No matter how advanced medical technology gets, for many patients modern health care begins in a hospital emergency room and ends with an unexpectedly huge bill.
On average, emergency-room bills for out-of-network care is 4.4 times higher than what Medicare allows for the same services, costing consumers more than $3 billion a year, according to a nationwide study by the Johns Hopkins School of Medicine, recently published in the Journal of the American Medical Association Internal Medicine.
Put another way, emergency medicine physician charges came to about $4 billion versus $898 million in Medicare allowable amounts. Overall, the study found that emergency departments are charging anywhere from 1.0–12.6 times ($100–$12,600) more than what Medicare pays for services.
The greatest disparities were for those who lack insurance or have to go to a facility that's not in their health plan's network. The biggest overcharges were made to poor and minority patients, and the biggest gaps between charges for Medicare and uninsured patients were at for-profit hospitals, mostly in the Southeast and Midwest, the study said.
The service with the highest median markup ratio? Wound closures, at 7.0, while interpreting head CT scans had the greatest within-hospital pricing variation, with markup ratios ranging between 1.6 and 27.
General internal medicine physicians had a markup rate, compared to Medicare pricing, less than half what is billed by ER physicians. For a physician review of an electrocardiogram, the median Medicare allowable rate is $16, but emergency departments charged anywhere from $18 to $317, with a median charge of $95 (or a markup ratio of 6.0), the Johns Hopkins study found. General internal medicine doctors in hospitals charged an average of $62 for the same service.