A few weeks ago, one of our negotiators forwarded me a single line from a massive $1 million hospital bill. “Cranial stabilization device. $900.” Nobody on our team could tell me what it was. It took our team five phone calls and more persistence than it should have to learn that the device in question was a pillow.
I spent years in professional kitchens before I ever worked in healthcare, the kind where I was trained to send a dish back because a carrot was cut a fraction too wide. I was raised by parents who, when I got a 95% on a test, wanted to know what happened to the other 5%. I thought I understood what it meant to sweat the details.
Then I started a company where, among many other things, we review hospital bills for a living.
I’ll be honest, when I first got into this industry over two decades ago, I assumed charges like that pillow were rare, an outlier. Sadly, they’re not. They’re common enough that our care negotiators have started keeping a list. Internally, we call it the “Pillow Tax.”
Here’s what doesn’t get said enough: 97% of the time, the provider or facility we’re working with is reasonable and adheres to a fair rate without an extended fight. These drawn out negotiations are the edge case, not the norm.
When a bill does land in that smaller 3% percentage, it also tends to be the largest and most stressful one, and we move at the pace healthcare allows, not the pace anyone would prefer. Our team handles that back and forth so our members don’t have to, because nobody recovering from illness should also have to argue with a billing office. That’s not true everywhere in this industry, but it’s true here, and I’d rather it cost us time and effort than cost our members stress.
It disturbs me that we operate inside a healthcare system that is broken. Often these extreme cases take the longest to resolve, since we advocate hard on our members’ behalf, and the outcome doesn’t just affect them, it affects every other member too, through the rates we all share.
That work matters: over the last five years, the average family health insurance premium nationally has risen 24%, according to KFF’s Employer Health Benefits Survey. We’ve gone 5 years without a single rate increase, and negotiating bills like these down instead of passing them through is a direct reason why.
We will keep doing what’s right and negotiate for fair payments so we can keep costs low for everyone. And we will keep being honest with you, because the more transparent we are, the more we can stand together against this system.
I still think about carrots more than a healthy adult probably should. But I think about the Pillow Tax every day. If a $900 line item can hide inside a bill this size, I’d rather my team spend the time finding it than the facility assuming nobody would notice. Our members notice. So do we.
If you’re staring down a bill like this right now, call our care team before you pay anything: 800-900-8476.
