KHN’s Gavin McIntyre
Last summer, Dani Yuengling tried to ignore a lump in his right breast.
She was 35, the same age her mother was when she was diagnosed with breast cancer in 1997. She lost her mother to the disease in 2017.
“Watching her suffer was the most painful experience,” said Jungling, who lives in Conway, South Carolina.
After a mammogram confirmed that the lump needed further investigation, Yuengling scheduled a breast biopsy this Valentine’s Day at the Grand Strand Medical Center in Myrtle Beach.
Among the many concerns she had prior to that appointment, the first was a possible cancer diagnosis. Jungling needed to know how much a biopsy would cost. There’s a $6,000 annual deductible — the amount that must be paid before health insurance premiums kick in — and she’s nowhere near meeting it. , I knew that most of it was up to me.
However, the hospital did not offer her a price. She was told that providers would not know the type of biopsy needle needed until surgery began, which would affect her price.
The hospital’s online “Patient Payment Estimator” found that patients without insurance would have to pay about $1,400 for the surgery.
“That’s fine. It’s no big deal,” she thought. Did it I have insurance. A Google search showed he could be close to $3,000, but Yengling thought the price was reasonable too. She had surgery, so she wasn’t too worried about her money.
That soon brought the good news that she wasn’t cancer.
Then came the bill.
patient: Dani Yuengling, now 36, joined Cigna through her employer, a human resources contractor for the Mayo Clinic.
Medical services: Ultrasound-guided breast biopsy.
Service provider: Grand Strand Medical Center is a 403-bed for-profit hospital in Myrtle Beach, South Carolina. It’s one of 182 hospitals owned by Nashville-based HCA Healthcare, which had revenue of $58.7 billion last year.
Total bill: $17,979 for the procedure, including lab work, pharmacy fees, and sterile supplies. Cigna’s in-network negotiated fee was his $8,424.14, of which the insurance company paid the hospital his $3,254.47. Yuengling was charged his $5,169.67 deductible balance.
Gives: It is not uncommon for patients who do not have insurance, or who are willing to pay in cash, to undergo surgery at much lower rates than those who have health insurance. For about 30% of American workers with high deductible plans like Yuengling, using insurance can lead to significantly higher expenses than not having insurance or using a credit card for prepayment. There is a nature.
Ge Bai, an associate professor of public health at the Johns Hopkins Bloomberg School of Public Health, recently published a study on the topic, showing that US hospitals charge cash prices lower than they charge to treat patients on commercial insurance. He said he often sets
“I can confidently say that this is very common,” Bhai said, recommending that all patients, regardless of insurance status, inquire about cash prices before undergoing surgery. It should be standard.”
Grand Strand charged Yuengling’s insurance a very high fee for her procedure. By comparison, a Medicare patient who needs an ultrasound-guided biopsy similar to the one Yungling underwent would only pay about $300, according to the federal government’s website, and her need for outpatient treatment. 20% co-insurance. Medicare will pay the hospital the remaining approximately $1,200 on the bill. The hospital expected her more than five times the Medicare price from her Yuengling and her insurance company.
According to Fair Health Consumer, an organization that analyzes health insurance claims, Conway patients with private health insurance who are being treated at other hospitals are typically paid for the same procedures by Yuengling. charged less than the amount.
Also, uninsured patients who require an ultrasound-guided breast biopsy at nearby Conway Medical Center will have to pay cash and are likely to pay even less, a hospital spokeswoman said. About $2,100, according to investor Allison Floyd.
Meanwhile, Grand Strand Medical Center spokesperson Caroline Preusser blamed the inaccurate information Yuengling had received on a “glitch” related to the hospital’s online calculators, blaming the hospital for breast biopsies. An accurate estimate of the cash price is said to be between $8,000 and $11,500. Exact procedures and equipment used. “
The hospital has removed certain procedures from payment estimates until they are corrected, Pleuser wrote. She didn’t say how long it would take.
resolution: Yuengling tried to contest the accusations with the hospital. When she called her billing department, she was offered a 36% discount, lowering the amount she had to pay to $3,306.29. Grand Strand Medical Center allows patients to make payment plans, but Yuengling wanted to get rid of it all, so she decided to charge the full amount to credit her card.
“I couldn’t sleep. I was going crazy. I had a migraine. I had an upset stomach,” she said. “I hate debt. I didn’t want to think about it. Obviously it didn’t work because I’m still thinking about it.”
She repeatedly requested to speak with the hospital’s patient advocate and was eventually connected to an outside company, Parallon, which audited her bills. I received a letter dated May 26th from “After reviewing the claim in question and your medical records, we have identified the following: The charge to your account was appropriate.”
“I don’t know why I was actually expecting a different result,” she said.
The hospital requested Yengling return for a follow-up appointment related to the biopsy. she refused.
Harlow Summerford, a spokesperson for HCA Healthcare, told KHN in an email that the hospital system apologized for the confusion caused by the payment estimate and was “working to resolve the issue.”
KHN’s Gavin McIntyre
Takeaway: Yuengling, who has a family history of breast cancer, was right to follow up with her doctor after feeling a lump. After not getting a clear answer on her costs from Grand Strand Medical Center, she could have taken the extra step of finding out what other hospitals in the area were charging. Her doctor referred her to the Grand Strand, but she was under no obligation to use the hospital. She could have saved a significant amount of money had she chosen to have her surgery elsewhere.
Additionally, patients like Yuengling with high deductible insurance plans should consider paying cash for certain procedures and not involving their insurance company at all.
Jacqueline Fox, a health care attorney and professor at the University of South Carolina School of Law, said she was unaware of the law against patients doing it. , she noted, always paying for prescription drugs in cash. It stands to reason that they can do the same for medical procedures.
However, some facilities make this difficult. For example, Grand Strand Medical Center offers an “uninsured discount” for “out-of-pocket” patients, but the discount is “not covered by third-party sources, Medicaid, charity, or other discounts.” It is limited to those who are not eligible for the program offered by the facility, according to the hospital’s website. Only confirmed patients who do not have health insurance will be provided information about the discount.
In some cases, paying cash for the procedure may not make financial sense in the long run as it does not apply to deductibles. The patient may save money on her one surgery, but will pay the full deductible if an unexpected medical expense occurs later in the calendar year.
Patients with insurance should contact their health plan for an honest estimate prior to the procedure. Under the No Surprise Act, medical insurance is supposed to provide members with an idea of their total out-of-pocket costs upon request. It asks for a “detailed explanation of the benefits,” but points out that this part of the law has not yet been implemented.
The No Surprises Act also allows patients, regardless of whether they have health insurance, to file complaints with the federal government about medical costs.
Yuengling filed a complaint in June.
Stephanie O’Neill contributed the audio portrait for this article.
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