Patients may think their insurers are fighting on their behalf for the best prices. But saving patients money is often not their top priority. Just ask Michael Frank.
This story was co-published with NPR.
Michael Frank ran his finger down his medical bill, studying the
charges and pausing in disbelief.
The numbers didn’t make sense.
His recovery from a partial hip replacement had been difficult. He’d
iced and elevated his leg for weeks. He’d pushed his 49-year-old body,
limping and wincing, through more than a dozen physical therapy
sessions.
The last thing he needed was a botched bill.
His December 2015 surgery to replace the ball in his left hip joint
at NYU Langone Medical Center in New York City had been routine. One
night in the hospital and no complications.
He was even supposed to get a deal on the cost. His insurance
company, Aetna, had negotiated an in-network “member rate” for him.
That’s the discounted price insured patients get in return for paying
their premiums every month.
But Frank was startled to see that Aetna had agreed to pay NYU
Langone $70,000. That’s more than three times the Medicare rate for the
surgery and more than double the estimate of what other insurance
companies would pay for such a procedure, according to a nonprofit that tracks prices.
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Source: ProPublica
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