美国国家公共电台 NPR--An $18,000 biopsy? Paying cash might have been cheaper than using her insurance

An $18,000 biopsy? Paying cash might have been cheaper than using her insurance

Transcript¹

When Dani Yuengling felt a lump in her right breast last summer, she tried to ignore it.

She was 35, the same age her mother had been when she received a breast cancer diagnosis² in 1997. The disease eventually killed Yuengling's mom in 2017.

"It was the hardest experience, seeing her suffer," said Yuengling, who lives in Conway, South Carolina.

After a mammogram confirmed the lump needed further investigation³, Yuengling scheduled a breast biopsy for Valentine's Day this year at Grand Strand⁴ Medical Center in Myrtle Beach.

Among many concerns she had ahead of that appointment — the first being a potential cancer diagnosis — Yuengling needed to know how much the biopsy would cost. She has a $6,000 annual deductible — the amount her health plan requires she pay before its contribution kicks in — and she wasn't close to hitting that. Whatever the procedure cost, Yuengling knew she'd be on the hook for most of it.

But the hospital wouldn't give her a price. She was told her providers wouldn't know what type of biopsy needle they needed until the procedure was underway and that would impact the price.

The hospital's online "Patient Payment Estimator" showed that an uninsured patient would owe about $1,400 for the procedure.

"That's fine. No big deal," she thought to herself, confident it would be cheaper for her because she did have insurance. A Google search indicated it could be closer to $3,000, but Yuengling thought that price seemed reasonable, too. She wasn't fretting⁵ too much about money as she underwent the procedure.

It soon brought the good news that she didn't have cancer.

Then the bill came.

The patient: Dani Yuengling, now 36, who is covered by Cigna through her employer, a human resources contractor⁶ for the Mayo Clinic.

Medical service: An ultrasound-guided breast biopsy.

Service provider: Grand Strand Medical Center, a 403-bed, for-profit hospital in Myrtle Beach, South Carolina. It is one of 182 hospitals owned by Nashville-based HCA Healthcare, which generated $58.7 billion in revenue last year.

Total bill: $17,979 for the procedure, including lab work, pharmacy⁷ charges, and sterile⁸ supplies. Cigna's in-network negotiated rate was $8,424.14, of which the insurance company paid the hospital $3,254.47. Yuengling was billed $5,169.67, the balance of her deductible.

What gives: It's not uncommon⁹ for uninsured patients — or any patient willing to pay a cash price — to be charged far less for a procedure than patients with health insurance. For the nearly 30% of American workers with high-deductible plans, like Yuengling, that means using insurance can lead to a far bigger expense than if they had been uninsured or just pulled out a credit card to pay in advance.

Ge Bai, an associate professor at Johns Hopkins Bloomberg School of Public Health, recently published research on this topic and said hospitals in the U.S. often set their cash prices lower than the prices they charge to treat commercially insured patients.

"We can very confidently say this is very common," said Bai, who advised that all patients, regardless of their insurance status, inquire about the cash price before undergoing a procedure. "It should be a norm."

Grand Strand charged Yuengling's insurance an extraordinarily¹⁰ high price for her procedure. By comparison, according to the federal government's website, Medicare patients who need an ultrasound-guided biopsy similar to the one Yuengling received would pay only about $300 — their required 20% coinsurance for outpatient care. Medicare would pay the hospital the remainder of the bill, about $1,200. The hospital expected more than five times the Medicare price from Yuengling and her insurer.

Patients in Conway with private health insurance who are treated at other hospitals also typically are charged less than what Yuengling paid for the same procedure — on average about $3,500, according to Fair Health Consumer, an organization that analyzes¹¹ health insurance claims.

And uninsured patients who pay cash prices and need an ultrasound-guided breast biopsy at the nearby Conway Medical Center are likely to owe even less — about $2,100, according to Allyson Floyd, a spokesperson for the hospital.

Meanwhile, Grand Strand Medical Center spokesperson Caroline Preusser blamed "a glitch¹²" involving the hospital's online calculator for the inaccurate¹³ information Yuengling received and said the correct estimate for the cash price for a breast biopsy at the hospital is between $8,000 and $11,500 "depending on the exact procedure and equipment used."

The hospital removed certain procedures from the payment estimator until they can be corrected, Preusser wrote. She did not say how long that would take.

Resolution: Yuengling tried disputing the charges with the hospital. She called the billing department and was offered a 36% discount, lowering the amount she needed to pay to $3,306.29. Grand Strand Medical Center allows patients to set up payment plans, but Yuengling decided¹⁴ to charge the full amount to a credit card because she wanted the whole thing to go away.

"I could not sleep. It was driving me crazy. I was having migraines. I was sick to my stomach," she said. "I hate having debt. I didn't want to think about it. Obviously, that didn't work because I'm still thinking about it."

She said she requested on multiple occasions to speak to the hospital's patient advocate and was eventually connected with an outside company, Parallon, which conducted an audit¹⁵ of her bill. She eventually received a letter dated May 26 from the hospital's Revenue Integrity Department. It stated: "After a review of the charges in question and your medical record, the following was identified; The charges on your account were appropriate."

"I don't know why I actually expected a different outcome," she said.

The hospital has requested that Yuengling return for a follow-up appointment related to the biopsy. She has refused.

Harlow Sumerford, a spokesperson for HCA Healthcare, told KHN in an email that the hospital system apologizes for any confusion caused by the payment estimator "and we are working to fix the issue."

