Why I’m Obsessed With Patients’ Medical Bills

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The emails readers sent me after I wrote about that $600 bandage gave me a solution. Many included medical bills with the price charged, what the insurer paid and what the patient was responsible for. The secrets were suddenly in plain sight.

Since then, readers’ medical bills have become a crucial source for my reporting. They are the documents that say exactly what medicine costs in the United States. Coupled with interviews with patients, who can explain the effects of those costs on their lives, they underpin powerful stories about living in a country where routine care can cost three or four times what it does abroad.

Last year, readers’ bills helped me figure out that the only trauma center in San Francisco was out of network with all private insurance companies, leaving patients with thousands of dollars in medical debt. I received those bills through a reporting project at my last job, where we crowdsourced a database of 2,000 emergency room bills.

Just last month, I got exceptionally lucky when four patients who received coronavirus tests in one Texas emergency room decided to send me their billing documents. Three patients sent them in totally unconnected to one another, each aghast at the prices. (The fourth came from one patient’s friend.) Together, they showed that the price of a test could range from $199 to $6,408 — all in the same facility.

That story made me eager to better understand what the price of testing and other coronavirus care looks like in the rest of the country, and, working with my Times colleagues, I decided that readers’ bills were the best way to tell the story. (When handling sensitive information, access is highly restricted and is never published without prior consent.)

Collecting medical bills is, admittedly, a slow, inefficient process that doesn’t lend itself to automation. The documents that come in are messy. Some are image files and others are PDFs. Each hospital and insurer uses its own formatting. A few medical bills — the ones I now swoon for — include detailed, itemized information that shows the price of every pill and scan. Others, frustratingly, lump everything together into one price.

Running a project like this is equal parts stressful and exciting because I don’t know in advance what stories I’ll tell. Instead, I’m waiting to see where the readers’ submissions will guide me.

Right now, I’m mostly excited: Since starting on Monday, we’ve already had nearly 200 submissions. The more I read, the more interesting patterns I start to notice.

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