providers are not banks. Banks would charge too much interest. Government would just make it worse.

    One can see how a few days in ICU or CCU can bankrupt people and force them not to do their follow up treatments or medication.


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