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Last June, Jay Comfort flew to the United States from his home in Switzerland to attend his only daughters wedding. But the week before the ceremony on a Friday evening Comfort said he found himself in excruciating pain.

This story also ran on NPR. It can be republished for free. Send Us Your Medical Bills

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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 Centers 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 husbands 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 daughters wedding and, eventually, traveled back to Switzerland.

Then the bill came.

The Patient: Leslie Jay Comfort, 66, a retired educator who worked in Japan and Switzerland. Comfort pays a monthly fee and deductible for Switzerlands 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 3 hours northeast of Pittsburgh. The UPMC health system is one of the states 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 procedures 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.

Im trying to do the right thing and say Im 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 Flckiger, 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 wouldnt pay off the $42,156.50 he owes UPMC. Email Sign-Up

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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 major 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 Comforts case.

Clarke said he would expect an appendectomy to be priced between $6,500 and $18,800, based on his analysis of Medicare payments in the Pittsburgh area. Healthcare Bluebook which evaluates insurers claims data to provide cost estimates based on what insurers have paid, rather than what providers charge says a fair price for a laparoscopic appendectomy in Williamsport is about $14,554.

Comfort said a reasonable price estimate based on his own internet research would be between $7,500 and $12,000.

Comforts care included an X-ray and an EKG, or electrocardiogram for his heart, because there was no information relating to past medical/surgical history for this patient, wrote Susan Manko, vice president of public relations at UPMC. The staff also conducted pathology work that identified cancer.

But those additional services did not fully explain the gap between cost estimates and what the hospital charged. For instance, UPMC charged $8,357 for Comforts three-hour stay in the recovery room.

Manko said Comforts total bill aligns with UPMCs standard charges.

The cost disparities highlight the stark difference in international pricing. Cost estimates last year showed the average amount paid for an appendectomy in the U.S. was nearly exactly double that paid in Switzerland, said Christopher Watney, chief executive of the International Federation of Health Plans, an industry association whose members include health insurers on six continents.

Health care in Switzerland, though, is often expensive compared with other European countries, Watney said. The Swiss pay double for an appendectomy compared with Germans, and more than three times that of those in Spain, he said. Across the globe, Watney said, many countries include an overnight stay in the cost of an uncomplicated appendectomy in contrast to Comforts experience, which was billed as outpatient care.

Comfort, who has dual residency in Switzerland and Japan after nearly three decades working abroad, said he worked in the U.S. long enough to qualify for Social Security benefits and Medicare. He said he had previously tried to gain Medicare coverage at one point but still is not enrolled, after being transferred to a couple of offices and playing phone tag.

Still, unlike many patients dealing with a five-figure medical bill, Comfort said he is not concerned about UPMC harming his financial reputation. The health system doesnt seem to put bad marks against peoples credit record and I dont have credit in the United States. Ive been out for 30 years.

Manko confirmed that, saying UPMC reviewed and updated its collection policy last year; it states the health system will not engage in extraordinary collection actions such as lawsuits, liens on homes, arrests, or reporting to credit agencies.

She said the health system which, as a nonprofit system, is tax-exempt maintains a robust financial assistance program for patients unable to pay. But to our knowledge Comfort has not applied for financial assistance, Manko told KFF Health News. After emergency surgery last year, Jay Comfort, an American expatriate with Swiss insurance, is facing a fve-figure bill. Costs for medical care in the U.S. can be two to three times the rates in other developed countries, so foreigners and expats with good insurance in their home countries need travel insurance to protect themselves from crazy prices.(Aria Konishi)

The Resolution: Comfort said he spent months waiting for a bill and finally reached out to UPMC because, if the bill had arrived this year, he would have had to pay his insurance deductible again on top of the charges.

Comfort received a full UPMC bill six months after his surgery. Manko said there was confusion at the time of Comforts ER registration. Comforts wife provided the insurance information, she said, but there was no documentation in the patients record for address, policy number or policy holder information.

Once Comfort received his bill, he realized it was much higher than his Swiss insurance reimbursement and, frustrated, contacted KFF Health News.

Flckiger said the original payment amount Comforts insurer calculated was by episode and did not include the scan or laboratory costs. After receiving questions from a KFF Health News reporter, Groupe Mutuel realized that we have not included the laboratory analysis and the CT scan, which are not routinely part of an appendectomy, Flckiger wrote.

After KFF Health News provided a detailed summary of the UPMC bill, the insurer increased the amount it would pay Comfort. In all, the insurer said, Comfort should receive 7,260.40 in Swiss francs, or about $8,184.

