There are two questions that aren’t asked often enough of physicians.
- Why?
- How much will this cost?
Perhaps this comes of respect for a doc’s expertise. Perhaps this is because we want to believe that the person in whose hands we place our health would put our welfare first. But people just don’t question a physician who tells you that you need something. Like a urine test.
In 2015, a college student in Texas named Elizabeth Moreno had back surgery to correct a painful spinal abnormality. The procedure was a success, and her surgeon followed it with just a short-term prescription for the opioid painkiller hydrocodone to ease a speedy recovery. Then came a “routine” urine drug test, ostensibly to ensure she didn’t abuse the powerful drug.
A year later, she got the bill for that test. It was $17,850.
Note the word “routine.” It’s how we’re sold on doing something that there is no reason to do. Moreno knew she wasn’t addicted to opioids. She didn’t need a test to tell her. But she never asked the questions.
When the surgeon’s office asked for the urine test in mid-January 2016, “I didn’t think anything of it,” Moreno told KHN. “I said fine, whatever.”
But doctors and experts say that test was unnecessary, the price “outrageous,” and the case just the latest in a new, alarming trend.
As it turned out, the lab used was “out of network” for Moreno’s insurance, another nit to note when the doc (or, more likely, somebody wearing a stethoscope around their neck and a white lab coat, whose previous employment was at the local Dairy Queen) sent her to pee in a cup. But if that’s the lab used by the office, who was she to quibble?
After all, spinal surgery would have already eaten up the $14,700 deductible and copay under Obamacare’s lowest tier insurance that everyone adores so much. Surely it had to cover a silly lab test, right?
The testing lab, Sunset Labs, was considered out of network for Moreno’s insurance. But that may be the least of the problem. Sunset also has an “F” rating from the Houston Better Business Bureau for charging thousands of dollars for tests that cost a few hundred dollars—tops. And Sunset Labs is part of a network of pain clinics owned by Houston anesthesiologist Phillip C. Phan, which is facing lawsuits and complaints related to forced, unnecessary testing and improper billing.
Moreno’s insurance company valued her $17,850 urine test at $100.92.
It couldn’t get any worse than that could it? Don’t be ridiculous. Of course it can.
Moreno’s doctor, Dr. Stephen Esses, reportedly said that he ordered drug testing on patients out of fear of getting in trouble with the state’s medical licensing board.
While a spokesman for the Texas Medical Board denies that such testing is required, physicians are scared of being subject to scrutiny, labelled a pill-pushing doc, if a patients ends up on a slab because of an opioid overdose. So they have unnecessary tests done to cover their butts, to create a record of how the patient left their care just fine, and if anything bad happens later, it’s not their fault.
So the doc tells the patient to get a test to cover his butt, and the lab sees the patient as a blank check, to charge at will.
The bill’s breakdown shows Sunset charged Moreno $4,675 to screen for a variety of opioids, $2,975 for psychiatric benzodiazepine drugs, $1,700 for amphetamines, $1,275 for a host of illicit drugs, and $850 for buprenorphine, a drug to treat opioid addiction. Sunset added another $850 fee to verify that the urine hadn’t been adulterated, among other charges.
It’s not just the dealer on the street corner making money off the opioid crisis, and people walk into it thinking they’re doing the right thing, following doctors’ orders and trusting that the system won’t cheat them.
And a sketchy lab can’t do it alone. The government is there to help. It, not you.
As consumers face rapidly rising drug costs, states across the country are moving to block “gag clauses” that prohibit pharmacists from telling customers that they could save money by paying cash for prescription drugs rather than using their health insurance.
The clauses force the pharmacists to remain silent as, for example, a consumer pays $125 under her insurance plan for an influenza drug that would have cost $100 if purchased with cash.
Unlike most of us, Moreno’s father was a physician himself, so surely he knew how to deal with the drug lab who took advantage of his daughter.
Moreno’s father, Dr. Paul Davis, is a retired family practice doctor and tried to fight the bill for her. In April 2017, he settled the bill with Sunset by paying $5,000—a move he now regrets. Dr. Davis also filed a complaint with the state’s attorney general’s office, which confirmed it had received complaints about Sunset but wouldn’t comment further.
While it’s good to have a doc in the family, sometimes having a lawyer in the family helps too. Same with a plumber and carpenter, for that matter, since there are times things need to be plumbed and carped, but I digress.
We are up to our eyeballs in panics, as we invariably seem to be since fear always serves as a prime motivator. The current opioid panic may have its roots in Big Pharma pushing docs to hand out candy, or may not, but the forces of the well-intended have pushed docs to self-protection and labs to outrageous profitability.
Why take the risk of selling smack on street corners when you can milk perfectly nice and trusting folks by charging outrageous fees for entirely unnecessary services? Even with the settlement negotiated by doc dad, that’s $5000 for a $100 test. Still a good payday. And nobody asks “why?”
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Why and how much are great, if not evergreen, questions.
My finance professor provided used to say: people respond to incentives, even bad ones.
It’s almost as if the quick fix laws we pass in reaction to major problems might not fix them without causing massive problems in turn.
