26 December 2019

A $28,000 bill for an outpatient clinic visit

How's this for a horror story about the American health care system?
Alexa Kasdan had a cold and a sore throat.

The 40-year-old public policy consultant from Brooklyn, N.Y., didn't want her upcoming vacation trip ruined by strep throat. So after it had lingered for more than a week, she decided to get it checked out. Kasdan visited her primary care physician, Roya Fathollahi, at Manhattan Specialty Care, just off Park Avenue South and not far from tony Gramercy Park. The visit was quick. Kasdan got her throat swabbed, gave a tube of blood and was sent out the door with a prescription for antibiotics.,,

When Kasdan got back from the overseas trip, she says there were "several messages on my phone, and I have an email from the billing department at Dr. Fathollahi's office."
The news was that her insurance company was mailing her family a check — for more than $25,000 — to cover some out-of-network lab tests. The actual bill was $28,395.50, but the doctor's office said it would waive her portion of the bill: $2,530.26...

How could a throat swab possibly cost that much? Let us count three reasons.

First, the doctor sent Kasdan's throat swab for a sophisticated smorgasbord of DNA tests looking for viruses and bacteria that might explain Kasdan's cold symptoms...

The second reason behind the high price is that the doctor sent the throat swab to an out-of-network lab for analysis. In-network labs settle on contract rates with insurers. But out-of-network labs can set their own prices for tests, and in this case the lab settled on list prices that are 20 times higher than average for other labs in the same ZIP code...

The third reason for the high bill may be the connection between the lab and Kasdan's doctor. Kasdan's bill shows that the lab service was provided by Manhattan Gastroenterology, which has the same phone number and locations as her doctor's office...

Even though Kasdan wasn't stuck with this bill, practices like this run up the cost of medical care. Insurance companies base premiums on their expenses, and the more those rise, the more participants have to pay... Marting says this is a common problem for insurance companies. Most claims processing is completely automated, she says. "There's never a human set of eyes that look at the bill and decide whether or not it gets paid."
More details at NPR.  The American health care system of financing is outdated and wide open to egregious abuse.  Radical changes need to be made.  Anyone who argues otherwise is being willfully blind to what's going on.


  1. And here in New Zealand the government funded my triple bypass heart operation and my 6 month recuperation, and all I have done is pay about 17% income tax since I started working.

  2. Somebody needs a prison visit. Say 5 years

    1. Unless rocky knows differently, I think most chicanery like this is done within the limits of existing state and federal law. The practitioners will typically get a slap on the wrist reprimand by their professional associations, with a caution not to do this again (wink, wink...)

  3. I am shocked! Shocked, I say, that the insurance covered out-of-network charges.

  4. I came down with a nasty case of strep throat last month. Luckily I'm in the UK so all I had to pay was a £9 prescription charge. The American healthcare system is absolutely and totally broken.

  5. I'd put my money on reason number three.


Related Posts Plugin for WordPress, Blogger...