A bill for emergency dialysis $524,600 ”• canceled. A bill for laughing gas during childbirth ”• reduced tenfold. But $25,865 for a throat swab? Paid for and absorbed into ever-rising insurance premiums, at least until our investigation brought the hefty charge into the sunlight. What explains the exorbitant, confusing and absurd medical bills to which Americans have grown accustomed? What is a patient to do when hit with a surprise medical bill ”• whether it’s a staggering half-million dollars or even a few thousand out of the blue?
In 2019, NPR and Kaiser Health News pushed to sort out the complexities of a crazy-quilt health system with our unique, crowdsourced “Bill of the Month” initiative. Partnering with our readers and listeners, KHN and NPR are using their medical bills as the foundation for a multimedia series that blends investigation, explanation and consumer education. Each month, we select a “Bill of the Month” from a growing stash of more than 2,000 cases that have been submitted through an online portal and social outreach. We aim to pick a bill that highlights a common and vexing part of our medical system. We assign a reporter who has particular expertise in that area to investigate.
To draw the series together, KHN and NPR have developed a common format, one that allows readers to explore and understand the case and issues it raises from various angles. Online ”• on the KHN and NPR websites ”• readers can meet the patient and go deep into the details of his situation and our investigation, including the actual bill. The stories include interviews with the providers and the middlemen responsible for the surprising charges. We relay the results of our digging in a section that blends investigation and explanation, titled “What gives?” We provide a “Takeaway” ”• advice and tactics to help other patients avoid the same kind of billing experience. And, finally, there’s the “Resolution,” in which we follow how the case unspools. (In many cases, the bill magically disappears or is “forgiven” once “Bill of the Month” comes calling.)
Each story also features a narrative audio presentation on one of NPR’s news magazines, as well as distribution through NPR One and the NPR app. Typically, a reporter from NPR’s Science Desk, or a reporter participating in our NPR-KHN member station health reporting project, interviews the patient and the providers involved with the bill, providing a window into the particular situation. We often follow that story with a host interview with Dr. Elisabeth Rosenthal, the editor-in-chief of KHN, a former New York Times health reporter and author of “An American Sickness: How Healthcare Became Big Business and How You Can Take It Back.”
For many installments, “CBS The Morning” presents a television version of our “Bill of the Month” as well, with an on-camera patient interview. In this format, we’ve covered an array of common issues that plague U.S. patients, including facility fees, the high prices for durable medical equipment, the unreliability of medical estimates, surprise out-of-network bills, drug prices, “skinny” plans that turn out to lack coverage for needed care, and outrageous charges generated when hospitals bill for use of the operating room or infusion time by the minute. In related offerings, we’ve created a user-friendly toolkit to help readers troubleshoot their bills.