A Routine Checkup Turns Costly
Reesha Ahmed, a 32-year-old woman from Texas, was excitedly awaiting the arrival of her first child when she went for a routine prenatal checkup. Little did she know that the blood tests she received at the hospital lab would result in a staggering bill.
High Prices for Common Tests
Ahmed's situation sheds light on the exorbitant prices that hospital-based labs often charge for routine blood tests. Even when patients are in-network, they can be left with thousands of dollars in medical bills. Research shows that hospitals typically charge much more than independent labs or physicians' offices for the same tests.
A Double Blow
Ahmed's situation was made even more difficult by the fact that she had suffered a miscarriage. Dealing with the emotional and physical toll of the loss, she was then forced to fight against a hefty medical bill that she believed was unfairly sent to her.
Ahmed's insurer, Anthem Blue Cross and Blue Shield, charged her for several tests that should have been covered at no cost to patients under the Affordable Care Act. Anthem claimed that the tests were submitted as diagnostic rather than preventive, and therefore not covered. However, experts argue that these screenings should have been considered preventive care.
The Markup Problem
The cost disparity between hospital labs and other providers is significant. In Texas, for example, the same lab tests were at least six times more expensive in a hospital than in a doctor's office. Patients often don't realize how highly marked up these tests are and end up with hefty bills.
Fighting for a Resolution
Ahmed refused to pay the bills and Texas Health sent the debt to collections. She reached out to the Texas attorney general's office and filed an appeal with Anthem, but to no avail. It wasn't until KFF Health News contacted Texas Health that they agreed to erase her bills and remove the charges from collections.
The Pitfalls of Hospital Labs
Ahmed's case highlights the pitfalls of using a hospital lab for routine testing. There is often no quality difference between independent labs and hospitals, yet hospitals charge significantly higher prices. Proactively seeking out commercial labs in your network can help patients avoid these extreme bills.
Congress is currently considering legislation to equalize payments for certain services, regardless of whether they are provided in a hospital or a doctor's office. This would help address the issue of high prices in hospital labs. In the meantime, patients should keep copies of itemized bills and insurance statements to avoid unexpected costs.
Bill of the Month is a crowdsourced investigation by KFF Health News and NPR that dissects and explains medical bills. If you have an interesting medical bill, share it with us!
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