Blake Pfeifer of Colorado Springs is calling on hospitals to uphold their legal requirements for transparent pricing.
Pfeifer underwent emergency stomach surgery at the University of Colorado Health Memorial Hospital Central in 2022 and was surprised when bills for his week-long stay just kept coming.
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“We literally had bills scattered all over the floor and it covered the entire office,” Dawn Pfeifer, Blake’s wife, shared with NBC News.
Pfeifer was originally charged $104,000 for his hospital stay, which was reduced to $58,124 as he would be paying out of pocket. However, more bills kept arriving, and Pfeifer’s attempts to contact the hospital for clarity on the charges reportedly went nowhere.
“I’ve always paid my bills,” Pfeifer, 63, told NBC News. “I wanted a little better explanation.”
A systemic issue
Unfortunately, patient advocate groups say that Pfeifer’s experience is quite common.
“Hospitals and insurance companies alike have even hired many middle-player firms to be able to maximize their margins and profits at every single patient encounter,” Cynthia Fisher, founder of PatientRightsAdvocate.org, told NBC News. “Sometimes what we’re finding is the charges like Blake’s that are billed are far beyond even the highest rate that they have within their hospital pricing file.”
Fisher told NBC News that hospital billing systems seem to be “intentionally complex.” NBC noted that under Colorado law, hospitals that violate the federal price transparency rule — which went into effect in 2021 — are liable to be penalized for deceptive trade practices. The law requires hospitals to clearly state pricing on their respective websites.
However, NBC News found that a number of Pfeifer’s bills are higher than the hospital’s listed prices, including $99 for a blood culture that was listed between $8 and $61 for insured patients, and $104 apiece for a series of 10 blood tests that should cost anywhere between $6.52 and $52.89 per test, based on the hospital’s website. In fact, NBC News found that only 25% of the charges Pfeifer received were listed on the hospital’s required price list.
“What happened to Mr. Pfeifer unfortunately repeats itself and plays out across the country thousands of times every year,” said Steve Woodrow, Pfeifer’s lawyer and a Democratic member of the Colorado House of Representatives. “We now have a situation where people are afraid to get medical care because of the financial ramifications.”
Dan Weaver, a spokesman for UCHealth, said in a statement shared with NBC News that the health system “does everything possible to share prices and estimates with our patients, encourage insurance coverage, assist patients in applying for Medicaid and other programs that may offer coverage.”
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Fighting a broken system
NBC found that the Centers for Medicare & Medicaid Services (CMS) had penalized only 27 hospitals for non-compliance with transparent billing practices in the last four years since the law took effect. However, the Department of Health and Human Services Office of Inspector General found in 2024 that only 63 out of 100 hospitals studied were up-to-date with price transparency requirements.
Furthermore, a study from The Commonwealth Fund found that over 45% of working-age adults in the U.S. who had insurance were charged for a health service that they thought was covered by their insurer.
NBC also interviewed Damon Carson, a small-business owner in Colorado who was sued by a collection company after he refused to pay the additional bills that started rolling in after his outpatient endoscopy at a UCHealth hospital.
Carson was originally quoted $1,448 for the procedure and paid upfront, out of pocket, but was later charged an additional $4,742. In mediation, his additional bills were reduced by one-third to settle the case.
“I was surprised they caved that fast,” Carson told NBC News. “[My wife] and I could easily have paid the $4,000 and our lives gone on. But this was a principle thing.”
“It’s driven by money”
The American Journal of Managed Care reported on “pervasive billing errors” and “aggressive tactics” in the health care and insurance industries in 2024. Dr. Jeffrey Sippel, associate director of inpatient clinical services and associate professor of clinical medicine in the Pulmonary Sciences and Critical Care Medicine Division at the University of Colorado School of Medicine, said he’s been overwhelmed with denied insurance claims from Medicare Advantage plans.
“It’s driven by money,” said Sippel in an article on The American Journal of Managed Care’s website. “It’s driven by a lack of appreciation of how dynamic these patients are, and how quickly they can change from sort of stable to doing quite poorly.”
These overbilling practices are all the more troubling considering how much the federal government spends on health care in the United States.
Data from the World Health Organization shows the U.S. government spends approximately double what other G7 nations spend on health care per citizen. In 2021, the U.S. spent $12,000 per person on health care while the average spend for other G7 countries was between $4,400 and $7,600. Canada, for example, reportedly spent $6,600 per person on health care, while the U.K. was at $6,200 per citizen.
Challenging inaccurate hospital bills
So, what can you do if you find yourself with additional bills piling up after a hospital stay? In Colorado, patients can sue a hospital for instigating debt collection proceedings against them if they believe the hospital violated price transparency laws.
If you find yourself in a dispute over a hospital bill, advocate for yourself and insist on a clear explanation of your charges. In fact, Fisher has some strategic advice for anyone facing charges after a stay in the hospital.
“No one should ever pay that first bill,” she told NBC News. “The onus of proof needs to be on the hospital and the insurance company to prove that they have not overcharged us.”
The CMS also advises patients to shop around for their health care and compare prices and price transparency practices between hospitals to avoid higher-than-necessary bills. Finally, it’s best to keep your primary care physician involved in the process, as they may be able to help advocate for you and offer additional information on finding accessible health care.
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