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Blood Test Surprise

In the spring of 2005, the sinus infection returned. I awoke severely congested with a pounding forehead and pain around my eyes that grew worse when I bent to tie my shoes. The feeling was familiar. Two years earlier, I had similar symptoms, but was uninsured and endured a miserable week with nothing but over-the-counter medication. Now they were back.

Fortunately, when I started graduate school, my father insisted that I have health insurance. As a healthy 24 year old, I didn’t see the need, but he agreed to foot the bill for a high-deductible insurance policy to cover me in the event of catastrophic illness. Except for four physician office visits subject only to a $35 co-payment, my policy offered no benefits until I spent $3,000 out of my own pocket. With my sinuses throbbing, I knew I needed to use one of those visits. Overwhelmed by the list of “in-network” providers on the insurer’s website, I picked an internist based on convenience—his practice was located in a medical complex near my home.

Arriving for my appointment, I checked in and presented my insurance card to the receptionist. “Your visit today will be $35,” said the woman behind the desk. I was relieved to hear that my coverage was working as promised. A nurse ushered me to an exam room, where the physician promptly entered, half-heartedly listened to my complaint, and confidently asserted that I did not have a sinus infection because I had no fever. I wanted to say “Really? Mind handing me a tissue so that I can show you what’s been coming out of my head?” but resisted the urge. Instead, I clarified that fever or no, I didn’t feel well, and believed my sinuses were the culprit. At this, the internist lost patience. He ordered some lab work and a sinus CT scan to rule out infection, and said that I could have everything done downstairs.

Despite my $35 office visit, I knew my insurance wouldn’t cover anything else until I met my deductible, so I needed to find out the cost of the CT scan. Doing so was much more difficult than I expected. Admissions didn’t know the cost, so they called the imaging department. Imaging had no idea, and threw it back to admissions where, after much searching, a big black binder full of prices was located in a cabinet, alongside packets of coffee creamer, some paper clips, and a couple of dried up ink pens. The sinus CT would cost roughly $900, which I could not afford. I headed instead to the lab to get my blood drawn, not knowing that I was about to make a costly mistake.

I worked as a phlebotomist during college, so I knew that lab tests were expensive, but that most insurers negotiated discounted rates that were only a fraction of the sticker price. Besides, the lab work was routine—a comprehensive metabolic panel and complete blood count—so I didn’t think to ask how much it would cost. My mistake was assuming that the lab was in-network, because the in-network internist I had just seen worked in the same building and referred me to the lab.

A month later, the bad news came in the mail. The lab was out-of-network, and I owed $478. While this wasn’t the five-figure medical bill many families face, everything is relative. For me, a graduate student living almost entirely on borrowed money, the bill changed how I bought groceries, socialized with friends, and commuted to school. For six months, I fought to scrape together enough money to make monthly payments. The experience, while costly, taught me a lot about our fragmented health care system, how little patients or providers know about the real cost of health care, and how hard it is for patients to make price-based decisions when the system isn’t designed with that in mind.

I had learned my lesson. Later, when a dermatologist put me on medication requiring monthly blood tests, I took out the yellow pages, looked up laboratories, and dialed the phone. “I’m uninsured,” I said (not far from the truth given my coverage) “and I need to have a lipid panel and a liver function test. How much will this cost?” Some labs knew, and some labs didn’t, and the answers varied widely. Needless to say, I chose the least expensive option. Making the decision was easy, getting the information on which to base the decision was—and is—the real challenge.

On Labor Day Costs of Care, a Boston-based nonprofit, offerred $1000 prizes for the best anecdotes from doctors and patients that illustrate the importance of cost-awareness in medicine. Two months later we received 115 submissions from all over the country – New York to California, Texas to North Dakota, Alaska to Oklahoma. We feel these stories are poignant because they put a face on some of the known shortcomings of our system, but also because they unveil how commonplace and pervasive these types of stories are. To learn more about the contest and read more of our stories please visit www.CostsOfCare.org (Twitter: @CostsOfCare).

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bubbadoc4converseAl Kennedyfamily car stickersAlex Fair Recent comment authors
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bubba
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bubba

Health care is certainly expensive, both for the insured and uninsured. However, I cant believe this story. In my experience, the insured have much lower pricing. The lower price is usually given after the insurance company calls to clarify charges. I expected to read that the charges would total about 5 or 10 dollars less than the annual deductible, which is what ive seen on EVERY 1000 to 50000 dollar hospital bill.

doc4converse
Guest
doc4converse

The $478 dollar bill helps to pay the tests for the other patients with the in-network insurance company (those patients may only be charged 50 cents for the test). Furthermore, a lab test in an internist’s office is not under the same scrutiny as a lab test performed in the large hospital/reference laboratory. I am not saying it is right, just that it is. There is no free market in healthcare because if this was a free market, then anyone can prescribe medication, sales taxes would be added to the cost of a visit like any services, and anyone can… Read more »

Al Kennedy
Guest

Interesting Blog, even though this was not what i was looking for (I am in search of clinics like this one> http://www.ccsviclinic.ca/ )… I certainly plan on visiting again! By the way, if anyone knows of a good clinic that does CCSVI Screenings? BTW..thanks a lot and i will bookmark your article: Blood Test Surprise…

family car stickers
Guest

Time can change most of things ,but not all of things.

