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

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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

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Olney: Yankees must replace Gerrit Cole — but they’ll probably have to wait

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2 hours ago

March 11, 2025

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Olney: Yankees must replace Gerrit Cole -- but they'll probably have to wait

Buster OlneyMar 10, 2025, 06:15 PM ET
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- Senior writer ESPN Magazine/ESPN.com
- Analyst/reporter ESPN television
- Author of “The Last Night of the Yankee Dynasty”

Gerrit Cole‘s season is over, now that he is headed for Tommy John surgery, and the New York Yankees will have to find a way to replicate the production of a Cy Young Award-winning pitcher, someone who is likely to one day make a speech on induction day in Cooperstown.

But this is not a case of a team being blindsided by an injury. Past injuries are the most predictive indicators for future injuries, and after Cole missed nearly the first three months of last season with nerve inflammation in his right elbow, the Yankees knew the chances of losing him were heightened. Their handling of his contract situation last fall was a strong indicator of the uncertainty around Cole.

The pitcher and his agent, Scott Boras, opted out of the last four years of his contract, while asking that the Yankees exercise a $36 million option for the 2029 season, effectively adding a fifth year to his four-year, $144 million deal. Owner Hal Steinbrenner and GM Brian Cashman declined to do so, firmly holding the line, and days later, Cole returned to the Yankees without any augmentation of his contract. While the Yankees hoped Cole’s elbow would remain functional, as Masahiro Tanaka’s elbow did following a diagnosis of a partially torn ligament in 2014, they weren’t willing to bet another $36 million on it.

But that doesn’t help them very much right now, when they have lost two starting pitchers to significant arm injuries: Before Cole went down, Luis Gil — the American League Rookie of the Year last season — suffered a lat strain this spring that will keep him sidelined for much of the 2025 season. Max Fried, signed to a $218 million contract over the winter to improve a good rotation, will now be the de facto ace, in front of right-handers Clarke Schmidt and left-hander Carlos Rodon. A month ago, there was a lot of speculation about whether Marcus Stroman would be traded, given his standing as the sixth starter behind a five-man rotation, and now Stroman is needed as the No. 4 starter.

Cashman’s habit is to be patient — to weigh internal solutions before diving into another free agent signing or trade. When Cole was sidelined last spring, the Yankees thought Will Warren might step into his spot in the rotation, and instead, Gil surprisingly emerged to fill in for Cole and was one of the league’s best starting pitchers in the first half.

This year, Warren is having a very good spring, having allowed just two hits and a run in eight innings of work, with two walks and 11 strikeouts. Warren, an eighth-round pick out of Southeast Louisiana in 2021, is the front-runner to move into the Yankees’ rotation.

Just as the Yankees continue to weigh market options for hitting help while Giancarlo Stanton is attempting to work his way back from elbow trouble, they will consider free agent possibilities such as veteran right-hander Kyle Gibson. The Yankees paid for insurance on Cole’s contract, and so they will recoup some portion of the salary they owe him; typically, that rate is about 75%. His contract still counts against their competitive balance tax total, but the insurance money will significantly offset the luxury tax they will have to pay for the addition of any replacement: The Yankees are taxed dollar for dollar, 100%, for any additional player salaries they take on. A new $5 million player costs the Yankees $10 million.

Eventually, their best alternatives, if needed, could be through the trade market, and maybe that turns out to be the Miami Marlins‘ Sandy Alcantara, the 2022 NL Cy Young Award winner who is back after an elbow reconstruction. Under the terms of a deal he signed with the Marlins early in his career, Alcantara is making $17.3 million this year and $17.3 million next season, and there is a $21 million option in his deal for 2027.

The Marlins are not expected to contend this year and have been in a cost-cutting mode since Peter Bendix took over the team’s baseball operations after the 2023 season. Last year, the Marlins demonstrated a willingness to deal very early in the season, when they swapped batting champion Luis Arraez to the San Diego Padres in the first week of May.

But the price of a trade in April or May is usually set by the team dealing away a star, and the Yankees would have to pay a big price in prospects in the spring after a rough year for their farm system, which is generally regarded as thin by other teams and ranked No. 21 in Kiley McDaniel’s preseason system rankings. Additionally, the Yankees would presumably compete against other teams if and when the Marlins look to trade Alcantara, leaving them at the same disadvantage they faced when trying to pry Garrett Crochet away from the Chicago White Sox — before Chicago dealt him to the Boston Red Sox.

Over the course of the summer, Gil could return from the injured list, and other pitchers could emerge on the trade market as some teams drift out of contention. If the Toronto Blue Jays struggle in the first half, they could be a key source for all kinds of needs, including starting pitchers. Jose Berrios, Kevin Gausman, Chris Bassitt and Max Scherzer might all draw interest if Toronto ever looks to rebuild and, in the Yankees’ case, is willing to deal within the division.

