After emergency surgery, an American expat with Swiss insurance now has a load of five-figure bills.
Aria Konishi/KFF Health News
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Aria Konishi/KFF Health News
After emergency surgery, an American expat with Swiss insurance now has a load of five-figure bills.
Aria Konishi/KFF Health News
Last June, Jay Comfort flew from his home in Switzerland to the United States to attend the wedding of his only daughter. But on Friday night, a week before the ceremony, Comfort said he found himself in “unbearable pain”.
“I tried to endure it for three hours because of insurance issues,” said Comfort, a former teacher and an American national with Swiss insurance.
When the pain became unbearable, Comfort called his brother, who drove him and his wife, Nazuna, a few miles away to the nearest emergency hospital at the University of Pittsburgh Medical Center Hospital in Williamsport, Pennsylvania. rice field.
Every time he hit the drive, “it felt like someone took something out and stuck it in my stomach,” he said.
At the hospital, Nazuna Konishi handed over her husband’s Swiss health insurance card and was confirmed to be covered by Group Mutuel. Jay recalled that staff made a copy of his insurance card, after which he was treated for acute appendicitis. Doctors performed emergency surgery to remove the inflamed appendix.
Diagnostic tests confirmed he had a rare cancer, and Swiss doctors removed the cancer in another operation after returning home. “It was a miracle,” said Comfort, adding that the cancer was completely eliminated.
After the appendectomy, Comfort vomited and remembered waiting in the recovery room. He spent a total of about 14 hours at his UPMC his Williamsport before his release. He attended his daughter’s wedding and eventually returned to Switzerland.
Then came the bill.
The patient: Leslie “Jay” Comfort, 66, former educator who has worked in Japan and Switzerland. Ms Confort pays monthly fees and deductibles for mandatory basic Swiss health insurance with Switzerland-based Groupe Mutuel. His allowance and procedure prices are set by the Swiss government.
Medical services: An emergency laparoscopic appendectomy and diagnostic tests revealed that Comfort had a rare subtype of cancer called goblet cell adenocarcinoma.
Service provider: The University of Pittsburgh Medical Center Williamsport is located about three and a half hours northeast of Pittsburgh. The UPMC Health System is one of the state’s largest employerswith 40 hospitals.
Total bill: $42,156.50, which covers emergency surgery, scans, lab tests, and three hours of treatment in the recovery room. His insurance company said it would pay him about $8,184 (7,260.40 Swiss francs), double the cost of the surgery in Switzerland. This left him with the remaining approximately $34,000.
What you get: Comfort has health insurance, but his Swiss insurance did not have contracts with the hospital in the US where he underwent emergency surgery or with other providers outside Switzerland.
With an excellent healthcare system, Switzerland is the most expensive country in Europe. Like the United States, this country also relies on private insurance companies and hospitals. But because treatment in Switzerland costs so much less than what is billed in the United States, the reimbursement offered by the insurance company is only a fraction of what Ms Comfort should pay to a hospital in the United States.
“I try to do what’s right and I try to do my part,” he said.
“Bill of the Month” is a crowdsourced survey. KFF Health News and NPR Explain medical expenses in detail. Have an interesting medical bill you’d like to share with us? tell me about it!
According to Groupe Mutuel spokeswoman Lisa Flückiger, Groupe Mutuel does not have contracts with foreign providers such as UPMC and does not deal directly with them. The insurance company initially agreed to reimburse Comfort for the amount it would have paid for the same treatment in a public hospital in Switzerland, but doubled that amount due to the emergency abroad, for a total of CHF 4,838. So we refunded about $5,460.
Mr Comfort said it was helpful, but that amount would not be enough to repay the $42,156.50 he owed UPMC.
UPMC has expanded its reach throughout Pennsylvania and is now the largest healthcare provider in many parts of the state. In 2016, purchased Small health system and today Run The two main hospitals are UPMC Williamsport and UPMC Williamsport Divine Providence Campus.
the study show This means that prices will rise in areas where hospital consolidation is increasing. With less competition, hospitals have more power to charge what they want if patients have private insurance or are paying out-of-pocket.
In the United States, medical bills are “all over the map,” he said. Jonathan Clark, Vice President of Strategy and Business Development at Penfield Care, a Canadian healthcare cost containment company. The firm negotiates medical bills on behalf of individuals, including foreign travelers to the United States, but is not involved in Mr. Comfort’s lawsuit.
Clark said he expects an appendectomy to cost between $6,500 and $18,800 based on an analysis of Medicare payments in the Pittsburgh area. healthcare blue book Although the organization evaluates insurance claims data and provides cost estimates based on what the insurance company paid rather than what the insurance company claimed, the fair price for laparoscopic appendectomy in Williamsport is about $14,554.
