NBC News
After Blake Pfeifer, a Rubyd of Colorado Springs, underwent an emergency stomach operation in a non -profit hospital in 2022, it was hard for him to understand the medical invoices he received, after his one -week stay.
The cost for the procedure at the Central Memorial Hospital of the University of Colorado was $ 104,000, according to the documents. As Pfeifer had no safe and had to pay his pocket, he was offered a discount of 58,124 dollars.
The man said he called the hospital to clarify the amounts, but did not get an answer. He made some payments until he could no longer. It was then that he asked for help from a group that defends the rights of patients.
“I have always paid my accounts,” said Pfeifer, 63. “I wanted a better explanation.”
The group that helped him, Patient Rights Advocate.org, discovered that Some of his positions were much higher than the amounts that the hospital declared under a federal rule of price transparency that entered into force in 2021.
Pfeifer’s experience is not unusual, according to patient defenders, lawyers of public interest and Medicare data.
The burden of medical debts, a problem facing 100 million Americans, has pushed many to delay their health care and even declare bankruptcy, according to research.
And something that worsens things is that many payments can be based on inaccurate sanitary invoices. These discrepancies occur even when hospitals should indicate the prices of attention on their websites.
The price transparency rule, promoted by the Medicare and Medicaid Services Centers (CMS), requires that the hospitals “establish, update and make public a list of all standard positions for all articles and services.” Implemented under the first Donald Trump government, this aims to help consumers seek attention and compare prices before going to the hospital.
Now, four years after the rule went into force, hospitals billing mechanisms seem to be “intentionally complex,” said Cynthia Fisher, founder of Patient Rights Advocate.org.
“Both hospitals and insurance companies have hired many intermediary companies to maximize their margins and benefits in each encounter with the patient,” he added. “Sometimes what we find is that the positions like Blake are well above even the highest rate they have inside their price file.”
The result is an increasingly expensive health experience for Americans. A West Health-Galup survey published on April 2 found that 35% of respondents said they could not access affordable and high quality medical care, a new maximum since 2021.
$ 99 for a blood test that costs $ 8
Uchealth is a non -profit hospital system with 14 hospitals in Colorado, southern Wyoming and West Nebraska. In financial documents, the hospitals system said that its discount program for patients paying on its own, such as PFEIFER, “reduces the obligations of unured patients to a level more equivalent to that of insured patients.”
Some of Pfeifer’s documents contradict this statement.
Pfeifer received 10 common blood tests, known as Metabolic Panel, and was billed 104 dollars for each. In comparison, public price of Uchealth prices show that it charged insured patients between 6.52 and 52.89 for each test, in 2022.
In another case, PFEIFER was charged $ 99 for a blood sample to measure bacteria, according to the records, while Uchealth prices data reflect that the range of charges for insured patients is between 8 and 61. For a phosphate level blood analysis, PFEIFER was charged 30 dollars, while insured patients were billed between 3.72 and 22.02.
(They had the right to free care, but the hospitals harassed them to pay)
Violations of hospitals pricing requirements constitute deceptive commercial practice, according to Colorado Law.
Dan Weaver, spokesman for Uchealth, said in a statement that the health system “does everything possible to share prices and estimates with our patients, promote insurance coverage, help patients in the medical application and other programs that can offer coverage.”
As for the PFEIFER case, Weaver said he could not comment. And he pointed to a 2024 Colorado state report in which it was stated that Uchealth hospitals “fully meet the transparency requirements.”
By 2022, when Pfeifer received attention in Uchealth, the document showed that the hospital that paid attention received a “fair” transparency rating by the State, above “poor” but below “good”.
Weaver added that CMS, the mother agency of Medicaid and Medicare and that determines the fulfillment of hospitals with the transparency requirements, “has not summoned Uchealth OA our hospitals for breach.”
Coercive measures against hospitals are extremely rare. On the CMS website only 27 hospitals have been imposed in the four years since the beginning of the requirements. There are 6,000 hospitals throughout the country, according to public data.
