Last June, Jay Comfort flew to the United States from his home in Switzerland to attend his only daughter’s wedding. But the week before the ceremony — on a Friday evening — Comfort said he found himself in “excruciating pain.”
“I tried to gut it out for three hours because of the insurance situation,” said Comfort, a retired teacher and American citizen who has Swiss insurance.
When the pain became unbearable, Comfort called his brother, who drove him and his wife, Nazuna, a few miles to the nearest emergency department, at the University of Pittsburgh Medical Center’s hospital in Williamsport, Pennsylvania.
Every bump of the drive was “like someone taking something and just jabbing it into my abdomen,” he said.
At the hospital, Nazuna Konishi Comfort handed over her husband’s Swiss insurance card, which confirmed coverage by Groupe Mutuel. Jay recalled the staff making copies of his insurance card and then treating his acute appendicitis. Doctors performed emergency surgery to remove the inflamed appendix.
Diagnostic tests confirmed he had a rare cancer, which doctors in Switzerland later removed with another surgery after he returned home. “It was a miracle,” Comfort said, adding that the cancer was completely removed.
After his appendectomy, Comfort recalled vomiting and then waiting in a recovery room. In all, he spent about 14 hours at UPMC Williamsport before being released. He attended his daughter’s wedding and, eventually, traveled back to Switzerland.
The patient: Leslie “Jay” Comfort, 66, a retired educator who worked in Japan and Switzerland. Comfort pays a monthly fee and deductible for Switzerland’s mandatory basic health insurance, which he has with the Swiss-based Groupe Mutuel. His benefits — and the prices for procedures — are defined by the Swiss government.
Medical service: Emergency laparoscopic appendectomy and diagnostic tests, which showed Comfort had a rare subtype of cancer called goblet cell adenocarcinoma.
Service provider: University of Pittsburgh Medical Center Williamsport, which is about 3½ hours northeast of Pittsburgh. The UPMC health system is one of the state’s largest employers, with 40 hospitals.
Total bill: $42,156.50, covering emergency surgery, scans, laboratory testing, and three hours in a recovery room. His insurer has said it will pay him about $8,184 (7,260.40 in Swiss francs), which is double the procedure’s price in Switzerland. This left him to cover the remaining roughly $34,000.
What gives: Although Comfort has health coverage, his Swiss insurance had no contract with the U.S. hospital where he underwent emergency surgery — or with any other provider outside Switzerland.
With what is considered an excellent health system, Switzerland has the highest prices for medical care in Europe. As in the U.S., the country relies on private insurers and hospitals. But the cost of care in Switzerland is substantially lower than what is charged in the U.S., so the reimbursement his insurer offered is a fraction of what Comfort owes the U.S. hospital.
“I’m trying to do the right thing and say I’m willing to pay my responsibility,” he said.
Groupe Mutuel does not have agreements with foreign providers, such as UPMC, and does not deal with them directly, said Lisa Flückiger, a spokesperson for Groupe Mutuel. The insurer originally agreed to reimburse Comfort what would have been paid in Switzerland for the same treatment in a public hospital and then double that because it was an emergency in a foreign country — a total of 4,838 in Swiss francs, or about $5,460.
While helpful, Comfort said, that amount wouldn’t pay off the $42,156.50 he owes UPMC.
UPMC has expanded its reach throughout Pennsylvania and is now the largest provider of care in many parts of the state. In 2016, it purchased a smaller health system and now runs two majors hospitals, UPMC Williamsport and UPMC Williamsport Divine Providence Campus.
Studies show that in areas where hospital consolidation is high, prices go up. Because there is less competition, hospitals have more power to charge what they want when patients have private insurance or are paying out-of-pocket.
In the U.S. the amounts charged for medical care are “all over the map,” said Johnathan Clarke, vice president of strategy and business development at Penfield Care, a medical cost-containment company in Canada. The company negotiates medical bills on behalf of individuals, including international visitors to the U.S., but is not involved in Comfort’s case.
