Hospitals and Insurers Are Quietly Charging Excessive Prices and Self-Insured Health Plans
Pay Millions in Extra Costs…
Even When the Bill Is Less
New York hospitals and insurance companies claim to help lower healthcare costs. But behind closed doors, they’ve agreed to contracts that require self-insured health plans to pay far more than what’s actually billed in certain cases.
Here’s how it works:
If a union member receives care at a hospital and is billed $2,000, the contract between the insurer and hospital may still require the health plan to pay $10,000 — the “agreed upon rate.” That extra $8,000? It goes straight to the hospital, for no additional care provided.
Buried Clauses.
High Prices.
ZERO Accountability.
Hospitals and insurers have restrictive contracts with “all-or-nothing” clauses and confidentiality provisions that keep health plans in the dark. Even when care is cheaper elsewhere, these agreements make it nearly impossible for self-insured funds to leave or negotiate better terms.
THE RESULT?
✔️ Higher costs for workers and employers.
✔️ Less money for wages, benefits, and care.
✔️ Patients and plans on the hook for more than they’re billed.
✔️ Hospitals profit.
Charging Excessive Prices to Working New Yorkers
Over the years, the 32BJ Health Fund, which provides healthcare coverage for 200,000 union members and families, has uncovered in its own claims shocking and unfair pricing across the greater New York City area.
The examples are egregious:
358% of Medicare: What some hospitals charge compared to federal baseline costs.
Source: HarlemWorld, 2021.$55,000 for a routine birth at one facility vs.$17,000 at another just miles away.