A December 2024 report from the Office of the Inspector General of the Department of Health and Human Services discovered that almost 40% of the 100 hospitals he studied did not meet the price transparency requirements.
The Colorado Law allows patients to sue a hospital to initiate a debt collection procedure against them when they consider that they have breached the price transparency requirements. Steve Woodrow, Democratic Member of the Chamber of Representatives of Colorado and lawyer of the Edelson de Denver, represents Pfeifer.
“Unfortunately, what happened to Pfeifer repeats throughout the country thousands of times a year,” Woodrow told our sister NBC News chain in an interview. “Now we have a situation in which people are afraid to receive medical attention due to financial ramifications.”
An imbalance of power
Last November, the Department of Justice claimed that Uchealth had excessively invoices Medicare and Tricare, the health insurer for members of the US service and their families. Between November 2017 and March 31, 2021, the government alleged, the suppliers of the Uchealth hospitals presented inflated claims of Medicare and Tricare for “frequent monitoring of vital signs” among patients in the emergency department.
Uchealth agreed to pay 23 million dollars to resolve accusations without admission of responsibility.
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Weaver, Uchealth spokesman, indicated that the hospital system reached an agreement to avoid prolonged and expensive litigation.
“Uchealth firmly denies these accusations,” he added, “and maintains that his billing practices conform to the guidelines established by the US College of Emergency Physicians.”
Although Uchealth is a non -profit organization, it has recently generated increasing income and benefits. The net income of Uchealth patients, according to their securities records, amounted to $ 8,000 million in fiscal year 2024, 17% more than the previous year. Exploitation income amounted to 523 million dollars, 58% more than in 2023.
Uchealth’s care expenses are higher than those of most profit non -profit organizations, according to Medicare data. In fiscal year 2022, the most recent figures available, Uchealth charged patients 6.6 times the costs of the hospital system for care. According to Ge Bai, professor of health policy and management at the Bloomberg Public Health School of Johns Hopkins, this figure is much greater than 4 times that, on average, the United States non -profit health systems charged for the attention that year.
Weaver, from Uchealth, clarified that hospital system rates are competitive with those of others. “Only last year, Uchealth provided $ 1.3 billion for total benefits to the community, including about 570 million in uncompromising care,” he said in his statement.
It is already quite problematic for patients who are charged more or are incorrectly billed for health care. But when hospitals file a lawsuit to collect these invoices, sentences are often issued in rebellion, according to jurists, against patients who do not appear before the court or do not respond. Sentences in rebellion can have dire consequences, such as the seizure of wages.
In recent years, Uchealth has sued thousands of patients by resorting to third parties or intermediaries for debt collection, a practice that is examined in a new research carried out by academics of the Law Faculty of the George Washington University, the Stanford University Clinical Research Center and the Fisher group.
The study, HOSPITALS SUING PATERS: The Rise of Stealth Intermediarieshe found that Uchealth and a debt collection signature filed 12,722 lawsuits against patients from 2019 to 2023. The legal records analyzed by the authors suggested that “many of the collection efforts were based on unfounded and inaccurate billing records.”
The use of legal intermediaries is a national trend and allows hospitals to hide their participation, avoiding the bad advertising that these demands can bring, said the investigation. Last year, Colorado legislators promulgated a law that prohibits hospitals from demanding patients under the name of debt collectors, after an investigation into this practice conducted by 9News, a NBC subsidiary, and The Colorado Sun.
Barak Richman is a professor Alexander Hamilton of commercial law at the George Washington Law Faculty and Co -author of the study.
“What this investigation shows is that people are dragged into the courts where an imbalance of power takes advantage of them,” he said. “You have to reflect a lot about what to do with courts in relation to medical debts.”
In a statement on the study, Weaver, of Uchealth, said that these demands constitute a “small fraction of our patient care; in fact, more than 99.93% of all patients’ accounts are resolved without a demand.”
He added: “This study, based on old data, does not reflect the changes introduced in recent years to minimize billing errors, ensure that patients know our financial assistance options and are well informed of their medical invoices.”
