OMG, how can I possibly deal with this bill?

January 20, 2014

Mark L. Friedman, MD, FACEP, FACP

Ever have that reaction after opening a bill from a healthcare "provider"?

While it has been stated by some that the Affordable Care Act (aka Obamacare) is the largest medical bill ever ($675 billion, according to, the largest single hospital bill I have ever seen was $5 million for a one-month hospital stay. Calculate the deductible and copay (at 20 percent) on that one.This is happening more often as insurers and Uncle Sam both continue to shift the cost of care back on to patients. The stated rationale is to give patients "more skin in the game," but in many cases it would seem more vital parts of the anatomy are at risk.

The bill that prompted me to write this blog was much smaller, however: a mere $1.7 million (for 32 days in the hospital). What caught my attention were the rates the hospital charged on its itemized bill (a listing of individual charges):

One day in the ICU: $26,871 (multiply by several days)
Total of pharmacy / medicine costs: $602,788
Operating room time: $139,095 (>$17,000 an hour)

The level of these charges was literally breathtaking. I had never seen charges of this magnitude before, and I've looked at a lot of medical bills. The payer, an insurance company, had agreed to a significant "discount off charges," but the hospital was still getting a Midas-sized payment based on the outrageous bill.

In my past ventures working for the payers (insurance companies), I have had great success in helping to control the costs of care. Through a variety of techniques we were able to significantly reduce what eventually was paid (and in many cases actually recover paid funds). Now, that same service is available to individuals, through First Stop Health's patient advocacy service.

Contact us with your medical bills or other medical insurance problems.

Originally published Jan 20, 2014 10:00:00 AM.