It's the rate they try to bill for hospital services if you are self-pay. They are as much a rip off as the cost of pharmaceuticals.
If there is any industry that rips you off more, I haven't seen numbers that would show it. Except mabey loans harks or payday lenders.

Except one with powerful political forces still clinging to imperialism and 19th century capitalism.

We live in Maryland.

One of our daughters was taken to the ER in bad shape last fall and remained hospitalized for several days.

Her BlueCross BlueShield insurance (for which we were paying almost $600 a month for her alone) covered much of the cost, but refused to cover physician care, which was provided by doctors from a group called South Sound Physicians, because it was "out of network." The bill came to almost $1000.

I contacted South Sound, which is one of a number of companies that contract with hospitals to provide "hospitalist" physician services. The person I spoke with said there was no way they could ensure that a particular ER doctor was a provider for a particular health insurance company. I said wouldn't it make sense, since BCBS is one of the nation's larger health insurance companies, to make sure that ER physicians are in the BCBS network? He did not seem to understand the issue and kept spouting his prepared talk.

I contacted the hospital, and its financial counselor called me back. She said this type of situation has been going on for years, and that mine was the third complaint this week alone. She said patients need to be their own advocates. I pointed out that people who come into ER unconscious or severely injured can't wave around their insurance card and insist on being seen by a doctor who takes BCBS, or whatever insurance the patient has. My daughter has anxiety disorder and finds it almost impossible to be her own advocate in situations like this.

I suggested that to the hospital woman that she start keeping track of the complaints and the dollar amounts at stake, and provide reports to the administrators about how often this causes problems. She agreed that that was a good idea.

Lastly I called Blue Cross BlueShield and spoke to a wonderful person who listened, understood the problem, and found a loophole whereby all the bills from South Sound could be covered. This, she explained, was because my daughter was brought to an in-network hospital.

But what about all the people who cannot advocate for themselves? People who are severely ill or injured, or who may not speak English, or who have underlying conditions such as mental health problems that keep them from advocating for themselves.

And FFS, why do we have to FIGHT to advocate for ourselves, anyway? Things like this should simply be covered. The entire health "care" system is designed to wear people down in order to ensure maximum profits for the shareholders.

in that the patient in the ER has no option. They paid a partial bill, then I was threatened with collections on the balance. Blue Cross advised me to wait until the first check cleared and then call back and ask them to issue a second check for the "uncontracted balance" noting "invisible provider". They paid the full ransom note. Still pisses me off as this is the only ER in town with inpatient care, and nothing has changed. At least now I know what to do, but as you have noted - how many don't know or don't have the mental/physical energy to track this shit down?

as an aspect of the Affordable Care Act.

Another thing is that maybe hospitals that contract with these hospitalist agencies should require in the contracts that every physician who works at that hospital be covered by some arrangement with the major health insurance companies companies in that area.

Of course, the real solution would be SINGLE-PAYER coverage for all.

state Insurance office. Since the bill was paid in full, there wasn't any reason to - but it took MONTHS (and dozens of phone calls) to get it all worked out.

Now, at least I know what to do if I end up in the ER again and it won't be nearly as time consuming - but how many DON'T know how to deal with this?

They'll probably steal another 5-10%. And then the hospitals take theirs and the doctors takes theirs. But hey! It's the best we can get!

Co-pay covers bloodwork/EKGs and the like, but weeks after a visit, the physician group sends a bill for hundreds of dollars.

Its a total scam and its everywhere.

Medicare for all.