This story additionally ran on NPR. This story may be republished totally free (details).
This is the debut of a month-to-month characteristic from Kaiser Health News and NPR that can dissect and clarify actual medical payments with a purpose to make clear U.S. well being care costs and to assist sufferers learn to be extra lively in managing prices. Do you might have a medical invoice that you just’d like us to see and scrutinize? Submit it here and inform us the story behind it.
In her late 20s and attending school in Texas, Elizabeth Moreno suffered from debilitating again ache brought on by a spinal abnormality. “I just could not live with the pain,” she stated. “I couldn’t get dressed by myself, I couldn’t walk across my house, let alone to class, and nothing, no drug that had been prescribed to me, even dulled the pain.”
Moreno says she additionally tried chiropractic drugs and acupuncture, however they didn’t make the ache go away. Finally, a health care provider on the pupil well being heart referred her to an orthopedic specialist who carried out exams and concluded a disc was blocking nerves down her legs and wanted to be eliminated. Moreno’s father, a retired Ohio physician who had seen many failed again surgical procedures over his profession, agreed it was the very best course.
In late 2015, Moreno had the operation in Houston, which she described as “a complete success.” She gave it little thought when the surgical workplace requested her to depart a urine pattern for a drug check.
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Then the invoice got here.
Patient: Elizabeth Moreno, then 28, a pupil at Texas State University in San Marcos.
Total invoice: $17,850 for a urine check in January 2016
Service supplier: Sunset Labs LLC of Houston
Medical remedy: Moreno had a disc faraway from her again in December 2015. Her surgeon prescribed an opioid painkiller, hydrocodone. At a follow-up workplace go to in mid-January 2016, the workers requested her to depart a urine pattern, which she figured was routine. In March 2017, over a yr later, the lab despatched her a invoice for $17,850 for testing her urine for a slew of medicine, together with cocaine, methadone, anti-anxiety medicine and several other different medicine she had by no means heard of.
(Story continues under.)
What offers: Urine drug testing has exploded over the previous decade amid alarm over rising opioid overdose deaths. Many docs who prescribe the drugs depend on the urine exams to assist cut back drug abuse and preserve sufferers with power ache protected. Yet the exams have develop into a money cow for a burgeoning testing trade, and critics cost that unneeded and infrequently costly ones are typically ordered for revenue somewhat than affected person care. Doctors can resolve whether or not to check sufferers who take opioids for brief intervals, akin to after an operation. Moreno’s surgeon wouldn’t focus on her urine check — why he ordered it and why the pattern was examined for thus many substances.
Related Story: Pain Hits Long After Surgery When Doctor’s Daughter Is Stunned By $17,850 Urine Test
Three specialists contacted by Kaiser Health News questioned the necessity for such in depth testing and had been shocked to listen to of the lab’s costs. They stated these exams hardly ever price greater than $200, and usually a lot much less, relying on the complexity and the know-how used. Some docs’ places of work use a easy cup check, which may detect a number of lessons of medicine on the spot and might be bought for about $10. Bills can climb greater when labs run exams to detect the amount of particular medicine and invoice for each, because the lab did right here.
The specialists KHN interviewed stated that the lab’s costs for particular person exams had been extreme, akin to charging $1,700 to test for amphetamines or $425 to determine phencyclidine, an unlawful hallucinogenic drug also referred to as PCP. They additionally criticized a cost of $850 for 2 exams to confirm that her urine pattern had not been adulterated or tampered with.
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Moreno’s insurer, Blue Cross and Blue Shield of Texas, refused to pay any of the invoice, arguing that the lab was out-of-network and thus not coated. Had it chipped in, it could have coated the service at $100.92, in response to an explanation of benefits the insurance coverage firm despatched to Moreno.
Sunset Labs says its record costs had been “in line” with its rivals within the space. It additionally stated docs treating ache agree in depth urine testing is “the best course of action” and that a lab “is not in the position” to query exams ordered by a health care provider.
Resolution: Fearing injury to his daughter’s credit standing, Moreno’s father, Dr. Paul Davis, paid the lab $5,000 in April 2017 to settle the invoice. A retired physician, he additionally has filed a proper grievance in regards to the invoice with the Texas legal professional common’s workplace, accusing the lab of “price gouging of staggering proportions.” The lab’s legal professional stated he was not conscious of the grievance. A Texas legal professional common’s spokesperson confirmed to KHN that the workplace had obtained complaints in regards to the lab, however declined additional remark.
The takeaway: When a doctor asks for a urine or blood pattern, all the time ask what it’s for. Insist that it’s despatched to a lab in your insurance coverage community.
Source: AG grievance; interviews
KHN’s protection associated to growing older and enhancing care of older adults is supported partially by The John A. Hartford Foundation.
Fred Schulte: [email protected]”>[email protected], @fredschulte
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