When leftists attack our health care system for its supposedly market-driven forces, they fail to grasp a key fact. American health care has rarely functioned like a market because few, if any, patients know the price of their care in advance. A recent personal experience illustrated this problem and reinforced the rules the Trump administration must finally implement to make prices transparent.
A Surprise Bill After the Fact
Last April, I went to the Surgery Center of Chevy Chase just outside Washington for outpatient foot surgery. Staff informed me in advance that my estimated financial responsibility would total $574.12 — an amount I dutifully paid the morning of the procedure. The surgery proceeded with no complications until the Surgery Center sent me an additional bill for $752.52 — more than the original estimated cost — weeks afterwards.
In theory, I never should have faced such a sizable after-the-fact bill. Section 111 of the No Surprises Act, signed into law in December 2020, contained a new Advanced Explanation of Benefits requirement that gives patients the right to a written estimate of total out-of-pocket costs before receiving care. In my case, this “all-in” Advanced EOB would have encompassed not just the Surgery Center’s charges, but those of my surgeon, anesthesiologist, and any other anticipated out-of-pocket costs.
The No Surprises Act provided an implementation date of Jan. 1, 2022, for the Advanced EOB requirement — more than two years before my surgery. But the Biden administration delayed implementation while insurers and health care providers reconfigure their billing systems. As a result, a requirement passed in the waning days of the first Trump administration lacks a firm implementation date more than six months into the second Trump administration.
Consumers Must Fight for Information
Because the statutory requirement to receive a written, itemized estimate in advance has not yet taken effect, I had to fight for information about my after-the-fact bill. Staff offered to “explain” the bill, but never answered my specific questions, even though a line on the statement — “Wrong Contract Selected” — clearly meant some type of error had occurred. The Surgery Center likewise failed to provide a substantive response to the Maryland Attorney General’s Office when I asked them to mediate.
Only after I threatened legal action did the truth finally emerge. Surgery Center staff made two separate errors in calculating my estimated responsibility, concluding that I was in an HMO rather than a PPO and that I was near to meeting my annual deductible. Billing staff disclosed the first error, but concealed the second for more than a year, sending my bill to collections rather than admitting a mistake that led to an inaccurate estimate of my out-of-pocket costs and the post-procedure bill I disputed.
While I eventually had my balance forgiven, I couldn’t help considering the matter a Pyrrhic victory. The time, hassle, and frustration I invested to get to that point far exceeded the $752.52 balance at issue, and providers like the Surgery Center know it. They also recognize that, when threatened with collection actions, most people will attempt to pay any balance a provider claims they owe — even if they can’t afford to do so, and even if, as in my case, the purported balance stems from the provider’s own mistakes.
Put Power in Patients’ Hands
But the American people deserve better. In no other field would customers accept businesses failing to tell buyers a price in advance — or attempting to change that price after the fact. Vulnerable patients should expect no less. The Trump administration should accelerate implementation of the Advanced EOB requirements to the earliest possible date so that all patients receive an accurate, written estimate of their out-of-pocket health care costs before receiving care.
