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Hospital And Insurance Company Battle Over $17,000 Stitches

In the summer, Ryan Edgerton paid a visit to the emergency room of  Bayonne Medical Center in Bayonne, New Jersey, after cutting his index finger while slicing a melon. Though he only needed “five or six stitches,” his insurance company was billed for more than $17,000 — about $2,833 a stitch, NY Daily News reported.

Edgerton is insured by UnitedHealthcare, but the hospital is owned by CarePoint Health.

CarePoint Health told WNBC that UnitedHealthcare hasn’t offered it a fair deal for in-network prices and state law allows out-of-network hospitals and physicians to charge almost anything they want.

"Being out-of-network is not a business strategy, it is a survival strategy,”  CarePoint spokesman Jarrod Bernstein said in an email. “We would like to be in-network with every insurer in our state provided they could offer us a workable rate of reimbursement that takes into account our obligation to provide care for the underinsured and the uninsured.”

UnitedHealthcare said CarePoint’s charges are 10 to 12 times higher than local hospitals in their network. "Out-of-network hospitals should be charging rates that are consistent with other facilities in the community, rather than using emergencies as an opportunity to bill patients excessive amounts and drive up the cost of health care,” UnitedHealthcare spokeswoman Mary McElrath-Jones said in an email.

Although Edgerton’s health insurance is paying for most of the procedure, he hasn’t paid his share, which is $1,170. 

Bernstein said CarePoint doesn’t use collection agencies for individual patients, but added that the higher prices billed to out-of-network insurers is acceptable because insurance companies offer better deals to hospitals with wealthier patients, especially those in suburban areas.

“[W]e are calling for a new health care reimbursement system that offers equivalent reimbursement rates for all patient encounters regardless of where they live and irrespective of their economic status,” he said.

Sources: NY Daily News, WNBC / Photo credit: slgckgc/Flickr

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