Polarized views on appropriate reimbursement levels for medical services “limit stakeholders at both the federal and state level from making progress,” says one expert. (Photo: Shutterstock)
When Drew Calver had a heart attack last year, his health plan paid nearly $56,000 for the 44-year-old's four-day emergency hospital stay at St. David's Medical Center in Austin, Texas, a hospital that was not in his insurance network. But the hospital charged Calver another $109,000. That sum — a so-called balance bill — was the difference between what the 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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