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The tale of the 8.7K bandage

Hospital, insurer battling over the bill, a symbol of health care's biggest issue

Bayonne Medical Center is one of three hospitals CarePoint owns in Hudson County.
Bayonne Medical Center is one of three hospitals CarePoint owns in Hudson County.-(CAREPOINT HEALTH)

If you’ve been looking for the hospital bill that illustrates the difference between in-network and out-of-network costs — and the fight between hospitals and insurers that goes with it — we’ve found it.

 


That’s what happened when reports of an $8,775 bill from Bayonne Medical Center to bandage a cut finger in the emergency room surfaced.


And while all parties involved admit the cost is out of line, how to fix it — and who is at fault for it — is not so easily agreed upon.


The bill, the result of an emergency room visit from a Bayonne man in 2013, has reignited calls for Trenton to clamp down on excessive “out-of network” ER costs that can result when patients show up to a hospital that’s not in their health insurance company’s network.


But the passionate response from health care stakeholders — with hospitals questioning whether insurers pay them a fair rate, and insurers contending some hospitals abuse out-of-network charges to shore up revenue — suggests it could be just as tough to find a consensus now as it was in 2010, when lawmakers tried and failed to regulate out-of-network hospital bills.


State Sen. Joseph F. Vitale (D-Woodbridge) said he’s ready to try again.


Vitale said in the Bayonne case, insurer UnitedHealthcare “was slammed for thousands of dollars for taking care of what was essentially a booboo. And that is absurd.”


He noted that under state law, a patient who gets emergency care at an out-of-network hospital is supposed to encounter the same billing terms as if that hospital were in-network. The insurance company, however, may have to pay hospital “charges” — prices that hospitals post but then routinely negotiate downward when they join an insurance company network.


And here’s the problem with that: When insurers pay high out-of-network charges, those costs get baked into the health insurance premiums that everyone pays.


Squaring off


Beth Fitzgerald

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