One or more National League West teams could end up feeding the trade market. The Padres enter this season with high expectations after nearly knocking out the Los Angeles Dodgers last summer, but if San Diego drifts behind in the playoff race, it holds two of the best impending free agents, Dylan Cease and former Yankee Michael King. Similarly, the San Francisco Giants have veteran Robbie Ray, who is under contract for $25 million this year and next, and the Arizona Diamondbacks‘ Zac Gallen will become eligible for free agency in the fall.

Likewise, in the AL West, the Mariners have so far clung to their starting pitchers, like Luis Castillo, but that could change if Seattle sinks in the standings. The Astros demonstrated their willingness to be aggressive with players nearing free agency with their trade of outfielder Kyle Tucker, and if Houston hovers around .500, it could flip Framber Valdez into the market — with his years of postseason experience attractive to contenders.

The pitching market could be flush with options in a few months. And the Yankees might wait until then to make a move to cover for Cole’s absence.

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Yankees ace Cole will have Tommy John surgery

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2 hours ago

March 11, 2025

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Yankees ace Cole will have Tommy John surgery

Jorge CastilloMar 10, 2025, 06:08 PM ET
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New York Yankees right-hander Gerrit Cole will undergo Tommy John surgery, the team announced Monday, ending his 2025 season before it began and leaving the club staggering from another blow as it prepares to defend its American League pennant.

The decision to have the surgery, which will sideline Cole for the 2025 season and at least part of the 2026 season, was made after seeking a second opinion from Dr. Neal ElAttrache on Monday. Cole will undergo the procedure Tuesday at the Cedars-Sinai Kerlan-Jobe Institute in Los Angeles. In a statement, the club said that “further updates will occur post surgery.”

Cole started two games this spring, giving up seven runs across six innings. On Thursday, he gave up six runs on five hits, including two home runs, over 2⅔ innings to the Minnesota Twins. He said he felt an “alarming” amount of pain that night into Friday morning, prompting him to notify the team and undergo imaging tests, which revealed a torn ulnar collateral ligament.

Cole, 34, went through the same series of stressful events a year ago: Elbow pain in mid-March, tests and opinions from doctors. But the result was different. Cole was diagnosed with nerve irritation and edema and, instead of surgery, he rested and rehabbed. He made his season debut on June 19 and pitched through the World Series without a setback.

In a statement he posted on Instagram later Monday, Cole said the surgery was a “necessary next step for my career,” adding that he has “a lot left to give, and I’m fully committed to the work ahead. I’ll attack my rehab every day and support the 2025 Yankees each step of the way. I love this game, I love competing, and I can’t wait to be back on the mound — stronger than ever.”

The ace logged 124 innings over 22 starts between the regular season and playoffs, tossing at least six innings in three of his five postseason outings. He then opted to alter his offseason throwing program by starting it earlier to continue his positive momentum. He said he was “in a really good spot” compared to other years at the start of camp.

But less than a month later, his season has been declared over.

Cole’s injury is the second major blow to the Yankees’ starting rotation this spring after Luis Gil, the reigning AL Rookie of the Year, sustained a lat strain that was expected to sideline him for at least three months.

Without the two right-handers, Max Fried, Carlos Rodon and Clarke Schmidt will top the Yankees’ starting rotation. Marcus Stroman, who was notably not expected to make the Opening Day rotation, is projected to slide into the No. 4 spot with Will Warren, a rookie who made his debut last season, and Carlos Carrasco, a soon-to-be-38-year-old veteran in camp as a non-roster invite, as the leading internal candidates to round out the quintet.

Other options in camp include right-hander Allan Winans, who has eight career starts on his résumé, and left-hander Brent Headrick, a starter in the minors who has never started a game in the majors.

The Yankees could also opt to sign a free agent — veterans Kyle Gibson and Lance Lynn are among those available — or swing a trade for an established starter.

Cole, a six-time All-Star, won the 2023 AL Cy Young Award and was the runner-up two other seasons. He has tallied at least 200 innings in six of his 10 full seasons (not including last year and the COVID-shortened 2020 season). He is as close to an old-school frontline workhorse in his prime that exists in baseball. It’s why the Yankees chose to sign Cole, a lifelong Yankees fan, to a nine-year, $324 million deal with a no-trade clause in December 2019 — the largest contract given to a pitcher at the time.

The agreement included a player opt-out after last season that the Yankees could’ve voided by attaching another year and $36 million to the four years and $144 million remaining on his contract. Cole exercised the opt out, but he never became a free agent and didn’t receive the extra year. Instead, the two sides agreed to continue as if Cole didn’t opt out two days later, keeping him under contract through the 2028 season at $36 million per year.

The Yankees have insurance on Cole’s contract, which will allow them to recoup some money for the time he’s out.

