Why I’m Obsessed With Patients’ Medical Bills

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My reporting obsession with medical bills started with a bandage. A very, very expensive bandage.

Four years ago, before I worked for The New York Times, a reader emailed me a surprising story. He had taken his 1-year-old daughter to the emergency room because after her nails were clipped a bit too short, her finger started spurting blood. The little girl was fine, and received a disposable bandage that fell off on the car ride home.

Then the bill came: $629 for the visit. How could such a simple visit cost so much? I discovered that the real cost lay in fees that every emergency room charges just for walking in the door. I also discovered something else important.

At the bottom of my article about the little girl’s case, I asked readers to reach out if they had similar bills to share. I expected a few dozen emails. I ended up with hundreds. Frustrated readers desperately wanted to share their billing experiences — and, I quickly learned, had access to some of the most valuable, most private information in the American health care system.

Now, I’m turning to the readers of The Times, where I work as an investigative journalist, to help me report on what people are being charged when they get tested or treated for the coronavirus. This week, The Times introduced a new form so patients may submit their bills, which contain insights that are nearly impossible to find elsewhere.

That’s because in the United States, hospitals and doctors’ offices typically keep their prices secret. Powerful lobbies want to keep things that way. But people in the Trump administration see transparency as a way to reduce medical costs. Last year, when they proposed a rule that would make public the prices that providers negotiate with insurers, the American Hospital Association sued to stop it. (The hospitals recently lost in federal court but plan to appeal the decision.)

The secrecy that surrounds health care prices is a huge hurdle for health care reporters like me. I know from academic studies that America’s health care prices are the highest in the world, and that fees can vary drastically from one hospital or doctor’s office to another.

But it’s still difficult, sometimes impossible, to write a story about which hospital or doctor is the most expensive or the least. That’s the information readers want. It’s the information I want, too. And it’s the hardest to get.

The emails readers sent me after I wrote about that $600 bandage gave me a solution. Many included medical bills with the price charged, what the insurer paid and what the patient was responsible for. The secrets were suddenly in plain sight.

Since then, readers’ medical bills have become a crucial source for my reporting. They are the documents that say exactly what medicine costs in the United States. Coupled with interviews with patients, who can explain the effects of those costs on their lives, they underpin powerful stories about living in a country where routine care can cost three or four times what it does abroad.

Last year, readers’ bills helped me figure out that the only trauma center in San Francisco was out of network with all private insurance companies, leaving patients with thousands of dollars in medical debt. I received those bills through a reporting project at my last job, where we crowdsourced a database of 2,000 emergency room bills.

Just last month, I got exceptionally lucky when four patients who received coronavirus tests in one Texas emergency room decided to send me their billing documents. Three patients sent them in totally unconnected to one another, each aghast at the prices. (The fourth came from one patient’s friend.) Together, they showed that the price of a test could range from $199 to $6,408 — all in the same facility.

That story made me eager to better understand what the price of testing and other coronavirus care looks like in the rest of the country, and, working with my Times colleagues, I decided that readers’ bills were the best way to tell the story. (When handling sensitive information, access is highly restricted and is never published without prior consent.)

Collecting medical bills is, admittedly, a slow, inefficient process that doesn’t lend itself to automation. The documents that come in are messy. Some are image files and others are PDFs. Each hospital and insurer uses its own formatting. A few medical bills — the ones I now swoon for — include detailed, itemized information that shows the price of every pill and scan. Others, frustratingly, lump everything together into one price.

Running a project like this is equal parts stressful and exciting because I don’t know in advance what stories I’ll tell. Instead, I’m waiting to see where the readers’ submissions will guide me.

Right now, I’m mostly excited: Since starting on Monday, we’ve already had nearly 200 submissions. The more I read, the more interesting patterns I start to notice.