To Pay Or Not To Pay?

Inflated medical expenses are one of the most pernicious problems in modern American healthcare. According to the U.S. Department of Health and Human Services, hospital prices have risen three times faster than inflation since the 1980s, making medical debt one of the leading causes for individual bankruptcy in the nation. What's more, hospitals are still deplorably underfunded, and doctors and administrators work longer hours for less pay than any decade in U.S. history since WWII.

Of course, these stratospheric prices are merely symptomatic of greater endemic issues in the healthcare industry. From insurance and healthcare reform a la Obamacare to lobbies against pharmaceutical patents, it can be difficult to escape the vicious cycle of rising medical expenses. However, desperate times call for creative measures, and some American patients even go overseas for vacation/treatment/rehabilitation combos that tally a combined cost that is still only a fraction of a domestic bill. But quizzically, public awareness of the unsustainability of U.S. medical treatments hasn't quelled the surge in prices. At times, it seems as if there is no end in sight.

It should come as no surprise that many are refusing to pay these exorbitant, unjustifiable fees. Jay Hancock articulates the questions that preoccupy patients and employers who are faced with exorbitant fees for inconsequential treatments:

"How can hospitals justifiably charge employers and their workers so much more than they accept from Medicare, the government program for seniors? How can hospitals bill $30 for a gauze pad? How can employee-patients consent to prices they will never see until after they've been discharged?"

As outrage increases, some are going corporate with their indignation. Enter the rise of "benefits consulting firms," companies that make a business out of confronting hospitals head-on. For example ELAP Services, one such firm, received a bill for a 3-day stay that came out to $600,000. After estimating costs for the actual treatment, ELAP paid $28,900 and never heard from the hospital again.

Problem solved? Not necessarily. On one hand, firms like ELAP can compound the problem by leveraging the same heavy-handed legal resources insurance companies use to extort vulnerable patients. It's useless for patients to partner with a consulting business instead of negotiating with an insurance provider if they are going to feel bullied either way.

Not only that, but hospitals might need to adjust their strategies as well. While it's no secret that some medical facilities do overcharge for their services – and justify their prices in cryptic ways – hospitals have limitations, too. Administrators have to worry about how to process their own billing, when to abandon cases that are more trouble then their worth, and of course the main concern: paying their staff.

How is it that despite rising medical costs, doctors and nurses are still underpaid? How are so many medical practices understaffed? The money has to come from somewhere, and if administrators aren't meeting their budgets from patient bills, they may turn their focus on those who do not have the legal firepower to deflect them. Firms like ELAP have the finances to pay the bill – and potentially legal fees if they need to – and so offer significant protection to patients who hire them. Unfortunately, this means patients who can't afford consulting firms may become targets, and they're the ones who need the biggest break in the first place.

While it's always great to have options like ELAP, it's doubtful that this poses a permanent solution to the nation's medical problems. As Americans well know, capitalism is all about supply and demand. If patients collectively transform their anger into action by refusing to pay exorbitant bills and taking their business (or in this case, their illness) elsewhere, insurance companies and healthcare providers will ultimately feel the pain that comes from weakening demand. But as with anything of this magnitude, change occurs slowly. So in the mean time: try not to get sick.

Kaiser Health News
Agency for Healthcare Research and Quality
ELAP Services
New York Times

About the Author:
Iris Stone is a freelance writer, editor, and business owner who has written on a range of topics. She has experience covering content on medicine, healthcare, and career training, as well as education. Iris is also interested in science and mathematics and is currently studying to be a physicist. Check out her Google+ Profile.

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