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I'm launching a new project today that will investigate the costs of coronavirus testing and treatment using readers' medical bills.

A thread explaining why I'm doing my reporting this way, and how you can help the @nytimes tell this story. (1/7)
nytimes.com/2020/08/03/rea…
There are two big things to know about health care prices in the United States:

1. They are very high

2. They are very secret

Patients don't know what their care costs until a bill turns up. (2/7)
Powerful lobbies want to keep things this way. The hospital lobby, for example, recently sued the federal government to keep their prices secret (3/7)
nytimes.com/2020/06/23/ups…
Sometimes, insurers and doctors do give reporters like me a small peek at their prices. But that's an exception, not the rule.

In a decade writing on the health care system, I've found the best way to get that information is going directly to patients (4/7)
About a month ago, I learned that the price of a coronavirus test ranged from $199 and $6,408 — inside *the exact same emergency room.*

I only learned that because multiple patients from that ER sent me their bills. (5/7)
nytimes.com/2020/06/29/ups…
Patient bills are such a powerful reporting tool.

@KHNews has done amazing, amazing reporting with their bill of the month project.

I'm personally proud of the work I did in this space with ER bills for @voxdotcom, too. (6/7)
vox.com/2018/2/27/1693…
Now I'm turning my attention to coronavirus, and I need your help.

If you've gotten any sort of medical bill or explanation of benefits related to coronavirus (testing, treatment, other medical care you changed in some way related to the pandemic) send them to me!
(6/7)
They can be big bills, small bills — the more confusing, the better. Reading confusing medical bills, and decoding them, is one of my favorite past times! 🤓

I'll be reporting on the set of bills we collect for the rest of the year at least. (7/7)

nytimes.com/2020/08/03/rea…
Send me bills that are big, send me bills that are small, send me bills that you don't really understand — I want to help understand them!
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More from @sarahkliff see all

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Sarah Kliff
@sarahkliff
There's an obvious culprit when it comes to America's sky-high health care spending: high prices.

But there's something less obvious, that's worth understanding a bit better: insurers do not have strong incentives to negotiate well on behalf of members.

A thread (1/8)
You can actually see that really clearly in the story I wrote yesterday, about a woman who got a drive-through coronavirus test. She used her insurance, and they were billed $6,408.

Her friend paid cash and was billed $199.

nytimes.com/2020/06/29/ups…

(2/8)
Why does an insured patient end up with a bill that is 3,200 percent of the cash price?

Most of the difference doesn't come from the actual price of the COVID Test. It comes from the ER tacking on a bunch of *other* tests just for the patient with insurance.(3/8)
Read 8 tweets
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Sarah Kliff
@sarahkliff
The biggest challenge facing hospitals right now isn't the lost revenue in recent months (which is, by all means, a significant challenge on its own).

The biggest challenge is a shift in the insurance landscape, that is already underway. A thread (1/9):
About 27 million Americans may have lost their private health insurance in recent months, per one @KFF analysis.

Most of those people will do one of two things: enroll on Medicaid, or become uninsured (2/9)
Medicaid typically pays lower prices than private insurance. Hospitals have built entire business models around the high prices that private insurance pays, sometimes 10 times as high as Medicaid. (3/9)
Read 10 tweets
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Sarah Kliff
@sarahkliff
I've covered hospitals for a decade.

I've never seen hospitals managed like the ones I wrote about in my new story.

A thread: (1/9)

nytimes.com/2020/04/26/us/…
Between 2014 and 2017, a for-profit hospital chain called Alecto purchased three hospitals in Ohio and West Virginia.

They served rural populations. They were struggling financially. Employees expected Alecto would turn them around.

The opposite happened. (2/9)
First, Alecto cancelled contracts with doctors — a move that seemed meant to save money on salaries. But when the doctors left, their patients went with them. Some days, the board meant to show scheduled surgeries was empty.

That created a revenue problem (3/9)
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