Private Equity Is Working Hard to Keep Surprise Medical Bills High

A mailer sent to New Hampshire voters telling them how horrible it will be if surprise out-of-network billing is banned.New York Times

Fight disinformation: Sign up for the free Mother Jones Daily newsletter and follow the news that matters.

One of the most outrageous aspects of American health care is surprise out-of-network billing. Most people, if they go to a hospital that’s “in-network,” quite reasonably assume that this means “the hospital’s doctors are in-network.” But that’s not the case. Sometimes hospitals contract with doctors who aren’t part of your insurance network, and these doctors can charge whatever they feel like. Your insurer won’t cover this—that’s what out-of-network means—which means that when you get home you’re likely to be greeted by a $40,000 anesthesiology bill.

This is obviously bad, and both Democrats and President Trump favor legislation to end it. However, there’s one group that thinks out-of-network billing is just fine: the private equity firms that own the medical groups that specialize in out-of-network care.

But this presents a problem: how do you make it sound bad to prohibit surprise out-of-network billing? Hmmm.

Here’s the answer: Attack the ban as “rate setting” by “big insurance companies.” Then add some scary stuff about not being able to see your doctor anymore and “profiting from patients’ pain” and you’re all set. Who wants to involved with anything like that?

But the best part of this particular attack ad comes at the very end: “Put Patients Before Profits.” How Trumpian! The whole point of out-of-network billing is to allow doctors to make lots of money at the expense of their patients. But who cares? You just say the opposite and then get huffy if anyone suggests you’re being a wee bit untruthful.

Out-of-network billing is hardly limited to medical groups owned by private equity firms. Still, they’re the only ones with the organized greed that’s required to mount an advertising campaign telling us that up is down and black is white. I wonder if it will work?

WHO DOESN’T LOVE A POSITIVE STORY—OR TWO?

“Great journalism really does make a difference in this world: it can even save kids.”

That’s what a civil rights lawyer wrote to Julia Lurie, the day after her major investigation into a psychiatric hospital chain that uses foster children as “cash cows” published, letting her know he was using her findings that same day in a hearing to keep a child out of one of the facilities we investigated.

That’s awesome. As is the fact that Julia, who spent a full year reporting this challenging story, promptly heard from a Senate committee that will use her work in their own investigation of Universal Health Services. There’s no doubt her revelations will continue to have a big impact in the months and years to come.

Like another story about Mother Jones’ real-world impact.

This one, a multiyear investigation, published in 2021, exposed conditions in sugar work camps in the Dominican Republic owned by Central Romana—the conglomerate behind brands like C&H and Domino, whose product ends up in our Hershey bars and other sweets. A year ago, the Biden administration banned sugar imports from Central Romana. And just recently, we learned of a previously undisclosed investigation from the Department of Homeland Security, looking into working conditions at Central Romana. How big of a deal is this?

“This could be the first time a corporation would be held criminally liable for forced labor in their own supply chains,” according to a retired special agent we talked to.

Wow.

And it is only because Mother Jones is funded primarily by donations from readers that we can mount ambitious, yearlong—or more—investigations like these two stories that are making waves.

About that: It’s unfathomably hard in the news business right now, and we came up about $28,000 short during our recent fall fundraising campaign. We simply have to make that up soon to avoid falling further behind than can be made up for, or needing to somehow trim $1 million from our budget, like happened last year.

If you can, please support the reporting you get from Mother Jones—that exists to make a difference, not a profit—with a donation of any amount today. We need more donations than normal to come in from this specific blurb to help close our funding gap before it gets any bigger.

payment methods

WHO DOESN’T LOVE A POSITIVE STORY—OR TWO?

“Great journalism really does make a difference in this world: it can even save kids.”

That’s what a civil rights lawyer wrote to Julia Lurie, the day after her major investigation into a psychiatric hospital chain that uses foster children as “cash cows” published, letting her know he was using her findings that same day in a hearing to keep a child out of one of the facilities we investigated.

That’s awesome. As is the fact that Julia, who spent a full year reporting this challenging story, promptly heard from a Senate committee that will use her work in their own investigation of Universal Health Services. There’s no doubt her revelations will continue to have a big impact in the months and years to come.

Like another story about Mother Jones’ real-world impact.

This one, a multiyear investigation, published in 2021, exposed conditions in sugar work camps in the Dominican Republic owned by Central Romana—the conglomerate behind brands like C&H and Domino, whose product ends up in our Hershey bars and other sweets. A year ago, the Biden administration banned sugar imports from Central Romana. And just recently, we learned of a previously undisclosed investigation from the Department of Homeland Security, looking into working conditions at Central Romana. How big of a deal is this?

“This could be the first time a corporation would be held criminally liable for forced labor in their own supply chains,” according to a retired special agent we talked to.

Wow.

And it is only because Mother Jones is funded primarily by donations from readers that we can mount ambitious, yearlong—or more—investigations like these two stories that are making waves.

About that: It’s unfathomably hard in the news business right now, and we came up about $28,000 short during our recent fall fundraising campaign. We simply have to make that up soon to avoid falling further behind than can be made up for, or needing to somehow trim $1 million from our budget, like happened last year.

If you can, please support the reporting you get from Mother Jones—that exists to make a difference, not a profit—with a donation of any amount today. We need more donations than normal to come in from this specific blurb to help close our funding gap before it gets any bigger.

payment methods

We Recommend

Latest

Sign up for our free newsletter

Subscribe to the Mother Jones Daily to have our top stories delivered directly to your inbox.

Get our award-winning magazine

Save big on a full year of investigations, ideas, and insights.

Subscribe

Support our journalism

Help Mother Jones' reporters dig deep with a tax-deductible donation.

Donate