I am a self-employed electrician and like millions of Americans I get my health insurance through the ACA Marketplace (Connect for Health Colorado). In October 2023, I was working in Aurora. My stomach was off that day, but I kept drinking water and stayed busy hoping it would go away. Unfortunately, the pain got worse, so around 3 pm I decided to wrap it up. As I was driving home, the pain intensified to the point that I was rocking back and forth in my seat and feeling unsafe to drive. I needed to find an ER, so I searched “ER near me” and the closest one was a UC Health facility on the corner of Mississippi and Chambers. It felt like an accomplishment just making it into the parking lot.
I checked in, paid my expected $300 copay, and was sent back to a room where I laid on a hospital bed writhing in agony while doing my best to answer a multitude of questions. After about an hour and a half, they did a CT scan, and I was given an IV and some pain medication. It was something that was going to pass through my system, probably from something that I had eaten. I was in the ER for 2.5 hours and sent home.
A few weeks later I received a bill from CU Medicine for $1095. After insurance payments, my portion of the bill was $620. I called them and asked if this was the only bill that I was going to receive for the ER visit, and was told that “It could be”, but they “weren’t sure because they were only representing the doctors. There may be some facility charges as well, but those would be separate”. I gladly paid the $620 and hoped that was it.
It was not. The following February I received a bill from UC Health and an explanation of benefits (EOB) from Anthem. The total charges for my 2.5 hour ER visit totaled $24,382 and I was responsible for $3,881. That was a bit of a shocker.
I spent the next several months dealing with Anthem and UC Health to figure out why my bill was so high and why my portion was so much. Every conversation with Anthem felt automated, like they were reading from a script. One representative told me the coding was incorrect as it was billed as an “out-of-network” visit. We both thought that would help clarify and reduce my bill, but after two or three more follow-up calls with Anthem, the total bill was the same but my portion increased to $4,658. I spent so much time trying to figure out why my bill was so high, and was hit with a higher bill. Infuriating.
I decided to reach out to the Colorado Division of Insurance and the federal No Surprises desk in hopes that they could help. They looked into my bill and after a few months told me that I should be responsible for $3,881 ($4,181 minus my $300 copay). They couldn’t help me with the bill itself as they only regulate insurance, not medical providers. It was then I realized that apparently no one regulates medical providers.
So I took a closer look at the itemized bill from UC Health:
- CT scan – $14,025
- Emergency room – $6,965
- Ekg – $755
- IV/Injection – $1,780
- Labs (general) – $742
- Pharmacy – $115
These charges are obscene. In any non-emergency situation, I would have been able to schedule a CT scan for under $1,000. As a consumer, I am feeling price gouged and taken advantage of. Apparently, these facilities can charge whatever they want with no protections or recourse for the patient.
Our health care system is a mess. Insurance companies are nothing more than a gate keeper between you and the medical services you need, as they determine what care is covered for patients, and medical providers continue increasing their rates. The US is the only industrialized nation with a “for profit” healthcare system, where people die because they’re either denied coverage or can’t afford the costs associated with the care they need. This is wrong and it needs to change.
Christian Jett