Comfort still hopes to negotiate directly with UPMC to reduce what he owes.

I dont want to try to walk away, saying I dont owe you anything, Comfort said. Thats not right. Were moral people, you know. But if youre going to try to gouge me and play the power trip and think youre going to try to get everything you can out of me, I wont play that game.

The Takeaway: Though the Affordable Care Act was meant to provide insurance to more Americans and bring down the cost of care, hospital bills remain extraordinarily high and highly variable.

For a nonemergency, Comfort could have tried to compare prices at other hospitals. But most hospitals in the area where he fell ill are owned by UPMC. And an inflamed appendix cant wait for comparison shopping.

Clarke, the cost-containment expert, said the only thing Comfort could have done differently was to purchase a travel health insurance policy before leaving Switzerland. While prices for health care in continental Europe are comparable to Switzerland, the high cost of care in the U.S. means Groupe Mutuel insurance is insufficient.

That is especially important for visitors to the U.S. since, as Robin Ingle, CEO of travel insurance company Ingle International, said: U.S. prices are kind of crazy numbers.

Bill of the Month is a crowdsourced investigation by KFF Health News and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!

Sarah Jane Tribble:, @SJTribble Related Topics Health Care Costs Insurance Bill Of The Month Hospitals Pennsylvania Contact Us Submit a Story Tip

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Binance lawyers allege SEC Chair Gensler offered to serve as advisor to crypto company in 2019




Binance lawyers allege SEC Chair Gensler offered to serve as advisor to crypto company in 2019

SEC Chair Gary Gensler mocks putting a gun to his head in response to a “Blazing Saddles” reference by Rep. Emanuel Cleaver, D-Mo., during the House Financial Services Committee hearing titled “Oversight of the Securities and Exchange Commission,” in Rayburn Building on Tuesday, April 18, 2023.

Tom Williams | CQ-Roll Call, Inc. | Getty Images

SEC Chair Gary Gensler, who is in the midst of a hefty crackdown on crypto companies, offered to serve as an advisor to Binance’s parent company in 2019, according to the lawyers for Binance and founder Changpeng Zhao.

Documents filed by the SEC on Wednesday indicate that attorneys from Gibson Dunn and Latham & Watkins, two of Binance’s law firms, allege that Gensler offered to serve as an advisor to the crypto exchange in several March 2019 conversations with Binance executives and Zhao. He eventually met Zhao in Japan for lunch later that month, the filing claims.

At the time, Gensler was teaching at Massachusetts Institute of Technology’s Sloan School of Management. He was appointed head of the SEC in 2021 by President Biden, and over the past year has come down hard on the crypto industry, suing numerous companies for allegedly selling unregistered securities.

Earlier this week, the SEC filed 13 charges against Binance and Zhao, alleging the company failed to register as an exchange and broker-dealer, improperly commingled funds and lacked critical internal controls over its businesses.

Before Gensler started going after Binance, he was trying to cozy up to the company, the lawyers say. The Wall Street Journal previously reported on Gensler and Binance’s relationship, citing internal Binance messages and a person close to the SEC chair. Both suggested that Binance approached Gensler.

In the latest filing, the Gibson and Latham attorneys say that Zhao continued to stay in touch with Gensler after the March meeting. And at the future SEC chair’s request, Zhao sat down for an interview with Gensler as part of a cryptocurrency course he was teaching at MIT.

The SEC on Tuesday described Zhao, who reportedly resides in the UAE, as a “foreign national” with a tendency for “geographic elusiveness.” Zhao’s lawyers now say that the Zhao understood that Gensler was “comfortable serving as an informal advisor.”

Later in 2019, the letter said, Gensler was slated to testify before the House Financial Services Committee, and he sent Zhao a copy of his intended testimony ahead of the hearing.

In July of that year, Gensler testified before the House over Facebook’s proposed and later canceled cryptocurrency Libra and its planned Calibra wallet.

“I do not advise any financial, technology, blockchain or other companies, nor do I own any cryptocurrencies,” Gensler’s prepared testimony read.

Gensler’s advice to lawmakers at the time was largely the same as his public statements today. He said that, with Facebook envisioning a wallet to store customer assets, rules needed to be in place “to guard against Calibra’s use or potential abuse of such customer funds.”

He also testified more broadly in language that’s resembles his latest pronouncements.

“We must guard against illicit activities, such as tax evasion, money laundering, terrorist financing and avoiding sanctions,” he said at the time. “We must protect individuals’ privacy.”

