Much ado was made by nonprofit University of Iowa Health Care about its purchase of Mission Cancer + Blood ― a $280 million deal announced in late 2024.
Messaging by UI Health leaders touted how bringing a 45-year cancer practice with 20 clinics around Iowa into the fold of a network that included the state’s only National Cancer Institute-designated cancer center would help build better care, particularly in rural Iowa.
And that’s important, we’re told, because, as most of us have heard by now, Iowa has the second-highest cancer rate in the country.
But little was said in the same messaging about how the deal would cost Iowans ― thousands of them ― a lot more money.
That’s because since last summer, Iowa’s largest cancer network has chosen to bill Mission Cancer + Blood patients much higher “hospital” rates for routine clinic services.
“As with many hospital and health care systems, hospital-based billing is an approach UI Health Care utilizes for services rendered within its hospitals or within a hospital-affiliated facility,” the network said in a statement. “This encompasses clinics that, while potentially situated remotely from the primary campus, remain integral components of the system, giving patients coordinated, high-quality care.”
Surprising charges from Mission Cancer + Blood are waking up Iowans to a national problem that’s become commonplace when large hospital systems acquire independent clinics: Bills for routine but potentially life-saving care in clinics become far costlier.
One reason: They often can include hospital facility fees to help cover staffing, equipment and overhead.
But that kind of billing ignores anther truth: More Americans are having trouble with higher expenses and more difficulty affording health care.
In an annual economic well-being survey conducted by the Federal Reserve Board, 26% of adults skipped medical expenses in 2025 because of the cost. Almost 40 percent of Americans cannot afford an unexpected $400 medical expense without selling assets or borrowing money.
On average, workers contribute $6,850 annually toward the cost of family coverage, according to KFF health news. The average deductible among covered workers in a plan with a general annual deductible was $1,886 for single coverage.
Higher rates charged by networks owned by hospitals have prompted at least nine states to ban charging outpatient facility fees for specified procedures or care settings, according to the Center on Health Insurance Reforms, a research center within Georgetown University.
In Iowa, we might expect huge spikes in charges for routine care from, say, a hospital owned by a private equity firm ― another disturbing trend, especially in rural America.
But we don’t expect them from a tax-exempt state institution whose mission isn’t to generate profit, but rather to serve us through clinical care, education and research.
The bill spikes have riled a lot of Mission Cancer + Blood patients, I learned last week.
Welcome to the $1,991 office visit
As happened when I penned one of the most-read Watchdog columns on health care (a cautionary piece about the high price of sending Cologuard poop tests via UPS), I stumbled into this groundswell of controversy.
Earlier this month, I received a text reminder that it was time to have my blood tested and stop in for a routine visit with Dr. Tara Graff, my feisty and much-respected oncologist. Along with regular mammograms, the jab and office visit are something I’ve been told to do since a breast cancer diagnosis, surgery and radiation treatment in 2017.
Before this year, it’s been a small price to pay for peace of mind. After a mammogram, I pop into a Mission Cancer + Blood to get my blood drawn to check for a protein that cancer cells shed.
Afterward, I see Graff, or more typically when there’s nothing new to discuss, her nurse. A $50 copay covered the visit.
But this year, the same jab and office visit cost $1,991, more than four times what the total cost last year. About $800 of that charge, a billing person told me, was for my provider’s services.
The rest, $1,192, was for the antigen blood testing. My cost, after my Blue Cross Blue Shield insurance kicked in, would be more than 5½ times the old $50 deductible: $277.66, a billing estimate said.
Mind you, the mammogram was negative.
I doublechecked that estimate with the billing person. She sighed, broke down the numbers in detail, and told me many patients have been complaining about the clinic’s higher charges since UI Health Care took over Mission Cancer + Blood’s billing last June.
“You could go somewhere else and get it a lot cheaper,” she said.
That got me thinking about all the other Iowans struggling with higher premiums, stagnant wages, inflation and spiking household costs. Estimates like the one I received from UI Health surely will drive a portion of Iowans away from care ― or away from the place being marketed as Iowa’s greatest cancer care network.
A promise of better care doesn’t mean much if folks can’t afford it.
A Washington Post analysis, released in July, shows health-care premiums are expected to increase significantly again this year. Higher hospital costs are one of the many reasons why.
The Post’s review of preliminary Affordable Care Act rates and nonpartisan organizations’ analyses of coming insurance costs suggested that the challenges to employers trying to offer coverage, individuals trying to buy insurance, and medical providers will only get worse.
Folks in the industry know well that hospital charges have ballooned as more independent clinics and physicians are swept up in the consolidation of health area networks. So much so that the Centers for Medicare & Medicaid Services also have been adopting site-neutral reforms that align reimbursement rates for certain services to match rates at independent clinics.
I did some poking around and turns out, lots of people have been complaining online about Mission Cancer + Blood’s higher billing on social sites like Reddit. Some folks’ bills have gone from the hundreds to thousands of dollars.
On Thursday, July 10, I cancelled my appointment at Mission Cancer and tried to get a recommendation for a less expensive provider who could do the blood work and follow-up check.
Dr. Graff’s nurse, Molly, and a patient relations guy named Steve Abraham from Mission Cancer + Blood called back.
Abraham said one small error in the billing estimate I received was made because I was coded as a new, rather than an existing, patient.
But most of the change, he said, was because of the switch to hospital-based billing. When that happened, he said, patients go from having to make a simple copay to paying out-of-pocket toward their deductible.
“That makes a huge difference,” he said.
Abraham said patients were notified of the change to hospital billing, but he also said many people he has talked to told him they hadn’t received the information.
“From a provider standpoint, we don’t have a choice in the way we bill,” he said. “For us to have these conversations, we don’t enjoy it.”
Failing to ask questions can be costly
I have no doubt Abraham dislikes conversations like the one he had with me.
But as runaway health care costs continue, more Iowans struggle with the loss of care and providers across the state, and execs at big for-profit and nonprofit networks continue to make top dollar (Mark Burkard, the UI Health Care system’s director, made $548,395 last year), many would be dubious of the “we don’t have a choice” part.
UI Health is governed by the Iowa Board of Regents. Regents are appointed by the governor and confirmed by the Iowa Senate. Legislators you elect have the ability to address the affordability of cancer care as well as limit hospital rates for outpatient care.
Circling back to Brandee Saunders, a marketing manager at Iowa Health, she told me July 13 a patient letter describing the billing changes was mailed to “current” patients on May 30, 2025. Flyers explaining hospital-based billing were also mailed and posted in clinic locations, she said.
I never got anything, and my last visit to Mission was in April 2025.
I also learned something last week. Graff’s nurse said I could get a cancer antigen 15-3 blood test through my regular provider. Turns out I didn’t need to be going to Mission Cancer + Blood at all.
Given how much I’ve written about high health-care bills, I should have known. But like most folks shaken by the C-word, I did as I was told.
Resources
UI Health says patients can reach out to their Patient Financial Services team at (319) 384-2196 or (866) 393-4605 for personalized assistance. Other resources they provided:
Lee Rood’s Reader’s Watchdog column helps Iowans get answers and accountability from public officials, the justice system, businesses and nonprofits. Reach her at lrood@registermedia.com, at (515) 284-8549, on Twitter at @leerood or on Facebook at Facebook.com/readerswatchdog.
This article originally appeared on Des Moines Register: Why you’re paying more after UI Health bought Mission Cancer+Blood
Reporting by Lee Rood, Des Moines Register / Des Moines Register
USA TODAY Network via Reuters Connect
By Lee Rood, Des Moines Register | USA TODAY Network