I wonder why? And how much the fixes might cost?
Was that in marco or micro economics? Among the many differences, individuals are often forced to make decisions; they can either get the test or tell the doc to shove it. Society would often do better without responses to the demands of “something must be done” because there are no solutions that don’t create other problems. But thinking is hard.
Incentives are over-rated and misunderstood. If they worked the way they were supposed to work, we would be able to solve all our problems. People, however, respond to them in unanticipated ways, including not responding at all, which is why society goes from problem to problem, never reaching the Utopia proponents of incentives tell us we’ll find if only we let them have their way.
I always check with GoodRx to see if it’s cheaper to pay cash, and frequently, it is, with a digital coupon accepted by the pharmacy. (I’m sure there’s other services).
Two pharmacy benefit programs that I’ve been enrolled with from my employers have both tried to compel use of their mail order service, then charged higher prices, or gamed the way it’s delivered to get more co-pays.
But Doctors and clinics get away with financial practices that we’d refuse to accept from any other service, and being a few steps removed from the actual payment process makes the problem worse. The *absolute* worst has to be the “Minor emergency clinics” and their arbitrary “Facility fees.”
Cool story, bro. I look forward to your sharing more of “things Gretz checks with.” Pics would be good too.
I feel sorry for their plight. They got taken to the cleaners, but I don’t entirely sympathize with them. They were suckers. Life’s about being you being responsible and performing due diligence. Doctors, Lawyers, Plumbers, etc they are spending your money. If you don’t engage with them and you accept their decisions without question, you’re a fool.
I agree with you that people shouldn’t merely acquiesce to others spending their money, but docs (far more than lawyers) are given carte blanche. Not the best way to deal with them, perhaps, but calling people foolish may be a bit too far. If you can’t trust them with your money, how can you trust them with your life?
Recently, Xmas eve to be exact, we had a medical emergency that resulted in the wife spending close to a week in the hospital. She is doing just fine now. It was an event that the quicker the action the better the outcome.
We have two ERs fairly close and I chose the one the one that our primary care doctor is with, I knew all the records would be in their system, no long filling out of forms as they had everything on file, and it is a preferred provider. Even if only one was close by, my best move was to get her to an ER, not call 911 and wait for EMS to show up to then take her to the ER.
So far no problems with the bills except for one. The person that reviewed the CT scan at the ER. Never saw them or talked to them to ask any questions. And why should I considering what the suspected issue was, a head/neck CT is exactly what needed to be done, and quickly. According to statements from insurance, the x-ray company is a preferred provider.
The company charged insurance, and of course insurance only paid the agreed upon prices. I had to pay a few dollars and the x-ray company has to eat what they charge above the agreed price to be part of the insurer’s network. However, they sent me a bill that reads like insurance paid nothing and I have to pay the whole deal.
Insurance fraud, greedy, or a just an error who knows at this point. I sent them the under $12 insurance said I owe and I’m waiting for an updated statement. It’s been a while and nothing. Something tells me they are not going to try and bill me further.
Two groups of people I would listen to their advice and not get into a pissing match with them. One a ER doctor saving a life, second a lawyer that is trying to keep me out of trouble. Sad when I have to pit one against the other.
You’re lucky. In many emergency situations, you get no choice, find yourself out-of-network, find out afterward that they won’t accept your insurance payment and get that big, mean old bill covered in drool. Do you know what a two-block ambulance ride in California costs out of network? I do.
I can imagine. We did get transferred to a completely different hospital that first day and that was a ride about 20 miles across town. The new hospital are national experts in the field. I did see the itemized bill including the transport.
I know a guy that works for a US arm of a very large Japanese company and several times a year flew over to HQ. He had a cardiac event in Japan. The hospital would not take his Japanese company provided health insurance, it was for the US only. They were not going to give him his things back, like his passport until he paid up.
He put a couple hundred K on his company supplied credit card and came home with his new pacemaker. He told the local company HR and accountants to figure it out and pay the credit card bill or he would call the chairman of the company in Japan. He didn’t pay a dime out of pocket as far as I know.
Some medical outfits now hire outside billing agencies who figure out how to best ding the patient’s coverage. I have personally experienced cases in which they have changed what the doctor coded in order to charge a co-pay in addition to the insurance payment. Yet, the frontline response when the charge was questions was “well that was submitted as “x” and we can’t change what the doctor coded.” A little follow-up revealed they had damned well done exactly that. This is even for $10 here and $20 there. In the aggregate, I’m sure it comes to hundreds of thousands of dollars. I can only assume their compensation arrangement is such that they share in the fraudulent overcharges.
Such a cool story. Have you ever considered starting a blog?
Outside billing agencies are like outside houses: You don’t want to go there,… unless you have unstoppable diarrhea. How dare they!
The doctor is right to regret his settlement. There goes any claim or defense he had. It’s too bad too. Debt defense attorneys exist for dealing with bogus or excessive debts and all their repercussions and potential ways to dispute or eliminate the alleged debt. The Doctor’s situation might have been resolved in other ways, but now no one will ever know. Certainty has its own value, though.
Did anyone suggest the doc was wrong to regret his settling?