He Returned to the US for His Daughter’s Wedding. He Left With a $42,000 Hospital Bill.

Published

2 years ago

May 24, 2023

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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.

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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@kff.org, @SJTribble Related Topics Health Care Costs Insurance Bill Of The Month Hospitals Pennsylvania Contact Us Submit a Story Tip

US

At least 51 people killed in Texas flooding as authorities face scrutiny over response

Published

2 hours ago

July 6, 2025

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At least 51 people killed in Texas flooding as authorities face scrutiny over response

At least 51 people have died after heavy rain caused flash flooding, with water bursting from the banks of the Guadalupe River in Texas.

The overflowing water began sweeping into Kerr County and other areas around 4am local time on Friday, killing at least 43 people in the county.

This includes at least 15 children and 28 adults, with five children and 12 adults pending identification, Kerr County Sheriff Larry Leitha said at a news conference.

In nearby Kendall County, one person has died. At least four people were killed in Travis County, while at least two people died in Burnet County. Another person has died in the city of San Angelo in Tom Green County.

An unknown number of people remain missing, including 27 girls from Camp Mystic in Kerr County, a Christian summer camp along the Guadalupe River.

Rescuers have already saved hundreds of people and would work around the clock to find those still unaccounted for, Texas governor Greg Abbott said.

But as rescue teams are searching for the missing, Texas officials are facing scrutiny over their preparations and why residents and summer camps for children that are dotted along the river were not alerted sooner or told to evacuate.

AccuWeather said the private forecasting company and the National Weather Service (NWS) sent warnings about potential flash flooding hours before the devastation, urging people to move to higher ground and evacuate flood-prone areas.

The NWS later issued flash flood emergencies – a rare alert notifying of imminent danger.

“These warnings should have provided officials with ample time to evacuate camps such as Camp Mystic and get people to safety,” AccuWeather said in a statement that called Texas Hill County one of the most flash-flood-prone areas of the US because of its terrain and many water crossings.

But one NWS forecast earlier in the week had called for up to six inches of rain, said Nim Kidd, chief of the Texas Division of Emergency Management.”It did not predict the amount of rain that we saw,” he said.

Officials said they had not expected such an intense downpour of rain, equivalent to months’ worth in a few short hours, insisting that no one saw the flood potential coming.

One river near Camp Mystic rose 22ft in two hours, according to Bob Fogarty, meteorologist with the NWS’s Austin/San Antonio office. The gauge failed after recording a level of 29.5ft.

“People, businesses, and governments should take action based on Flash Flood Warnings that are issued, regardless of the rainfall amounts that have occurred or are forecast,” Jonathan Porter, chief meteorologist at AccuWeather, said in a statement.

“We know we get rain. We know the river rises,” said Kerr County Judge Rob Kelly, the county’s top elected official. “But nobody saw this coming.”

Judge Kelly said the county considered a flood warning system along the Guadalupe River that would have functioned like a tornado warning siren about six or seven years ago, before he was elected, but that the idea never got off the ground because “the public reeled at the cost”.

Homeland Security Secretary Kristi Noem was asked during a news conference on Saturday whether the flash flood warnings came through quickly enough: “We know that everyone wants more warning time, and that is why we are working to upgrade the technologies that have been neglected for far too long.”

Presidential cuts to climate and weather organisations have also been criticised in the wake of the floods after Donald Trump‘s administration ordered 800 job cuts at the science and climate organisation NOAA, the parent organisation of the NWS, which predicts and warns about extreme weather like the Texas floods.

A 30% cut to its budget is also in the pipeline, subject to approval by Congress.

Professor Costa Samaras, who worked on energy policy at the White House under President Joe Biden, said NOAA had been in the middle of developing new flood maps for neighbourhoods and that cuts to NOAA were “devastating”.

“Accurate weather forecasts matter. FEMA and NOAA matter. Because little girls’ lives matter,” said Frank Figliuzzi, a national security and intelligence analyst at Sky’s US partner organisation NBC News.

UK

How Prevent is tackling young extremism 20 years after the 7/7 bombings

Published

5 hours ago

July 6, 2025

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How Prevent is tackling young extremism 20 years after the 7/7 bombings

Radicalised nine-year-olds, teenagers mixing incel culture with extreme right ideologies and a Muslim who idolises Hitler – this is just some of the casework of those tasked with deradicalising young extremists in the UK.

Monday will mark 20 years since the 7/7 attacks on the London transport network when four suicide bombers killed 52 people and injured 770 others.

A year later the government set up its deradicalisation programme Prevent as part of its counter-terrorism strategy.

Sky News has spoken to two leading intervention providers (IPs) at Prevent who both say their work is getting ever more complex and the referrals younger.

The Metropolitan Police’s Prevent co-ordinator, Detective Superintendent Jane Corrigan, has also told Sky News it is “tragic” that when it comes to terrorism, “one in five of all our arrests is a child under 17”.

