It’s Sunday and there are plenty of people wearing green, but for once it has nothing to do with the Eagles. Happy St. Patrick’s Day, Philly. This morning we’re eagerly awaiting news on the NCAA tournament and wishing Bryce Harper’s ankle a speedy recovery. We’re also chatting with reporter Sarah Gantz about her work on health care costs. It’s never fun finding a surprising medical bill in the mail, but in her reporting Sarah has found it’s something almost everyone deals with — and sometimes there’s a happy ending.
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Each week we go behind the scenes with one of our reporters or editors to discuss their work and the challenges they face along the way. This week we chat with health reporter Sarah Gantz, who reports on health care costs and the medical bill issues that many Philadelphians face every day.
You’ve focused on health costs in Philadelphia for the past year. What’s the most surprising thing you’ve learned in that time?
What surprises me is how ubiquitous billing problems are. Everyone seems to have a story — I’ve even met health economists who study insurance design for a living who have gotten tripped up navigating the system. Earlier this year I wrote about a woman who seemingly did everything right: She made sure she had prior authorization for her breast MRI, used her insurer’s price tool to estimate the cost and even called the doctor to make sure the office accepted her insurance. She still got billed twice the estimated price.
And what questions do you still want to answer?
I’m interested to know more about how health care costs — especially those associated with a lifelong, chronic illness — affect our health long-term. To learn more about this, I’ll be working on a project this year about the costs associated with diabetes that will look at financial hardships, such as insulin prices, as well as the emotional, mental and physical costs of managing diabetes.
For the Philly Health Costs project, readers contributed stories of their own health care costs and medical bills to aid in your reporting. Why was it important to get your audience involved?
Readers who participate in these stories make them relatable for other readers — including the health system leaders and policymakers who read the Inquirer. Health policy on its own can be dense and it’s often difficult to understand how it affects you personally. But when a reader raises his or her hand and says “this happened to me,” it’s easier to see the human impact of policy decisions.
I was overwhelmed by the responses from several readers wanting to help Alyssa, who fell into debt after a miscarriage. I am always happy to help make a connection like this, but it can be complicated because I’m not allowed to give out a source’s contact information or accept money on their behalf. In this case, with the reader’s permission, I passed on his email to Alyssa so that she could get in touch with him. The anonymous donor ultimately contacted the collection agencies holding Alyssa’s $325 debt and made payments directly to them. Outcomes like these are a bright spot in our news cycle, but they point to a serious issue: It doesn’t take much to become overwhelmed by a medical bill and many people are finding the kindness of strangers is their only hope for overcoming stifling health care costs. Forty percent of Americans don’t have savings to cover a $400 emergency and a third of the money raised through GoFundMe goes toward medical expenses.
While that story had an uplifting ending, not all families are so lucky. What could the medical industry do to make this process easier?
One of the takeaways from this story was that no one is safe from baffling medical bills — not even families grieving the loss of a child during pregnancy. Policy experts I talked to think health plans could be designed to better address women’s health needs. But what I think could also go a long way, at least in terms of lessening the blow of a bill, is better communication. Regardless of what their bill is for, the patients I talk to have had so much trouble getting information from their insurers and providers. It would be a kindness if this could be at least a little easier.
Generally, what recourse is available for those who think they’ve received an inaccurate or unexpectedly high bill?
There are a few steps you can take and I recommend anyone interested check out this story. Some experts estimate that as many as one in five medical bills has an error, so it’s worth it to always look over the bills that come from your doctor and the explanation of benefits from your insurer, which gives more detail about how your plan handled the bill. Don’t be afraid to ask questions or challenge a bill you think is wrong!
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