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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  • EmilyAnon

    Another way to get discounted blood tests outside the hospital/doctor’s office is through online lab brokers. No prescription needed, and you can keep the results private or sent to your doctor.
    My CA 125 monitoring blood test costs over $400 when done at the hospital (including $150 facility) and approx $65 through these brokers. You pay for a voucher and present it to one of the labs they contract with (hundreds all over the country to choose from). Google ‘discount blood tests’ for list of many brokers.

    • SarahJ89

      In my area: Vitamin D testing costs $94 online with Lab A drawing the blood and doing the test. $300 with a local scrip at Lab B. $700 at the local hospital which then sends it to Lab B for the actual work.

  • Patient Kit

    Interesting that your hospital lab was so much less expensive than your non-hospital lab. That’s a big difference between $81 and $400.

  • Suzi Q 38

    If your insurance company refuses to pay your medical bills every again, try to withhold payment and negotiate the price down.
    Tell them that you are without money for insurance, only work part-time, and don’t have the money to pay them.
    Ask them if they will accept $100.00, because that is the true amount your insurance would have paid them in the first place.
    If they agree, get them to send you a letter or agreement stating such terms in writing.
    If you do not get it in writing, don’t pay it, until they send you another bill.
    Call them every time they send you a bill….eventually they will understand that it was not your fault your insurance company went bankrupt.

    Good luck.

  • Suzi Q 38

    Wal-mart is usually the cheapest for me.
    Also ask the doctor for samples.
    You can also contact the drug company and ask for free product.
    Sometimes they have a form to fill out and your doctor has to sign it.

  • http://clearhealthcosts.com/ Jeanne (clearhealthcosts)

    Very nice piece!

    The big paradox we’re hearing a lot about recently is that people with insurance are choosing to pay cash or self-pay rates for certain procedures (MRI’s, for example) instead of the negotiated rate. One friend said “I was going to be billed $830 through my PPO for an MRI. The cash price? $500.” We also hear a lot about people buying generic prescriptions on cash, because the price at a big-box store can be lower than the co-pay with insurance. Topsy turvy!

    P.S. here’s a link to some of our blood-test prices. http://clearhealthcosts.com/blog/procedure-category/blood-tests-3/

  • Karen Ronk

    Insurance companies play a big part in this problem as well. There is the game of submitting every code a provider can think of and seeing what will stick. Meanwhile, if you are the patient, you wait to see what your 20% of what sticks will be and know you have no control over that. And I have seen ridiculous inconsistencies in what a provider is paid for what I consider to be a highly skilled procedure and one that is significantly less so. I always try to ascertain the cost of a procedure (other than office visit) before I agree to it, but often the amount ends up being different -sometimes in my favor- or in some instances, the provider cannot give you an upfront cost.

    Streamlining and cleaning up the fuzziness of medical codes and payments would go a long way towards helping everyone involved in the process. Patients who are in pain and living disrupted lives should not have to be trained to navigate the health care system.

  • Jennifer Jonsson

    I worked for a medical billing company for a while and was shocked to learn that 4 different people could walk into the emergency room with the same kind of broken bone and be charged 4 different prices depending on whether they had Medicare, worker’s comp, private insurance or no insurance at all. And for no reason I could tell, the hospital expected the uninsured person to pay the most. Why is that? There should be one uniform charge billed to everybody, regardless of insurance, and the insurance can then cover whatever percentage their contract with the hospital states.

    • SarahJ89

      This is why the notion of people “having skin in the game” and being able to act as “consumers” of medical services is absurd. The game is rigged.

    • querywoman

      This is the current version of Teapot Dome. Hospitals have been sued for overcharging the uninsured. At least in some areas, hospitals should be the uninsured an average of contracted rates.
      I always want to know if the hospital gets to write off a larger amount for the uninsured.
      A public hospital billed me $16,000 for extracting four teeth. No, I didn’t pay that. I gave them a $10 copayment the day I went in.
      They are a federally qualified health center and they get extra money for the feds to do just that.
      What I want to know is they really get to write off the $16,000?

  • SarahJ89

    What a great idea! Unless, of course, you’ve just broken your arm and cannot think because of the pain. Or your heart is beating only 30 times a minutes, greatly impeding your ability to make phone calls or even stay conscious.

    As for keeping your own records–our local hospital gets quite nasty when you have the temerity to ask for a CD of your CT scan. What we get from our doctors is a watered down description of the office visit.

    Keep dreaming.