She believes parents should talk to their children about what they are reading and seeing online.

“Parents instinctively know when something doesn’t feel right when their child is becoming withdrawn or isolated – not wanting to engage,” she says.

People worried that someone they know has thoughts that could lead to terrorism can refer them to Prevent.

‘A pic-n-mix of ideologies’

Home Office figures show 11-year-olds are the largest age group to get referred.

Concerning cases are passed on to IPs such as Nigel Bromage who told Sky News: “Often there will be a pic-n-mix of ideologies.

“From my own examples and experience, we are aware of people looking at the incel culture and mixing that with some far-right elements.”

Incels, meaning “involuntary celibates” are men who have been unable to have a relationship with women despite wanting one and become misogynistic and hateful as a result.

Like many IPs, Mr Bromage from Birmingham comes from an extremist background himself, having once been a regional organiser for the proscribed Neo-Nazi group Combat 18.

For him too, it began as a child.

“It all started with someone giving me a leaflet outside my school gates,” Mr Bromage says.

“It told me a horrific story about a mum getting killed by an IRA bomb explosion – and at the end of the leaflet there was a call to action which said: ‘If you think it’s wrong then do something about it’.”

He developed a hatred for Irish republican terrorism which morphed into general racism and national socialism.

“At the very end I thought I was going to go to prison, or I would end up being hurt or even killed because of my political beliefs,” he says.

Boy, 9, groomed by his brother

Mr Bromage reveals his youngest case was a nine-year-old who had been groomed by his brother.

“He was being shown pro-Nazi video games, and his older brother was saying ‘when I go to prison or I get in trouble – they you’re the next generation – you’re the one who needs to continue the fight’,” he says.

“Really, he had no interest in the racist games – he just wanted to impress his brother and be loved by his brother.”

Every year, nearly 300 children who are 10 or younger are referred to Prevent.

Home Office figures show that over the last six years 50% of referrals were children under the age of 18.

Eleven-year-olds alone make up a third of total referrals, averaging just over 2,000 a year, with the figure rising even higher in the most recent stats.

Another IP, Abdul Ahad, specialises in Islamic extremism.

He says the catalyst for radicalisation often comes from events aboard.

Ten years ago, it was Syria, more recently Gaza.

“It is often a misplaced desire to do something effective – to matter, to make a difference. It gives them purpose, camaraderie and belonging as well – you feel part of something bigger than you,” he says.

Clients want someone to ‘hear them’

Some of his clients “don’t fit into any particular box”.

“I’m working with a guy at the minute, he’s a young Muslim but he idolises Hitler and he’s written a manifesto,” he says.

“When you break it down, some people don’t know where they fit in, but they want to fit in somewhere.”

Mr Ahad says the young individual mostly admires Hitler’s “strength” rather than his ideologies and that he was drawn to darker characters in history.

Often his clients are very isolated and just want someone to “hear them”, he adds.

Mr Ahad is also an imam who preaches at the Al-Azar Mosque in South Shields, a well-regarded centre for community cohesion and outreach.

He uses his understanding of the Islamic faith in his Prevent sessions to help guide his referrals away from extreme interpretations of the Koran by offering “understanding and context”.

He says: “We quote the correct religious texts – we explain their responsibility as a Muslim living in the UK and we re-direct their energies into something more constructive.”

Common theme of mental health issues

Mental health problems are a common theme among those referred to Prevent including depression and autism.

A recent inquest into the death of autistic teenager Rhianan Rudd found she took her own life after being radicalised by two white supremacists.

Her mother was critical of Prevent, as well as the police and MI5 after she had referred her daughter to the deradicalisation programme and Rhianan was subsequently charged with terrorism offences.

Last month a coroner found some failings in the processes around protecting Rhianan, but none of them attributable to Rhianan taking her own life.

Det Supt Corrigan says a referral doesn’t mean individuals end up being arrested or on an MI5 watchlist.

She says: “You’re not reporting a crime, but you are seeking support. I would say the earlier you can come in and talk to us about the concerns you have the better. Prevent is just that – it is a pre-criminal space.

“It’s tragic when you see the number of young people being arrested for very serious charges. Just look at terrorism – one in five of all our arrests is a child under the age of 17. We need to think about how we respond to that.”

Prevent has been criticised for failures such as when Southport killer Axel Rudakabana failed to be recognised as needing intervention despite three referrals, or when MP David Amiss’ killer Ali Harbi Ali went through the programme and killed anyway.

It’s harder to quantify its successes.

Mr Ahad says he understands why the failures hit the headlines, but he believes the programme is saving lives.

He says: “I think the vast majority of people get radicalised online because they are sitting in their room reading all this content without any context or scholarly input. They see one version of events and they get so far down the rabbit hole they can’t pull themselves out.

“I really wish Prevent was around when I was a young, lost 15-year-old because there was nothing around then. It’s about listening to people engaging with them and offering them a way of getting out of that extremism.”

