How much do blood tests cost? Or, how to argue a bill for a $3,000-plus trip to the doctor.

Filed Under: Costs, Health plans, Patients

It was one of those shares that seemed hard to believe.

The charge for the blood tests at University of North Carolina Hospitals was $2,378, and the person who shared was asked to pay $1,474.92. Cigna, the insurer, paid nothing.

The comment: “The UNC facility in question notably distinguished by Cigna as meeting certain quality and cost efficiency measures provided me with an expected visit cost to be ‘between $24.00 and $1,500.00,’ but charged well above the upper expected limit for blood tests that were incurred without my prior knowledge and consent with the physician referencing ‘standard of care’ in ordering labs above and beyond what I was counseled to expect.”

I asked some questions, and he answered:

1. Can you tell us about the circumstances? As in what were they testing for?

I was referred to the UNC Neurology Clinic as an in-network “Cigna Care Designation” facility to review and discuss my recent brain MRI images (provided by Raleigh Radiology dated 9/24/18) as well as my most recent October 2018 blood work (provided by Quest Diagnostics) as it was suspected by both my primary care physician (the referring doctor), as well as my ENT, that there may have been a vitamin deficiency, specifically in regard to B12, causing my “sensation disturbance” symptoms in my tongue.

2. The explanation of benefits doesn’t shed any light on what these tests were — did the hospital also send a bill?

Other than Cigna’s “laboratory” line items, I never received an itemized bill from UNC nor have I received any clinical follow-up or test results interpretation other than a phone call a couple of weeks later after my prodding – an after-the-fact explanation referencing “standard of care” in ordering blood work above and beyond what I was counseled to expect; all I have are the following nine (9) test result line items uploaded to my UNC online medical chart: Folate, Vitamin D Total (25OH), Vitamin B12, Sed Rate, Hemoglobin A1C, Comprehensive Metabolic Panel, TSH, CBC with Auto Diff, Serum Protein Electrophoresis and Immunofixation,

3. Did they do anything else besides lab tests?

The physician reviewed and discussed my recent brain MRI images but inappropriately referred to my older and outdated blood test results dated 3/16/17 (taken during a time I was hospitalized and in recovery from open heart surgery at UNC REX Heart & Vascular Hospital) and completely overlooked my more recent lab results including a standard Lipid Panel and Comprehensive Metabolic Panel dated 10/23/18, a hard copy of which I brought with me to my 2/13/19 visit and personally discussed with the doctor; of further note, I was previously placed on B12 supplements and its related conjecture was eventually ruled out, but the Neurology Clinic went ahead and performed a repetitive and unnecessary test on my B12 levels.
In (incorrectly) hypothesizing that I exhibited hypocalcemia (based on an outdated blood test),I was sent across the hall to solely check on my calcium level without ever discussing his ordering of a more overreaching and unaffordable neuropathy panel for what I am now being told was to diagnose diabetes, hypothyroidism, renal failure and related neuropathy indications that my full medical history and most recent blood work – if paid more attention to – could have helped allay without the need for additional and costly tests that I’ve since learned are most often administered for tingling and/or numbness of feet and hands (or legs and arms), and not the tongue.

4. It looks to us as if you have a high deductible plan. So insurance paid exactly nothing?

Correct! As a high deductible patient, I waited over three months specifically to be seen at the UNC facility since they were notably distinguished by Cigna as meeting certain ”quality and cost efficiency measures.” I have always been very attuned to my out-of-pocket costs and took particular note of the typical cost range provided to me by the facility with my visit expected to be “between $24.00 and $1,500.00,” but I was easily assuming the low range based on all historical billings for similar medical attention.

5. The pre-visit estimate was delivered by the hospital, right? Or was it by Cigna?

Correct… delivered by the hospital in the waiting room: Of further note: the Healthcare Blue Book estimated each and every test uploaded to my UNC Chart at a cost below $50.00 for our zip code area. And as a valid comparison, I arrived at the UNC office with a recently completed B-12 test and Lipid Panel and Comprehensive Metabolic Panel that Quest Diagnostics billed at a fair and reasonable price of $47.59 and $200.22 respectively – with an out-of-pocket total amount allowed by Cigna of $56.33. In contrast, UNC’s unbundling of blood work resulted in a multitude of laboratory line item billings, some of which Cigna has deemed “not medically necessary”

I followed up: Are you arguing the bill with the hospital or insurer?

Interestingly enough, Jeanne, UNC Patient Relations has reviewed my concerns and apologized “for not meeting [my] expectations” and asked UNC Patient Accounts to apply a 40% adjustment to my “Hospital Based” charges as a “courtesy” to me (not including additional physician fees charged for the visit in question). I still find their laboratory billing practices quite objectionable and wonder why they’re taking partial responsibility by offering a 60/40 split on the balance due as a remedy towards accountability instead of a more equitable financial reprieve. And this still fails to appropriately consider and address all the other issues I raised including the fact that there still has been no interpretation of test results offered to me or my referring physician and no further clinical judgment provided to help alleviate my symptoms which I continue to struggle with to this day… in plain terms, absolutely nothing to show for my money, whether it be $2,378 or a marked-down $1,426.80.

Thank you for all you’re doing, Jeanne… your work is very much appreciated!

A day or two later, I asked about the adjustment, and this email arrived:

UNC billed Cigna $2,378 in facility charges (including all the unbundled “laboratory” line items for my blood work) + additional various physician charges for what I’ve been told include “interpretation” and “professional oversight” (oh, the irony!), for a total billing for my outpatient 2/13/19 “consultation” in excess of $3K.

Cigna discounted the amount billed in facility charges by $694.08, with my out-of-pocket (high deductible) adjusted balance due being $1,474.92.

Let the buyer beware games begin: following my complaints, UNC is now willing to provide me with a commendable albeit imperfect “courtesy” discount of 40%, leaving me still paying $884.95 for the “hospital portion” of the billings related to my blood test while leaving the various physician charges of $600+ unchanged… so I’m still owing about $1500 out-of-pocket total now.

I have filed complaints with both the Attorney General of NC’s Consumer Protection Division as well as the NC Medical Board asking them to investigate this abhorrent billing practice that goes against all expectations of customer care and affordability – for a 15 minute office visit consult and what was subsequently supposed to be a check on my calcium levels.