Randy Slaughter spent three days in a nonprofit hospital in College Station, Texas, in April 2024 after experiencing severe abdominal pain. But doctors were unable to determine the cause and advised him to change his diet and sent him home, Slaughter said.
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His stomach problems gradually subsided, but the financial pain from his visit to Baylor Scott & White Medical Center remained.
Slaughter, 36, said he has health insurance through his employer’s construction company, but his insurance has a high deductible of $10,000 and requires hefty out-of-pocket payments. His records show his hospital costs totaled $33,393, with an out-of-pocket expense of $9,309, which he arranged to be repaid monthly on an interest-free plan.
“$150 a month is a real shock to the shins,” Slaughter said.
Hospital costs are one of the main factors pushing Americans into further debt and widening inequality. Zack Cooper, an associate professor of public health at Yale University, said that over the past two decades, these costs have risen much faster than in other areas of the U.S. economy.
Cooper said paying for hospital care is “a major driver of increased health spending.” “And a lot of the affordability pressures that people are feeling have to do with health care.”
For many Americans, experts say the situation will get even worse.
At least 10 million Americans will lose health insurance by 2034 under President Donald Trump’s signature bill, the One Big Beautiful Building Act, according to the Congressional Budget Office. The bill would introduce cuts to Medicaid, primarily through stricter work requirements, and reduce the number of people eligible for cost-relief coverage under the Affordable Care Act, also known as Obamacare.
Like many others with high hospital bills, Slaughter struggled to make ends meet. But when he asked the hospital if it could reduce his payment, the billing department threatened to put his account into collections, according to a recording of the phone conversation reviewed by NBC News.
“When you talk to a billing representative, you don’t get to talk to someone who’s making these decisions, and you don’t get to go to the hospital and meet someone in person,” he said.
When NBC News asked the hospital about its experience with Slaughter’s billing, the hospital said it had erased a $4,431 balance on his account.
Julie Smith, a spokeswoman for Baylor Scott & White, said she could not discuss the details of Slaughter’s case because she has not signed the legal documents freeing her. (Slaughter said he was concerned that hospitals could share his personal information with third parties.)
But Smith acknowledged that the billing process is “one of the most complex and confusing parts of the healthcare journey,” especially for patients receiving emergency care.
“One of our top priorities is to improve the experience of the people we serve,” she added.
Flag a medical bill
How much does a particular procedure cost at your local hospital? You should be able to find out easily.
A federal rule went into effect in 2021 that requires hospitals to provide such information in a “consumer-friendly format.” However, pricing information on hospital websites can be difficult to understand due to large data files and the complexity of how they are displayed.
When we analyzed pricing at half of the nation’s hospitals (3,236 total), we found that the cost of the same procedure was literally spread across the map. And those without health insurance, whose ranks are expected to grow by millions over the next decade, will be billed the highest.
OrbDoc, a healthcare technology company that uses artificial intelligence to create tools for clinicians, conducted an analysis for NBC News to examine which hospitals bill uninsured patients for certain procedures compared to what Medicare pays. These numbers do not allow for apples-to-apples comparisons, as insurance companies negotiate different rates for different procedures.
OrbDoc’s analysis found that, on average, hospitals charge uninsured people nearly five times more than what Medicare pays for the same procedure. This analysis reflects the conclusions of other academic studies.
Nevada hospitals charge the highest premiums for Medicare payments, at about 12x, while Maryland hospitals have the lowest premiums in the nation, at 1.2x. Maryland is an anomaly, having regulated hospital prices through the Health Services Cost Review Board since 1971. Slaughter’s hospital in Texas charges nearly eight times the Medicare price for the same procedure.
According to OrbDoc, for-profit hospitals charge an average of 8.7 times what Medicare pays for surgeries, while federally owned hospitals charge four times as much. State and local hospitals charge an average of 4.5 times more, and private nonprofit hospitals charge 5.4 times more than what Medicare pays.
Patients with insurance still pay high out-of-pocket costs for hospitalization, although their insurance companies negotiate with facilities to reduce charges. For example, Slaughter’s hospital records show that Baylor Scott & White billed him $1,486 for his emergency room visit. Medicare pays $166.53 for such a visit, according to government data.
After her insurance paid part of the bill, Slaughter’s out-of-pocket cost for her emergency room visit was $456, nearly three times what Medicare would pay, according to OrbDoc’s analysis. The company has a free tool that alerts you to problems with your medical bill, such as duplicate charges and high markups.
“If forensic accounting is required for insureds to understand their bills, the system is broken.” OrbDoc CEO Abdus Muwakil said:
Smith, the Baylor Scott & White spokesperson, said in an email that the $1,486 charged to Slaughter is “the standard rate for a physician providing Level 5 care in an emergency department.”
“This fee is the same for everyone, regardless of insurance type,” Smith added. “However, the reimbursement of this fee varies depending on the type of insurance.”
Experts say a major driver of hospital costs is industry consolidation, or hospital systems acquiring other facilities. A 2024 research paper co-authored by Professor Cooper of Yale University found that from 2010 to 2015, anticompetitive hospital mergers increased prices by more than 5%.
Another problem is that hospitals don’t make it easy for patients to access or understand financial assistance programs.
Slaughter said he experienced this during a three-day stay at Baylor Scott & White. On the second day, he said, a hospital billing representative came to his room, provided an estimate of costs and requested a credit card for partial payment. Slaughter, who said he was taking painkillers and felt groggy, recalled asking about the hospital’s financial assistance program, but officials told him he didn’t qualify.
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