‘Radicalisation can happen in days to weeks’

Det Supt Corrigan says: “I’ve sat with parents whose children have gone on to commit the most horrendous crimes and they all spotted something.

“Now, with hindsight, they wished they had done something or acted early. That’s why we created this programme, because radicalisation can happen in days to weeks.”

Twenty years on from 7/7 the shape of the terrorist threat has shifted, the thoughts behind it harder to categorise, but it is no less dangerous.

Sports

Volpe toss hits Judge as sloppy Yanks fall again

Published

6 hours ago

July 6, 2025

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Volpe toss hits Judge as sloppy Yanks fall again

Jorge CastilloJul 5, 2025, 09:42 PM ET
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NEW YORK — A blunder that typifies the current state of the New York Yankees, who find themselves in the midst of their second six-game losing streak in three weeks, happened in front of 41,401 fans at Citi Field on Saturday, and almost nobody noticed.

The Yankees were jogging off the field after securing the third out of the fourth inning of their 12-6 loss to the Mets when shortstop Anthony Volpe, as is standard for teams across baseball at the end of innings, threw the ball to right fielder Aaron Judge as he crossed into the infield from right field.

Only Judge wasn’t looking, and the ball nailed him in the head, knocking his sunglasses off and leaving a small cut near his right eye. The wound required a bandage to stop the bleeding, but Judge stayed in the game.

“Confusion,” Yankees manager Aaron Boone said. “I didn’t know what happened initially. [It just] felt like something happened. Of course I was a little concerned.”

Avoiding an injury to the best player in baseball was on the Yankees’ very short list of positives in another sloppy, draining defeat to their crosstown rivals. With the loss, the Yankees, who held a three-game lead over the Toronto Blue Jays in the American League East standings entering June 30, find themselves tied with the Tampa Bay Rays for second place three games behind the Blue Jays heading into Sunday’s Subway Series finale.

The nosedive has been fueled by messy defense and a depleted pitching staff that has encountered a wall.

“It’s been a terrible week,” said Boone, who before the game announced starter Clarke Schmidt will likely undergo season-ending Tommy John surgery.

For the second straight day, the Mets capitalized on mistakes and cracked timely home runs. After slugging three homers in Friday’s series opener, the Mets hit three more Saturday — a grand slam in the first inning from Brandon Nimmo to take a 4-0 lead and two home runs from Pete Alonso to widen the gap.

Nimmo’s blast — his second grand slam in four days — came after Yankees left fielder Jasson Dominguez misplayed a ball hit by the Mets’ leadoff hitter in the first inning. On Friday, he misread Nimmo’s line drive and watched it sail over his head for a double. On Saturday, he was slow to react to Starling Marte’s flyball in the left-center field gap and braked without catching or stopping it, allowing Marte to advance to second for a double. Yankees starter Carlos Rodon then walked two batters to load the bases for Nimmo, who yanked a mistake, a 1-2 slider over the wall.

“That slider probably needs to be down,” said Rodon, who allowed seven runs (six earned) over five innings. “A lot of misses today and they punished them.”

Jazz Chisholm Jr.’s throwing woes at third base — a position the Yankees have asked him to play to accommodate DJ LeMahieu at second base — continued in the second inning when he fielded Tyrone Taylor’s groundball and sailed a toss over first baseman Cody Bellinger’s head. Taylor was given second base and scored moments later on Marte’s RBI single.

The Yankees were charged with their second error in the Mets’ four-run seventh inning when center fielder Trent Grisham charged Francisco Lindor’s single up the middle and had it bounce off the heel of his glove.

The mistake allowed a run to score from second base without a throw, extending the Mets lead back to three runs after the Yankees had chipped their deficit, and allowed a heads-up Lindor to advance to second base. Lindor later scored on Alonso’s second home run, a three-run blast off left-hander Jayvien Sandridge in the pitcher’s major league debut.

“Just got to play better,” Judge said. “That’s what it comes down to. It’s fundamentals. Making a routine play, routine. It’s just the little things. That’s what it kind of comes down to. But every good team goes through a couple bumps in the road.”

This six-game losing skid has looked very different from the Yankees’ first. That rough patch, consisting of losses to the Boston Red Sox and Los Angeles Angels, was propelled by offensive troubles. The Yankees scored six runs in the six games and gave up just 16. This time, run prevention is the issue; the Yankees have scored 34 runs and surrendered 54 in four games against the Blue Jays in Toronto and two in Queens.

“The offense is starting to swing the bat, put some runs on the board,” Boone said. “The pitching, which has kind of carried us a lot this season, has really, really struggled this week. We haven’t caught the ball as well as I think we should.

“So, look, when you live it and you’re going through it, it sucks, it hurts. But you got to be able to handle it. You got to be able to deal with it. You got to be able to weather it and come out of this and grow.”