Comfort said a “reasonable price estimate” based on his own Internet research would be between $7,500 and $12,000.
UPMC’s vice president of public relations Susan Manco wrote that Ms Comfort’s treatment included an x-ray and an electrocardiogram of her heart because “there was no information regarding this patient’s prior medical history or surgical history”. there is Staff also performed a pathology examination to identify cancer.
However, these additional services did not fully account for the gap between cost estimates and what hospitals charge. For example, UPMC charged Mr. Comfort $8,357 for his three-hour stay in the recovery room.
Manco said Comfort’s total bill was in line with UPMC’s standard rate.
The cost disparity highlights large differences in international prices. Last year’s cost estimate It said the average amount paid for an appendectomy in the United States was “almost exactly twice” what was paid in Switzerland. Christopher Watneychief executive of the International Health Planning Federation, a trade association of which health insurers on six continents are members.
But according to Watney, health care costs in Switzerland are often more expensive than in other European countries. He said the Swiss cost twice as much for an appendectomy as the Germans and more than three times as much as the Spaniards. Watney said that in many countries around the world, an overnight stay is included in the cost of an uncomplicated appendectomy, whereas in Comfort’s experience it was billed as an outpatient procedure.
After working abroad for nearly 30 years, Comfort, who has dual residency in Switzerland and Japan, said he worked in the United States long enough to qualify for Social Security benefits and Medicare. He said he had tried to enroll in Medicare in the past, but he has not yet enrolled because he has been transferred to several offices and “played pretend on the phone.”
Still, unlike many patients who have to pay five-figure medical bills, Comfort said he’s not worried about UPMC hurting his financial reputation. The health care system “doesn’t seem to put a bad mark on people’s credit records. And I have no credit in the US. I haven’t been healthy in 30 years.”
Manco confirmed, saying the UPMC had reviewed and updated its report. collection policy Last year; it said the health care system would not engage in “unusual collection practices,” such as lawsuits, housing liens, arrests, and reporting to credit agencies.
She said the health care system is tax-free as a non-profit scheme but maintains a “strong financial assistance program” for patients who cannot afford to pay. But “to our knowledge,” Comfort has not applied for financial assistance, Manco told KFF Health News.
solution: Comfort spent months waiting for the bill because if it had arrived this year, he would have had to pay the deductible again on top of the bill, before finally contacting UPMC. said.
Comfort received a full UPMC bill six months after her surgery. Manco said there was “confusion” during Comfort’s ER enrollment. Comfort’s wife provided insurance information, but “there was no documentation of address, policy number or policyholder information in the patient record,” she said.
After receiving the bill, Ms. Comfort realized that the amount was much higher than her insurance reimbursement in Switzerland.
Flückiger said the initial payment calculated by Comfort’s insurance company was specific to the appendectomy and did not include scans or tests. Group Mutuel, questioned by a KFF Health News reporter, “noticed that the lab tests and CT scans were not included,” which are not normally included in an appendectomy, Flückiger wrote.
After KFF Health News provided a detailed overview of UPMC’s bills, the insurer increased its payment to Comfort. In total, Comfort will receive $7,260.40 in Swiss francs, or about $8,184, according to the insurer.
Comfort still hopes to negotiate directly with UPMC to reduce the debt.
“I don’t want to walk away saying I don’t owe you anything,” Comfort said. “It’s not. We’re moral people. But if you think you’re going to gouge me, power trip, and try to get the most out of me, I won’t do it.” Please don’t play games. ”
To the point: Although the Affordable Care Act was intended to insure more Americans and reduce healthcare costs, hospital bills remain unusually high and highly volatile.
In non-urgent cases, Comfort could have tried to compare prices from other hospitals. However, most of the hospitals in the area where he fell ill are owned by his UPMC. And the inflamed appendix can’t wait for comparison shopping.
Cost containment expert Clarke said the “only thing Comfort could have done differently” was to purchase travel health insurance before leaving Switzerland. Medical costs in continental Europe are comparable to those in Switzerland, but the high cost of medical care in the United States makes Group Mutuel insurance “insufficient”.
This is especially important for travelers visiting the United States because, as Robin Ingle, CEO of travel insurance company Ingle International, said, U.S. prices are “some kind of crazy numbers.” is.
KFF Health NewsFormerly known as Kaiser Health News (KHN), it is a national news editorial office that produces in-depth journalism on health issues and is one of its core operating programs on health issues. KFFMore — An independent source for health policy research, polls and journalism.
Emmarie Huetteman of KFF Health News edited the digital story and Taunya English of KFF Health News edited the audio story. NPR’s Will Stone edited the audio and digital story.
