A friend writes about an experience here in New York:
So my husband’s at a routine checkup with our primary care provider’s physician’s assistant, Maria (whom we really like). He tells her he has this ongoing thing with his heart where he sometimes gets lightheaded going upstairs. He’d seen a cardiologist but didn’t really get anywhere. Maria suggests that he do some sort of heart sonogram (that’s how he heard or recalled it).
“How do I go about scheduling that?” he asks.
“Let me see if I can get you in right now!” she says. “It’s right down the hall.”
Well, that was super convenient! Until we got the bill. Turns out the test was a Doppler test that -— in this case -— cost $4,464.00. At no time did anyone say, “Hold up, let’s check this out with insurance first.”
Insurance, speaking of which, paid nothing. Seems they wrote it down by the sum mentioned, but since we had not met our deductible, apparently, they put the remaining sum, $966.77, over to that to satisfy our deductible. Also they charged us the $93.10 New York State surcharge, which -— as Clear Health Costs later informed us!—- if they had paid anything, they would have picked up all or a portion. (And: If he had gone to a heart center not based at a hospital, the $93.10 would not have been charged.) So that left us with a super fun surprise bill of $1,059.87.
We call every office we can find. Maria tells us to call, I don’t know, Evelyn, who literally never answers or calls back. The cardiologist says we have to call billing, and billing says we have to call the cardiologist. While being polite, we also try to make everyone at least acknowledge that really, really need to -— at very least — tell people they’re about to get a fancy $4,000 test. (When people have a heart attack, they’ll have more business! Folks!)
If only we had checked
The real, real bummer is that — had we thought or been prompted to stop and check — he could have gotten this for much, much less many other places. When you go to this page and search on 93306 (the code for that procedure) within 50 miles of our zip code, you get a price of $400. That is more than ONE WHOLE ZERO LESS. And there are many places where you could get it for much less than $400.
We also later learned through ClearHealthCosts that hospitals are often the most expensive place to have this type of thing done, where an independent center charges much less. Now we know that often, the doctor sends you to have it done in the hospital as a part of their routine employment arrangements, as in: “I practice at X hospital and can see the results immediately, so that’s why I am sending you there.” Unsaid: They may be penalized in salary or bonus for referring outside of the hospital system.
Epilogue: We finally talked to a human in billing who offered to take 20% off the bill. At this point, time was money, so we grudgingly paid our $700+ and thought: there goes our savings for a heart-healthy treadmill.