Alex Fair
Guest

Hey Folks, I feel your pain Brad. In undergrad and then grad school I tore both ACLs but didn’t have coverage so just “walked it off.” Nowadays, I would probably have better options, as would you and your Cost of Care folks. Let me elaborate. I generally disapprove of plugs in posts so I won’t put in a link to my site, but clearly not enough people know about our new and useful service for anyone in Brad’s situation (although Health 2.0 has been very supportive – thanks Matt, Indu, Lizzie,…) In short, if anyone is in Brad’s situation, we… Read more »

Susan
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Susan

Face it Nate–people like Gary L. want their health care for free. They do not want to take any personal responsiblity for any part of their lives when it comes to health care. They will always want to blame someone else. They will never look in the mirror and they can do absolutely nothing for themselves. They can’t even get their lazy butts to the doctors office. A bunch of big babies.

Nate Ogden
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Nate Ogden

“How ludicrest it is that, Health Facilities and Insurance can secretly set pricing and still not be up front with their members.”
Ya you go Gary how dare those sneaky insurance companies set secert pricing then try to cover it up by printing it on every EOB and labeling it Provider discount with a note that the member isn’t responsible? How are people like Gary suppose to know discounted amount really means evil secert negiotated price?

Gary Lampman
Guest
Gary Lampman

Welcome to the maze of Health Care ambushes.Can’t you feel the knife sliding between your shoulder Blades. In the real world ;such shifty,underhanded and unethical behaviors would land most business’s in bankruptcy and prison. How ludicrest it is that, Health Facilities and Insurance can secretly set pricing and still not be up front with their members. Oh don’t you love those suprises! The consumer is being scammed by insurers and providers. Paying little to nothing and taking entitlement payments for shafting customers! Health Insurance has played on your fears and made fools out of all of us. Ask yourselves why… Read more »

Nate Ogden
Guest
Nate Ogden

“My favorite one of these is when you’re having surgery” You meant emergency surgery right, not the more common schedule surgery that accounts for 80% of all surgeries. Being that scheduled surgeries are well scheduled and you have plenty of time, weeks even months, to make the phone calls to confirm they are in network your rant really wouldn’t apply. Then again most emergency surgeries fall under emergency benefits, at least they keep the naming simple, where you aren’t penalized for not taking action you couldn’t possibly take. It almost, in a way, appears they designed the system to be… Read more »

Vitamin B12
Guest

If you need a comprehensive health checkup or any expensive medical work done, I would suggest trying a hospital in another country. I had a very comprehensive check-up in Bumrungrad hospital in Bangkok for around $1500. That included about 6 lots of blood tests, chest x-ray, bone density check, urine test and lost more, incuding seeing doctor and nutritionist. Basic blood tests in Bangkok are about $5-10. Even the most expensive ones are under $50. I’m from the UK and I have to say that the quality of the facilities, the quality of the doctors and the quality of teh… Read more »

Toni Brayer
Guest

Your story is far too common. As an Internal Medicine Doctor, I hear stories like this every day from patients and I try hard to anticipate what will or will not be covered for them. If you survey 10 physicians and ask what a sinus CT or a metabolic panel will cost, I bet none will be close to correct. I can think of no other “industry” where this would occur.
The myth of the “informed consumer” shopping for health care and driving competition and lower prices is ridiculous when there is no transparency at all.

Stephen Meyers, MD
Guest

Mr. White, What an unfortunate situation. It appears that those serving you failed you in several ways. First, unless there is more to the story than presented, I simply can’t justify your physician’s approach to your symptoms. One could argue for or against the merit of a CT scan (most would probably vote for a trial of antibiotics first), but why the labwork? Sinus infection, allergies, migraine, brain tumor, whatever the cause, a CBC and (especially) a CMET are minimally helpful in the workup of head pain. Your story regrettably illustrates that one should think twice before spending more on… Read more »

MelanieG, MD
Guest
MelanieG, MD

Pitfalls for doctors too. I am n ot in any networks because I do not want to be beholden to the idiot insurance carriers. When they ask me to produce records so they can snoop on my care, I tell them to buzz off, since I am not in the network. The pitfall for me is that the insurance carriers pay much less but sorse yet, theysend the checks to the patients, to punish me for refusing to “join” the network, aka conspiracy. The patients then think these checks are their money and pay me nothing. I am happy to… Read more »

Aimee
Guest

Today you would at least get some guidance even though you should always check price before you go to a provider. Healthcarebluebook.com provides pricing by zip code for common treatments and procedures. What you get is the price that health plans pay their providers so you know what other patients are paying for what you need done. I’ve used the Healthcare Blue Book multiple times for this and switched providers because the one I’m using or the doctor recommended is just too expensive. Many providers will offer a cash paying patient a discount but you have to ask. Knowing what… Read more »

propensity
Guest
propensity

Think you could change my last name to “Wright” — thanks!
My oh my, simply a case of misidentification. If you were in a hospital with an EMR causing most employees to be decorticate as they blindly trust the computer, you could have been killed and mis-billed.
Prop