Treatment of a common cold cost an American $ 28 thousand

After Alexa Kasdan had a sore throat for more than a week, she went to her doctor. He sent a throat swab and a blood test to an off-line lab for complex DNA tests. The patient later received a staggering $ 28 bill. About how this could happen, the newspaper writes. NPR.

Going to the doctor

Brooklyn, NY, a 40-year-old public policy consultant, did not want her upcoming vacation to spoil strep throat. So a week after the sore throat continued, Alexa Kasdan decided to check it out.

The woman visited her physician, Roya Fathollahi, in Manhattan, not far from Park Avenue and Gramercy Park. The visit was quick. They took a swab from Kassdan from the throat, collected a test tube with blood and issued a prescription for antibiotics.

Soon she felt better, and the trip went well.

Then came the bill

Alexa Kasdan is insured by Minnesota Blue Cross and Blue Shield through her partner’s employer.

The total bill she received for visiting the doctor was $ 28. Her insurer wrote a check for $ 395,50.

It is worth explaining that Dr. Roya Fatollahi of Manhattan Specialty Care conducted laboratory tests to study potential bacteria and viruses that could be associated with Kasdan cough and sore throat.

When Kasdan returned from a trip abroad, she saw several messages on the phone and an email from the billing department in Dr. Fatollahi's office.

The news was that her insurance company sent a check (more than $ 25000) to pay for some off-net lab tests. The actual bill amount was $ 28, but the doctors said in the office that they would exempt her from paying part of the bill, namely from $ 395,50 2.

“I decided it was a mistake,” said Alexa. “I thought maybe they meant $ 250.” I couldn’t understand how you can go to the doctor to conduct a test to identify streptococcus and for antibiotics, and in the end get a bill for $ 25. "

The doctor’s office continued to reassure the patient by phone and email that the tests and the invoice were completely correct.

How could a throat swab cost so much

According to the source, there are three reasons for this.

First It is that the doctor sent a smear from Kassdan's throat to a complex DNA test in search of viruses and bacteria that could explain the symptoms of her cold.

Dr. Ranit Mishori, professor of family medicine at Georgetown University School of Medicine, said such a study was superfluous. “In my 20 years as a doctor, I never ordered any of these tests, not to mention the fact that I saw one of my colleagues, students, and other doctors order something like this on an outpatient basis,” she said. “I have no idea why they were ordered.”

“The tests can make sense for a patient in an intensive care unit or for a severe case of pneumonia,” Mishori explained. Flu tests are potentially helpful as there are medications that can help. But there is also a cheap rapid test that could be used instead.

On the subject: Doctors from Long Island arrested for selling drugs, he faces 59 years in prison

“There are about 250 viruses that cause the symptoms of the common cold, and even if you knew that there was virus A against virus B, it would not matter, because there is no cure in any case,” she said.

By the way, the results of the Kasdan analyzes did not reveal the specific virus that caused the common cold. All results were negative.

The second reason The high price is that the doctor sent a throat swab for analysis to an off-line laboratory. Network laboratories settle with insurers at contractual rates. But non-network ones can set their own test prices, in which case the laboratory is calculated at list prices, which are 20 times higher than the average prices of other laboratories in the same ZIP code.

LabCorp at NPR informed that if the doctor sent a throat swab to LabCorp (Alexa's network provider), he would have billed the insurance company $ 653 for “all ordered tests or their equivalent.”

Third reason a huge bill may be lurking between the laboratory and the doctor Kasdan. The patient’s account shows that the laboratory was provided by Manhattan Gastroenterology, which has the same phone number and location as her doctor’s office.

Manhattan Gastroenterology is registered as a professional corporation in the state of New York, which means that it is owned by doctors. The corporation may be the parent company of Manhattan Specialty Care, but this is not clear from its documents.

Fatollahi, the attending physician of Alexa, did not answer journalists' questions about the invoice. Like Dr. Shawn Khodadadian, who is indicated on the state records as Manhattan Gastroenterolog CEO.

The medical expert, as follows from the records of the insurance company, is Dr. Calvin L. Strand. He is listed in the State Archives as director of the Manhattan Gastroenterolog and Brookhaven Gastroenterology Laboratory in East Patchog, NY. They also tried to contact him for comments.

What's next

“She (Alexa Kasdan. - Red.) may not pay anything for this specific requirement, ”said Richelle Marting, a lawyer specializing in medical billing at the Forbes Law Group in Overland Park, Kansas, who was involved in this case for NPR.

Marting says this is a common problem for insurance companies. According to her, the processing of most applications is fully automated. “It’s never been that people look at the bill and decide whether they will pay it.”

How much Kasdan actually paid to the doctor

In fact, Kasdan paid $ 25 for a visit to the doctor and $ 9,61 LabCorp for a separate set of laboratory tests. “I made it clear (to the doctor’s office. - Red.) that is dissatisfied with what happened, ”said Kasdan. The patient stated that she reported the doctor to the Office of Professional Medical Conduct in New York State. She then turned to Bill of the Month, a joint project of NPR and Kaiser Health News.

After a reporter started asking questions about the invoice, Blue Cross and Blue Shield from Minnesota have stopped paying for her invoice and are currently investigating.

Jim McManus, director of communications for BCBS Minnesota, said the company is in the process of identifying excessive allegations. “Unfortunately, these necessary checks did not happen in this case,” he wrote in an email.

How to protect yourself from such situations

The patient runs the risk of receiving a huge bill for visiting a doctor if the hospital involves another provider that is not part of the insurance network without his consent. But often the patient is almost unable to determine when this happens.

Patients can try to protect themselves from unexpected bills by specifying details at the doctor’s appointment. “I always ask where they send my tests or my pictures (like x-rays) so I can make sure they are online with my insurance company,” Marting explained.

You can also clarify why this or that test is ordered. “It's okay to ask your doctor why he orders these tests and how they will help him create a treatment plan for you,” said Mishory from Georgetown. “I think it is important that patients are empowered and ask these questions, and not run into unnecessary testing, unnecessary treatment, and, as in this case, outrageous billing.”

In addition, New York State has a law protecting patients from unexpected bills. It requires doctors to warn patients in advance that they use the services of off-network providers and that patients can be held liable for excessive costs. If the patient does not agree with the proposal of the doctor, then he should be exempted from financial liability on the bill. But this does not stop the off-net doctor from sending the bill or receiving it from the insurer.

According to Kasdan, she was not told during the reception that a swab from her throat would be sent to an off-line laboratory. Although perhaps one of the many documents that she signed contained a warning that some services might be provided offline.

If you suspect that the invoice issued to you indicates a violation of the law, you can report it to state authorities. Similar complaints are being investigated by the New York State Department of Financial Services.