Have good health insurance? Damage. You Could Still Get a Bill for $250,000

Former U.S. Surgeon General Jerome Adams recently tweeted his disbelief at being charged $4,896 for an emergency room visit for dehydration after a hike – and it’s After his insurance had paid its part. If he has a hard time understanding why health care bills are so high, that doesn’t bode well for the rest of us.

As a professor of emergency medicine and health policy at the University of California, San Francisco, I have spent more than a decade researching our health care system and documenting the Wild West of bills hospital. It all started when a friend in my neighborhood was hospitalized with appendicitis and was billed over $53,000. He asked me what the typical rate for appendicitis was, and after doing some research, I found that rates for uncomplicated appendicitis cases ranged from $1,500 to $180,000.

These ranges are not limited to surgical procedures; even common cases, like a normal vaginal delivery, can cost between $3,296 and $37,227. These variations are common even in the most common blood labs, with one hospital charging more than $10,000 and another charging $10 for the same cholesterol blood test.

Most of us who are lucky enough to have insurance hope and feel safe from this nonsense. Unfortunately, it is not the case. None of us – even if we are insured – are immune from the financially devastating effects of the administrative monstrosity of the American health care system.

My friend Jack Emerson is an example of an educated, employed, and doubly insured American who finds himself in exactly this situation. He paid into Medicare throughout his working life, for more than 40 years, and he and his employer also paid monthly premiums for private insurance.

Post-pandemic work for him and his company had been remote for years, and last March they decided to hold a company-wide reunion in anticipation of an upcoming 50th anniversary celebration. While Emerson was on stage preparing for a presentation, he suddenly had a cardiac arrest. Fortunately for him, the very public nature of his medical event resulted in almost immediate CPR, and 911 brought him to the emergency room at Kaiser Redwood City, California, where he was admitted for six days and surprisingly survived for tell his story.

Unfortunately, his release from the hospital would be the start of what has been 15 months (and counting) for him of significant mental anxiety and stress due to the financial ramifications of a lack of communication between the hospital and its insurance companies.

Emerson is fortunate to be covered by both Medicare Part A and employer-based health insurance through United Healthcare. The costs of his total hospitalization exceeded $250,000. Despite repeated requests to Kaiser, United Healthcare and Medicare, it appears there are more than 30 outstanding requests that in one way or another have not been submitted or processed. As many of us who have touched the health care system know, Emerson’s multiple phone calls to each of these entities provided conflicting information without any definitive action.

A closer look at Emerson’s hospital bills shows only the date of service, a generic description such as “inpatient visit” and an even less descriptive provider disclosure (e.g. “Permanent Medical”). In some cases there is the name of an actual provider, but again there is no further description of the service they provided other than something like “Radiology Services”. It’s like going to Safeway to buy bread, milk and eggs, and the receipt we receive as “food”. Except that the charges in this case are astronomical.

In reviewing his claim summaries, I created an Excel spreadsheet so I could view them in one place. There are 55 of these esoteric and poorly described services in categories such as “inpatient visits,” “inpatient services,” “medical services,” and “diagnostic services.” Under the “Inpatient Services” category, three of the same services are listed with the same claim number and dates of service, but were billed separately for $18,323, $58,408, and $99,508. There is no further description of what these “inpatient services” entail.

Is this a billing error? Or fees for different services? There’s no way to know. Unfortunately, this lack of reporting information is not specific to Kaiser; it’s simply the way things have been done and accepted in American health care. Although the next step will be to request itemized invoices so we can clarify what he is actually being billed for, the whole process – even for me as a health researcher who has dedicated her career to studying these issues – is exhausting. Imagine the burden this would place on someone who almost died and is now recovering.

There is no other industry in the United States where we Americans tolerate such opacity in pricing and such incompetence in pricing pricing on the part of service providers, whether hospitals or insurance companies.

How can we ensure that we are not caught as helpless patients in this complex administrative tangle? On an individual level, each of us, after receiving medical services, might embark on an exhausting and time-consuming process of obtaining our itemized bills and negotiating with the hospital and insurance company (or several, in some cases ). But unfortunately, the chances of success are low.

It is time that we devote our collective energies to changing the health care zone without arbiter.

Recent policies have focused on price transparency, which 90% of Americans support, with examples such as the Centers for Medicare and Medicaid Services’ Hospital Price Transparency Rule and other bills pending in the Congress, such as S.3548 HR 4822 and HR 410, which require cost transparency, including from insurers. There are legitimate concerns about the potential unintended consequences of price disclosure, which could include price gouging (from hospitals raising their prices to match those of their competitors rather than lowering them because patients do not cannot act as real consumers). Yet while we don’t have all the answers, it is clear that the current status quo of “mystery prizes” is not serving the public.

At a broader level, more fundamental reform addressing fragmented health care delivery and financing is needed. This is happening across the country, in many states. California SB770, for example, was signed by Governor Gavin Newsom to begin the process of creating a statewide single-payer financing system. There are also more progressive approaches to a “public option” that allow individuals to join a government-administered plan that competes with private plans. Washington state and Colorado have operational public option programs (although they use a non-traditional model of private insurers), and Nevada’s program is expected to launch in 2026.

Although no program is perfect, we must change the system so that we do not continue to be victims of a costly and ineffective system. Overbilling and insurance costs account for 15% of healthcare spending in the United States. These costs do not translate into the provision of health services.

Overhauling our system would mean that the $350 billion we spend each year on overbilling and insurance management could easily cover the $195 billion in collective health care debt faced by 41 percent of Americans.

As it stands, under the current system, if Emerson and a former U.S. surgeon general can’t figure out their health care bills and get them paid, we’re all screwed.