Wildly differing prices for the exact same medical service

Before losing my health insurance in 2009, it never occurred to me to be concerned about a little thing like a blood test.  Since 1986 I’d been having three vials of blood drawn each year during my physical.  My doctor would authorize it, the nurse would draw the blood in the office and send it to the lab for processing.

A few days later she would call me with the results and I would refill my prescriptions accordingly.  But then a series of events changed everything.  I lost my job and with one month left to go on COBRA,  my former employer suddenly changed health insurance companies and notified only current employees, not COBRA employees.  Things got even more complicated when two months later the new health insurance company filed for bankruptcy and defaulted on all claims.  I was left with a bill from the lab diagnostics company for the blood test, and they wanted nearly $400 immediately.  That’s not a small amount when you are unemployed, though many others were left dangling with unpaid “covered” bills, procedures in progress and may headaches bigger than a simple lab test.

Still, a year later, I was employed only part time and not eligible for any health insurance from the company I worked for.  In fact, my new boss bragged about keeping my hours under 30 per week specifically so she would not have to offer benefits of any kind, not only health care insurance but also no holidays , sick leave, vacation, or retirement.  But in a small rural community I had few employment options.    I also found myself 270 miles away from my doctor, which was manageable only because I was healthy and only needed to see the doctor for my yearly physical.  For more immediate problems there was a clinic less than a mile from my home.

Mid-year, my doctor wanted another blood test before renewing my prescription.  I asked if I could get it done closer to home so the doctor’s office sent a letter to take to my local hospital as no labs were close to home.  I saved up $400, knowing I would have to pay immediately, took a deep breath over the huge cost, and went to the local hospital 14 miles away.  They were pleasant and accommodating, telling  me I would have to pay out of pocket at time of service.  I nodded my head in agreement.  Of course, it had to be done.  The receptionist got out her calculator and ran some numbers.  I held my breath.  That will be $81, she said.  I gave you a discount because you are paying in full right away.  $81?  Inside I wanted to jump for job.  I paid her and was glad I got to keep the remainder of the $400 to cover other bills.

Ever since this experience I have been thinking about the wildly different amounts for the exact same service.  In either case I was not given the opportunity to comparison shop.  As a patient and consumer I was expected to just pay the amount that was charged me.  Had I known there was such a big difference, I would have been getting my blood tests at the hospital all along.

But more to the point, when I had insurance I never cared how expensive the blood test was because it was paid for by the insurance.  The cost, the payment, any agreements between the lab and the health insurance company, all were a mystery to me, and not something I thought about until it became an out of pocket expense.  Transparency in the costs of medical procedures, tests and other costs would go a long way to letting us manage our own health care costs and not have to hold our breath and pray, as I was, that the cost of the procedure would not outstrip the budget.  I was lucky to be healthy and not need anything more than that blood test, but that is no excuse for not being aware.  I am happy today to say that I have changed jobs and in my probationary period, after which I will once again be insured.

But my diligence will still be there.  Never again will I take for granted that I have to pay whatever is asked of me.  I want to know my health care costs and manage them as prudently as I manage any other aspect of my life and finances.

Jay Warner is a participant in the Costs of Care essay contest.

Wildly differing prices for the exact same medical service

This post originally appeared on the Costs of Care Blog. Costs of Care is a 501c3 nonprofit that is transforming American health care delivery by empowering patients and their caregivers to deflate medical bills. Follow us on Twitter @costsofcare.

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