I’m angry that people who don’t understand and can’t help themselves and don’t know how to fight back are getting ripped off every day.” – David Silverstein
This man will help you get out of expensive medical bills
Published: June 2, 2017 6:58 a.m. ET
David Silverstein says the people he’s worked with haven’t had to pay their hospital bills, and it hasn’t harmed their credit
David Silverstein’s nonprofit, Broken Healthcare, helps people with hefty hospital bills challenge them.
By EMMACOURT
As the father of four sports-playing children, David Silverstein has long grappled with the high cost of hospital care. “There’s always a bill for something,” he said, laughing.
But something changed years ago when he received an emergency room bill for his then-high school-aged daughter, Kailey. The total came to $12,000, but Silverstein’s portion came in just under $1,000.
Despite a background in health care — Silverstein has worked with hospitals and insurance companies for years through his management consulting business — he was flummoxed by the math. The 92% discount may have benefited him, but it also seemed arbitrary and confusing, he said.
But after he paid the bill, he couldn’t get the hospital to respond to his questions. So he decided not to make that mistake again.
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He has been challenging hospital bills ever since, and started doing it for non-family in early 2016, through his Colorado-based nonprofit Broken Healthcare. Silverstein estimates that he’s reached a couple of hundred people since, including those who have used his techniques on their own. None of the roughly 40 patients he’s given direct help to have paid a cent, he said.
Providence Saint Joseph Health, where Silverstein has challenged his daughter’s emergency room bills, told MarketWatch that it’s worked to simplify its medical billing for a number of years.
“We work to help patients navigate what is an overly complicated process, but the industry has to do better,” said , Providence Saint Joseph Health’s Kathleen Dowling. “The fix will take advances in technology, coordination among the government, providers and the health insurance industry and a tremendous investment.”
Silverstein’s strategy is an unusual one, and possibly even unique. Plenty of non-profits and for-profit businesses aim to help consumers with expensive medical bills. But while these groups may dispute or negotiate bills, there’s an assumption that patients will ultimately pay any legitimate charges, for fear of eventually damaging their credit.
But more and more people are now affected by high out-of-pocket costs, thanks to the rise of cost sharing, lending Silverstein’s efforts a new urgency.
“The problem I’m trying to address is that nobody has figured out how to do anything about it. We know the problem is there, but we have a broken political system that is incapable of fixing it,” he said. “I know it sounds crazy that one guy can take on the health care system but… I have no choice not to act.”
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Challenging hospital bills
After a few days of extreme pain last year, Jamesia Shutt realized what she thought was back spasms was probably something worse. She knew she had to go to the emergency room.
Four hours, several tests, some morphine and IV saline later, the 34-year-old received a diagnosis of pneumonia and was sent home.
Then the bill came, two weeks later.
“Oh my gosh, yeah, I freaked out,” she said. “I went in there expecting it to be expensive — it’s an emergency room. But I didn’t expect after their adjustments and everything to spend $8,000 for a four-hour visit.”
The bill was technically $16,800, not including the roughly $1,000 cost of the emergency room doctor. After uninsured discounts, the total came to about $9,000 — still too much for Shutt, an art student, who’s lived in Colorado her whole life.
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That’s where Silverstein came in. Together, they reached out to the hospital, asking it to explain its billing. In return, Shutt said, the hospital simply insisted that she pay, offering her payment plans.
David Silverstein began challenging hospital bills for non-family members in 2016, and says the roughly 40 people he’s worked directly with haven’t had to pay a cent.
Parker Adventist Hospital, which is part of Centura Health, wouldn’t comment on Shutt’s particular case. But it did note that Centura Health has offered an online price tool — which includes regional pricing for the top 65 procedures for those who self-pay — since May 2015, and patients can request a custom price quote.
“We are committed to evolving our transparency strategies and sharing resources to help patients navigate and better understand where to go for care,” a Parker Adventist Hospital spokeswoman said.
Shutt and Silverstein continued to press for more information. Though medical providers will give out a more detailed bill upon request, those don’t provide a rationale for the listed cost.
So bills appear confusing at best, indecipherable at worst. One of Shutt’s charges, for the emergency room, totaled around $9,000. Then she was charged separately for a number of other tests, medical imaging and pharmacy services.
She wondered, was the $9,000 charge simply for the room itself? Should anything else have been included in that? But there was nothing to refer to, she said: no public pricing list, just the hospital’s word that the prices were correct.
“How do you know you’re not just getting raked over the coals, which you probably are?” Shutt asked. She and Silverstein wanted “to clarify what is being charged, how do you come up with billing, how are your prices charged. Do you pull them out of thin air?”
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Advocates like Silverstein say this is part and parcel of a larger problem: U.S. patients have long been unable to find out the price of a medical procedure until after it occurred.
In this, the U.S. health care system is unlike any other customer experience. Imagine sitting down to a meal, going on a flight, or sending your kids off to school, all without knowing the cost or outcome until later, health care advocates say.
“There’s no other market in the world where we ask this much of the consumer and give them this little information about what they can expect from us upfront,” said David Vivero, chief executive of health care transparency company Amino.
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Here’s the real reason why U.S. health care is so expensive
But hospitals say price transparency is difficult, because a number of factors affect how a patient is charged. Perhaps more importantly, they also say it’s proprietary, leveraged in negotiations with health insurers.
This has always posed a problem for uninsured patients like Shutt who, without anyone to negotiate for them or pick up part of the tab, are exposed to the highest prices.
But the rise of cost-sharing has started to expose insured patients, too, who may pay thousands of dollars out-of-pocket after a hospital stay.
Shutt’s billing back-and-forth has lasted around a year, and may well continue, although she hasn’t heard back from the hospital since late February.
Why do this at all?
Silverstein does this work on the side, with some staff from his firm helping out. He has hopes of getting someone full-time for Broken Healthcare, but he’s not quite there yet.
This all might raise the question: Why do this in the first place?
He has a simple answer: “Because I’m angry… I’m angry that people who don’t understand and can’t help themselves and don’t know how to fight back are getting ripped off every day.”
The threat of a bill being sent to collections and harming an individual’s credit means most people who don’t understand a hospital bill simply pay up.
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In general, any patient who doesn’t pay a medical bill should “proceed with caution,” said Dr. Raffi Terzian, senior vice president of clinical operations and senior medical director at Health Advocate, a leading company that works with employees to navigate health care and insurance problems.
“In our experience many facilities and providers will try to work with the member” before sending a bill to collections, he said.
But Silverstein said his method avoids harming credit scores.
Though most bills go to collections agencies, “thus far it’s always been removed after we intervene on the patient’s behalf,” he said. Still, he encourages those he works with to sign up for credit monitoring, to ensure that doesn’t change.
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His ultimate goal is to end up in court, to make hospital price information public through the legal discovery process. (He’s not an attorney but a lawyer at his firm assists with legal questions and research.)
But if that doesn’t work out, he believes what he’s doing now could possibly “bring the system to its knees,” and force hospitals to voluntarily make changes.
Shutt is hopeful about not having to pay the bill. But ultimately, she said, it’s not about that.
“I almost feel sometimes like they’re taking advantage of people who are vulnerable. Because you’re sick, sometimes you’re really out of it and can’t make a clear decision, so you just do what they say,” she said.
“They can charge anything they want because people need their services. And nobody disputes their bill, or few people do, so they get away with it, I guess.”
