Patients and health care providers challenged by costs and billing -- 

Whether they have health insurance or not, people seem to have similar challenges in paying for health care or understanding how health services are billed.

Lilia Tapia, a business owner in Alameda, took her baby son to Oakland Children’s Hospital for surgery to fix a problem with his eye. It’s been seven months since the surgery, and Lilia has just received another bill from

another health care provider – the third separate company (in addition to the hospital) to send her a bill. “Unless you’re a billing professional or work for a hospital you don’t know what they writing,” says Lilia. “They bill you from different places, so you don’t know when you’re finally done paying,” she adds.

Though Lilia has insurance, she felt the care was very expensive. She also seems to be among the majority in not being aware of California’s Hospital Fair Pricing Act, a law that limits the amount that most uninsured and underinsured patients have to pay to the amount that a public insurer would pay for the same care. In most cases, this will be the Medicare price.

HospitalBillHelp.org is a new consumer information website aimed at raising awareness of the Hospital Fair Pricing Act and helping patients deal with hospital and other medical bills.

"In our current health system, self-pay patients lack bargaining power, and are asked to pay more than anybody else for needed care," said Anthony Wright, Executive Director of Health Access.

Shelley Horwitz, administrator of Bay Valley Medical in Hayward, says her organization charges everyone the same. “There is one fee schedule Bay Valley Medical uses to generate any service that is rendered here,” she says. “The huge issue with health care is what an organization charges is rarely what they get paid,” adds Horwitz. “They get paid what the insurance company allows for that service or what the government allows.”

For people with health insurance, the billing practices of the health care provider may be less important than the fine print of their insurance plan.

The case of Laura Burwell of Chico, CA is demonstrative of the way in which deceptive “junk” insurance policies can be very costly. Laura thought she was buying comprehensive coverage when she purchased health insurance with a $281 monthly premium, a $500 deductible and $50,000 in hospital coverage. She didn't realize that her hospital coverage was capped at $3,000 a day, until a rattlesnake bite landed her in a hospital and with a $73,000 hospital bill. 

"I was thinking I was covered for $50,000," Burwell said, “but my insurance only paid $3,000 and then I was responsible for the rest.”

Fortunately for Laura, she was protected by California’s Hospital Fair Pricing Act.  In her case, that meant her final bill was reduced to $7,300, one-tenth the original bill. 

"The hospital never told me I was entitled to a discount,” she says. “I had to do a lot of research on my own before I even found out about the Fair Pricing Act.” 

Having a good insurance plan that you fully understand seems to be a good start in avoiding costly situations. Like avoiding a bad home loan, consumers can always protect themselves by better informing themselves about health insurance.

“Consumers can use HospitalBillHelp.org to discover loopholes in their own insurance plans,” said Laurie Sobel, senior attorney with Consumers Union. “The site provides important information to help consumers make informed decisions when purchasing health insurance.”

The rising cost of health care is significant only to the people who pay for it, which is a shrinking percentage of all people who receive care. The resultant cost shifting is impacting every payer. In 2008, the costs of uncompensated care provided by California hospitals totaled $11.3 billion, according to the California Hospital Association (CHA). An additional $2.1 billion in 2008 losses are attributable to bad debt and charity care.

According to the CHA report, more than 57 percent of hospitals have seen a rise in the number of uninsured patients during the first quarter of 2009. The report shows a 73 percent increase in consumers having difficulty paying their out-of-pocket health care costs, and a 33 percent increase in uninsured patients visiting the emergency room.

“As more people lose their jobs in this declining economy, they are losing their job-based health insurance,” said CHA’s president and CEO, C. Duane Dauner. “The growing number of uninsured patients, coupled with inadequate Medi-Cal payments and the ripple effects of the financial market crisis, is leading to a decline in the financial health of California’s hospitals at the very time when demand for health care services is growing.”

Shelley Horwitz points to the rising cost of health care, which she says is increasing at a much higher rate than inflation or the cost of other goods and services. “It’s putting pressure on healthcare providers and on people paying for healthcare,” she says. Decreasing that pressure through consumer action or health care reform is the focus of an upcoming article in Visión Hispana Newspaper.