Polarized views on appropriatereimbursement levels for medical services “limit stakeholders atboth the federal and state level from making progress,” says oneexpert. (Photo: Shutterstock)
When Drew Calver had a heart attack last year, his health planpaid nearly $56,000 for the 44-year-old's four-day emergency hospital stay at St. David's MedicalCenter in Austin, Texas, a hospital that was not in his insurance network. But the hospitalcharged Calver another $109,000. That sum — a so-called balance bill — was the difference between whatthe hospital and his insurer thought his care was worth.
Though in-network hospitals must accept pre-contracted rates from health plans,out-of-network hospitals can try to bill as they like.
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