Hospital Consolidation Led to Outrageous Medical Bill for Emergency Surgery

By Consumers for Quality Care, on June 14, 2023

Hospital Consolidation Led to Outrageous Medical Bill for Emergency Surgery

When an American citizen now living overseas came back to America to attend his daughter’s wedding, his unplanned medical emergency led to his receiving a five-figure bill, according to KFF Health News

Last summer, Leslie “Jay” Comfort and his wife, Nazuna Konishi Comfort traveled from Switzerland to Pennsylvania for his daughter’s wedding. During their trip, Jay developed a case of acute appendicitis, which required emergency surgery at the University of Pittsburgh Medical Center’s (UPMC) hospital, in Williamsport. The surgery was successful, allowing Jay to attend the wedding and return home with no further medical issues. And then the bill came: according to UPMC, he owed the hospital $42,156.50.

His insurer, a Swiss provider, Group Mutuel, has no contracts with U.S. hospitals and would cover only a fraction of the cost. But that’s not the only reason Jay was left with such a large bill. The other reason is hospital consolidation in America, a practice whereby hospitals merge with and acquire one another, all in an effort to increase their market power and charge patients as much as they can for care.

In particular, UPMC has significantly expanded its reach throughout Pennsylvania. In 2016, they bought up two smaller health systems and are the main medical provider in large parts of the state. Because of this consolidation, there are fewer alternatives for care, allowing UPMC to charge higher prices from patients who have no choice but to pay up. 

Johnathan Clarke is Vice President of Strategy and Business Development at Penfield Care, a medical cost-containment company based in Canada. Penfield negotiates costs of medical care for international visitors to the United States. Clarke explained how prices in the U.S. are “all over the map.” Based on data from Medicare payments in the Pittsburgh area, he estimated the cost of an appendectomy should be between $6,500 and $18,800, a fraction of what Comfort was billed.

After six months, Jay is still negotiating with UPMC to reduce the amount he owes. His Swiss insurance ended up covering more than what they said they were originally going to cover, but it is not anywhere near the full amount.  “I don’t want to try to walk away, saying I don’t owe you anything. That’s not right. We’re moral people, you know,” he said. “But if you’re going to try to gouge me and play the power trip and think you’re going to try to get everything you can out of me, I won’t play that game.”

Decreased competition hurts consumers, often leading to fewer options and higher costs. CQC urges both regulators and lawmakers to keep a close eye on hospital consolidations and work to ensure that consumers don’t foot the bill for anti-competitive practices.