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Source: Dodgers, Roberts agree on 4-year deal

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2 hours ago

March 11, 2025

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Source: Dodgers, Roberts agree on 4-year deal

Alden GonzalezMar 10, 2025, 03:55 PM ET
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GLENDALE, Ariz. — Dave Roberts and the Los Angeles Dodgers are in agreement on a four-year extension that will set a record for average annual value on a manager’s contract, a source told ESPN on Monday.

The new deal, which runs from 2026 to 2029, will pay Roberts $32.4 million, carrying an $8.1 million average annual value that will narrowly edge out the yearly rate on Craig Counsell’s five-year, $40 million contract with the Chicago Cubs. Roberts, 52, will manage the 2025 season under his current contract, which was entering its final year.

A new deal was considered a foregone conclusion after the Dodgers secured their second championship in five years last fall. Serious negotiations began sometime around February; significant progress was made last week; and an announcement could come before the Dodgers fly to Japan to begin their season March 18. The 2025 season will mark Roberts’ 10th with the Dodgers.

“I can’t talk so much about it, but I do think that there’s finally some closure,” Roberts said after Monday’s Cactus League game. “I’m excited. Obviously this is the place I want to be. I’m sure I’ll go into it more. Hopefully there’s an announcement coming soon; I’m waiting. But this is the place I’ve always wanted to be. I just love what we’re doing.”

A cult hero in Boston for the stolen base that helped trigger an unprecedented comeback in the 2004 American League Championship Series, Roberts carved out a 10-year career as a major league outfielder, then spent five years on the San Diego Padres‘ coaching staff. The Dodgers hired Roberts to replace Don Mattingly in November 2015, making him the franchise’s first minority manager.

Since then, Roberts has guided the Dodgers to four National League pennants, eight division titles and a .627 regular-season winning percentage, the highest for someone who has managed at least 250 games. From 2016 to 2024, the Dodgers won 907 regular-season and postseason games. Only the Houston Astros (862) and the New York Yankees (807) even surpassed 800.

The Dodgers won at least 100 regular-season games in five of six full seasons from 2017 to 2023 and finished the 60-game 2020 campaign with a .717 winning percentage. The only year the Dodgers have not won the NL West under Roberts, in 2021, they finished with 106 victories — fewer by one than a San Francisco Giants team they later eliminated in the playoffs. And yet Roberts has only one Manager of the Year Award to his name, a sign of the harsh realities of his job.

For years, the Dodgers’ triumphs have been widely credited to an ownership group with deep pockets and a baseball operations department that is among the most astute in the industry. Roberts, meanwhile, had been left to shoulder the blame for repeated postseason disappointments. That was never more true than in 2019, when another 106-win Dodgers team lost in the NL Division Series to the Washington Nationals after Roberts rode Clayton Kershaw a little too long in a decisive Game 5.

But Roberts went on to manage the Dodgers through an unorthodox 2020 postseason that was staged in a bubble and did not include any days off within series, claiming the franchise’s first title in 32 years and buying himself more time. More October disappointment followed thereafter. The Dodgers were outlasted by the Atlanta Braves in the NLCS in 2021, then were defeated by inferior division rivals in the NLDS in 2022 and 2023, first the Padres and then the Arizona Diamondbacks.

A similar fate seemed to await the Dodgers in 2024. They found themselves a game away from elimination by the Padres in the NLDS, having to win in San Diego to keep their season afloat. A third consecutive early exit, immediately following a first-round bye, would have probably cost Roberts his job. But he managed through a bullpen game in Game 4, then rode more dominant pitching in Game 5 to advance. The Dodgers then breezed past the New York Mets and Yankees to secure their first full-season championship since 1988.

The 2024 season ultimately highlighted Roberts’ best traits. His even-keel demeanor helped the team navigate the betting scandal surrounding Shohei Ohtani‘s then-interpreter, Ippei Mizuhara, early in the year. His trademark positivity kept the team’s spirits high when injuries plagued star players such as Mookie Betts, Max Muncy, Yoshinobu Yamamoto and Tyler Glasnow throughout the summer. And in the fall, while dealing with an extremely compromised starting rotation, Roberts seemed to press all the right buttons.

He navigated through bullpen games on four occasions, most notably to save the season against the Padres and to win the pennant against the Mets. And in Game 5 of the World Series, when starting pitcher Jack Flaherty didn’t pitch past the second inning, Roberts rode a beleaguered group of relief pitchers while the Dodgers made a spirited comeback and entrusted another starter, Walker Buehler, to record the final three outs.

With the win, Roberts put himself alongside Walter Alston and Tommy Lasorda as the only Dodgers managers to win multiple rings. It more than likely secured his place in the Hall of Fame. But what he was most proud of was that the trust he had always extended to his players had been reciprocated.

“That’s everything,” Roberts told ESPN shortly after securing the championship. “I believe in them. And this is the first team that I felt really like the trust went both ways. And that regardless of whatever decision I made, they were going to support me 100 percent.”

The New York Post was first to report Roberts’ extension.