Study reveals costly medical procedures for policyholders

ALBUQUERQUE, NM (KRQE) – A new study shows that uninsured patients in New Mexico are often billed up to 10 times more for medical treatments than insured patients for the same services. The study was presented to the Legislative Health and Human Services Committee on Tuesday.

“Over 200,000 New Mexicos are uninsured, which of course makes them more likely to incur medical debt when they need access to medical care,” says Nicolas Cordova, health director for the New Mexico Center on Law and Poverty. “Unfortunately, one of the biggest barriers to accessing healthcare is medical debt.”

At Roundhouse Tuesday, health care advocates presented a new study that showed uninsured New Mexicans often pay much more for medical treatment than someone with health insurance or state health plans for the same services. The study examines the prices of 17 different medical services at 43 hospitals in New Mexico.

The services they consider include things like CT scans, emergency room visits, and cardiovascular procedures. Researchers say a pattern emerged in the numbers. “The pattern you might suspect [is] that often uninsured patients are charged higher prices. The higher prices may be referred to as “cash rebates” or “self-pay rebates” or other types of discounts, but they’re generally higher,” says researcher Fred Hyde, MD, of Fred Hyde and Associates, Inc.

An example in the study showed that the average list price for a given coronary artery stent was about $85,000, but the average commercial health insurance payments were only about $44,000. This means that the uninsured patient was charged a bill almost double that of the insured patient.

“The variability in these fees … the most important from a public policy perspective is this unpredictability that keeps people from accessing healthcare. That’s the bottom line,” says Hyde.

Why are the prices so different? According to the study, insurance companies and governments are negotiating significantly lower prices with hospitals. “In some hospitals, for some specific codes, those fees can be six, seven, eight, or ten times what Medicare would actually pay,” Hyde says. “There’s no rhyme or reason for these things, other than generally speaking, what the uninsured will pay is higher than almost any commercial health insurance payment and has little relation to the actual cost of the service.”

The state passed the Patient Debt Collection Act in 2021, which prohibits hospitals from suing low-income patients or sending them to collection agencies if they fail to pay their medical bills. However, the legislature enacted a provision that would stop price discrimination practices. Now proponents are urging lawmakers to look further into hospital fees to see if more legislation is needed.