Part 1: The Hidden Cost of Health Insurance

Jul 11

Updated: Jul 12

Medical Bills that Can Break the Piggy Bank

A recent story in the news shows us a father doing what any good parent would do. When his daughter needed emergency care, he called an ambulance. It wasn’t a luxury or a convenience — it was urgent, necessary, and life-saving. Days later, the bill arrived: $600. Steep, but not surprising. Thinking it might be missing his insurance information, he called to provide it — believing, reasonably, that this would reduce his out-of-pocket cost. That’s when the price jumped — from $600 to over $1,300. Same ride. Same service. More than double the cost. All because he used his insurance.

This isn’t a one-off. It’s a symptom of something much bigger — a healthcare system so tangled and perverse, it punishes you for trusting it. For following the rules. For doing exactly what we’ve been told makes us “good patients.” [You can read more about his case here.]

When Coverage Hurts More Than It Helps

Most people assume insurance is a safety net — a buffer between medical crisis and financial catastrophe. But in today’s America, insurance often functions like a reverse discount. Having coverage can mean you pay more than if you walked in without it.

Why? Because of cost-shifting, billing games, and a profit-first infrastructure built on layers of confusion.

Imagine booking a hotel and being charged extra for being in the rewards program. Or ordering a meal and paying more because you said you’re a loyal customer.

Absurd, right? But in healthcare, it’s routine.

Providers set artificially inflated “chargemaster” rates to negotiate with insurance companies. Insurers, in turn, negotiate “discounts.” And caught in the crossfire are patients — especially insured ones — stuck with deductibles, coinsurance, copays, and surprise facility fees tied to contracts they’ve never seen.

I, too, have a similar story. I recently visited urgent care with the worst flu symptoms I’ve ever experienced. I went to UCSD Health, presented my insurance card at the front desk, and waited nearly an hour before I was taken back to see the nurse and, eventually, the doctor. After running a few tests, they diagnosed me with the flu and prescribed an inhaler because my lungs sounded terrible. Before I left, the nurse asked if I’d ever used a spacer inhaler before. I told her I was a registered nurse and very familiar with it.

A month later, I received the itemized bill...nearly $200 for a COVID test — one I’d already taken at home for free. When I called UCSD billing, they simply said, “That’s our rate.” I was also charged over $100 for “inhaler education,” even though I’d explicitly said that wasn’t necessary — and it was never provided.

My insurance barely negotiated any of it because my plan requires me to meet a $3,000 deductible before anything is covered at a reduced rate. The total? $1,600 for a single urgent care visit. Ridiculous? Absolutely. But it’s not a glitch. It is the system.

The Ambulance Trap

Ambulance services are a perfect example of this madness. Over 70% of ambulance rides in the U.S. are out-of-network. That means even if you go to an in-network hospital, the people who drive you there might not be covered.

But when a loved one can’t breathe, you don’t shop for network status. You call. They come. You get help. Then the bill arrives — sometimes weeks or months later — and it can feel criminal. Not because anyone made a mistake, but because the system is designed this way.

I know that from personal experience. As a clinical director for a healthcare organization, I often oversaw the coordination of transportation for seriously ill patients. Many of those trips weren’t covered because we didn’t have contracts with certain ambulance providers. Out of necessity, patients or their families would agree to incur whatever cost was required to save their loved one — only to later find themselves drowning in medical debt.

In the intro example of the father's case, he didn’t even question the original $600 bill. He just tried to be honest. That one call — providing his insurance info — cost him $700.

The Illusion of Choice

We’re constantly told we should “shop around” for healthcare. Compare prices. Ask for estimates. As if we’re booking a vacation, not facing an MRI or an emergency C-section.

But try calling a hospital and asking how much something costs. You’ll get vague answers — if any. The price may depend on the provider, the date, the diagnosis code, and your insurance plan. And even if you do get a quote, it’s rarely what you’ll actually pay.

You don’t shop around during a heart attack. You don’t ask for itemized pricing while bleeding.

The expectation is absurd. And yet, it’s used to justify the system’s failure: “Well, you should have asked.”

It’s a rigged game.

Even as a healthcare professional, I had a hard time deciphering my insurance quote. I was given a page or two with examples of coverage costs, but none specifically applied to my situation. So, I requested a detailed explanation of costs for services from my insurance provider. In the thousands of pages I was sent, nowhere did it specifically state the cost of each service. I was repeatedly told the cost depends on “the provider, the codes the provider uses, and the dates of service.”

Even providers will tell you, “Well, that all depends on your insurance.” Some provider offices have become fed up with negotiating with insurance companies, so they charge patients upfront and then bill the insurance company later. This leaves the patient footing the bill, despite paying monthly premiums to a company that’s supposed to protect and help them in the event of a healthcare emergency.

From the Inside: What Providers See

I work in healthcare. I train clinicians and care teams on documentation, coding, and risk adjustment — the mechanics that determine how services get billed, reimbursed, and justified. I also train the teams that support these efforts.

What I see is staggering. Clinicians are drowning in codes. Instead of focusing solely on the human in front of them, they’re often consumed with crafting documentation that satisfies insurers. The goal isn't always what’s medically accurate — it's what gets approved.

Providers aren’t the enemy. They’re trapped too.

The administrative burden pulls focus from healing. Meanwhile, patients are stuck battling denied claims, duplicate bills, surprise charges, and Explanation of Benefits statements written in legalese. And when they ask why it costs so much, they’re met with shrugs — because no one can truly explain it.

So What Now?

We have to start by telling these stories and pushing back by bringing these shocking examples to the forefront. We have to face reality if we want to bring change. We must refuse to normalize this inadequacy or try to mask the pain.

My hope is to push for legislation that bans surprise billing and brings emergency services into network by default. To fight for transparency in pricing. To advocate for a system that prioritizes prevention, equity, and access — not one that punishes people for needing help.

And most importantly, to speak out. Loudly. Repeatedly.

Because if enough of us name this system for what it is — predatory, profit-driven, and punishing — we can dismantle the silence that allows it to survive.

No one should be punished for needing care. No one should go bankrupt for calling an ambulance. And no one should have to fight their insurance company harder than their illness. It doesn’t have to be this way.

Add your voice — because silence serves the system, and your story can help break it. Share it. Shout it. Change starts with us. Tell us what you've experienced — publicly in the comments, or privately through our contact form.

Your voice matters, and we’re listening.

Read more about where our health insurance premium dollars actually go in Part 2 - Premiums and Profits: The Truth About Where Your Health Insurance Dollars Actually Go.

— Stephanie Alexandre, RN, MBA, Founder of Alexsol Health