Because of Gensler’s ties to Zhao, Binance’s lawyers said they’d asked for his recusal from any actions regarding the company. They say they got no acknowledgement from SEC staff.

An SEC spokesperson said in a statement to CNBC that, “the Chair is very familiar with and full compliance with his ethical obligations including any recusal obligations.”

The SEC’s probes into Binance.US and Binance began in 2020 and 2021, respectively, well after Gensler and Zhao’s last alleged contact.

WATCH: SEC wages war against crypto industry

SEC vs. crypto: Regulators take on Coinbase and Binance

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NIO sets YTD order intake record after new ES6 launch in May




NIO sets YTD order intake record after new ES6 launch in May

NIO’s new ES6 already looks to be a key factor as the EV maker looks to expand its brand and compete in the booming Chinese electric vehicle market. According to Morgan Stanley, NIO hit a new year-to-date order intake record aided by the launch of the second-generation ES6.

After launching what many consider its most important model to date two weeks ago with its second-gen ES6 electric SUV, NIO has seen increased interest in the brand.

Although NIO was the only major EV maker in China to see a monthly sales decline in May, delivering 6,155 models (down 8% from April), the company has a plan to turn things around… and it already looks to be paying off.

Although the ES6 has been the company’s top seller since launching in 2018 as a more affordable option to the ES8, NIO knew it was time for an upgrade.

The EV maker is focusing on its NT 2.0 EV platform vehicles, including the recently launched EC7, second-generation ES8, ET5, and ES7 models. All NT 2.0 models are built on the NIO Adam supercomputer using four Nvidia DRIVE Orin system-on-chips (SoCs).

New ES6 boosts NIO’s order intake to record YTD high

A research report released last week from the Chinese consumer behavior research agency CarFans highlighted consumer behavior in NIO stores within the first 72 hours of launching (May 24 to May 27) the new ES6.

The report found each NIO store received 90 pre-orders on average, with around 20 confirmations that included a down payment.

New NIO ES6 (Source: NIO)

With roughly 330 stores, that’s around 29,700 pre-orders or 6,600 confirmations. For just three days, that’s pretty impressive for a premium SUV.

Although the cancellation rate is expected to be around 10%, the new ES6 is already leading to a new order intake record for the year, according to Morgan Stanley analyst Tim Hsiao (via CnEVPost).

In a research note on June 5, Hsiao said the firm had been tracking feedback from startups’ major sales channels in Tier 1 cities since last year to analyze the market. The team shared data that confirmed the new ES6 accounted for 35% to 40% of new orders in May, suggesting a meaningful impact on inflow as it launched in the final week of the month.

NIO’s overall traffic at flagship stores rose 30% to 40% month-over-month, with momentum continuing into early June. The new ES6 is NIO’s cheapest electric SUV, starting at RMB 368,000 ($51,614).

Meanwhile, the team said that despite customer traffic at the stores it tracks returning to levels seen this February, they are still “20% below last September’s level when the company rolled out ET5.”

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Vineyard Wind 1’s first turbine blades arrive in the US




Vineyard Wind 1's first turbine blades arrive in the US

The first turbine blades for Vineyard Wind 1, the US’s first commercial-scale offshore wind farm, have arrived at the New Bedford Marine Commerce Terminal in Massachusetts.

The $3.5 billion offshore wind farm will feature 62 GE Haliade-X 13-megawatt (MW) turbines spaced one nautical mile apart. The first turbine blades – each one 107 meters (351 feet) long – arrived at the Port of New Bedford (pictured above) from GE’s production site in Nazaire, France, on the heavy load vessel Rolldock Sky. (And no, it’s not lost on us, either, that wind turbine blades arrived on a fossil fuel vessel. May we collectively resolve that ironic problem ASAP.)

The turbine sections will be assembled at the terminal before they’re shipped out and installed this summer.

The 800 MW Vineyard Wind 1 is 15 miles south of Martha’s Vineyard and Nantucket and 35 miles from mainland Massachusetts. It’s a 50-50 joint venture between clean energy company Avangrid and Copenhagen Infrastructure Partners (CIP) funds CI II and CI III.

Vineyard Wind I will supply clean energy for over 400,000 homes and businesses in Massachusetts and reduce carbon emissions by over 1.6 million tons per year. It’s expected to come online at the end of 2023.

Read more: This US offshore wind farm is piloting a bubble curtain – what it is and why it’s cool

Photo: Avangrid

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