The takeaway: With a family history of breast cancer, Yuengling was right to follow up with her doctor after feeling a lump. After failing to get a clear answer on her costs from Grand Strand Medical Center, she could have taken an additional step to explore what other hospitals in the area charge. Although her physician referred her to Grand Strand, she was not obligated to use that hospital. She could have saved a significant amount of money by opting¹⁶ to undergo the procedure elsewhere.

Furthermore, patients like Yuengling who have a high-deductible insurance plan should consider paying cash prices for certain procedures and not involving their insurance company at all.

Jacqueline Fox, a health care attorney and a professor at the University of South Carolina School of Law, said she isn't aware of any law that would prohibit a patient from doing that. After all, she pointed¹⁷ out, patients with health insurance pay cash prices for prescription¹⁸ medications all the time. It stands to reason they could do the same for medical procedures.

But some facilities make this difficult. Grand Strand Medical Center, for example, offers "self-pay" patients an "uninsured discount," but that discount is limited to people who have "no third party payer source of payment or do not qualify for Medicaid, Charity or any other discount program the facility offers," according to the hospital's website. Only patients confirmed to have no health insurance are offered information about the discount.

In some cases, paying a cash price for a procedure might not make financial sense in the long run because none of it would be applied¹⁹ toward the deductible. Patients might save money on one procedure but end up paying their full deductible if unexpected medical expenses mount later during the calendar year.

Insured patients should reach out to their health plan for a good-faith estimate before a procedure. Under the No Surprises Act, health plans are supposed to give members an idea of their total out-of-pocket costs upon request. Ask for an "Advanced Explanation of Benefits," said Sabrina Corlette, a research professor at the Georgetown University McCourt School of Public Policy, though she points out this part of the law isn't being enforced yet.

The No Surprises Act also allows patients to file complaints with the federal government regarding their medical bills — whether or not they carry health insurance.

Yuengling filed her complaint in June.

Stephanie O'Neill contributed the audio portrait with this article.

Bill of the Month is a crowdsourced investigation by KHN and NPR that dissects²⁰ and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism²¹ about health issues. It is an editorially independent major operating program of KFF (Kaiser Family Foundation).

1 transcript   

n.抄本，誊本，副本，肄业证书

参考例句：

• A transcript of the tapes was presented as evidence in court.一份录音带的文字本作为证据被呈交法庭。
• They wouldn't let me have a transcript of the interview.他们拒绝给我一份采访的文字整理稿。

2 diagnosis   

n.诊断，诊断结果，调查分析，判断

参考例句：

• His symptoms gave no obvious pointer to a possible diagnosis.他的症状无法作出明确的诊断。
• The engineer made a complete diagnosis of the bridge's collapse.工程师对桥的倒塌做一次彻底的调查分析。

3 investigation   

n.调查，调查研究

参考例句：

• In an investigation,a new fact became known, which told against him.在调查中新发现了一件对他不利的事实。
• He drew the conclusion by building on his own investigation.他根据自己的调查研究作出结论。

4 strand   

vt.使（船）搁浅，使（某人）困于（某地）

参考例句：

• She tucked a loose strand of hair behind her ears.她把一缕散发夹到了耳后。
• The climbers had been stranded by a storm.登山者被暴风雨困住了。

5 fretting   

n. 微振磨损 adj. 烦躁的, 焦虑的

参考例句：

• Fretting about it won't help. 苦恼于事无补。
• The old lady is always fretting over something unimportant. 那位老妇人总是为一些小事焦虑不安。

6 contractor   

n.订约人，承包人，收缩肌

参考例句：

• The Tokyo contractor was asked to kick $ 6000 back as commission.那个东京的承包商被要求退还6000美元作为佣金。
• The style of house the contractor builds depends partly on the lay of the land.承包商所建房屋的式样，有几分要看地势而定。

7 pharmacy   

n.药房，药剂学，制药业，配药业，一批备用药品

参考例句：

• She works at the pharmacy.她在药房工作。
• Modern pharmacy has solved the problem of sleeplessness.现代制药学已经解决了失眠问题。

8 sterile   

adj.不毛的，不孕的，无菌的，枯燥的，贫瘠的

参考例句：

• This top fits over the bottle and keeps the teat sterile.这个盖子严实地盖在奶瓶上，保持奶嘴无菌。
• The farmers turned the sterile land into high fields.农民们把不毛之地变成了高产田。

9 uncommon   

adj.罕见的，非凡的，不平常的

参考例句：

• Such attitudes were not at all uncommon thirty years ago.这些看法在30年前很常见。
• Phil has uncommon intelligence.菲尔智力超群。

10 extraordinarily   

adv.格外地；极端地

参考例句：

• She is an extraordinarily beautiful girl.她是个美丽非凡的姑娘。
• The sea was extraordinarily calm that morning.那天清晨，大海出奇地宁静。

11 analyzes   

v.分析( analyze的第三人称单数 )；分解；解释；对…进行心理分析

参考例句：

• This approach analyzes management by studying experience usually through cases. 这个学派通常从实例获得经验，用以分析管理。 来自辞典例句
• The econometrician analyzes statistical data. 经济计量学者要分析统计材料。 来自辞典例句

12 glitch   

n.干扰；误操作，小故障

参考例句：

• There is a glitch in the computer program somewhere.这个计算机程序中的某个部分有点小问题。
• It could just be a random glitch that can be solved by restarting the machine.可能只是一个小故障，重新启动主机就能解决了。

13 inaccurate   

adj.错误的，不正确的，不准确的

参考例句：

• The book is both inaccurate and exaggerated.这本书不但不准确，而且夸大其词。
• She never knows the right time because her watch is inaccurate.她从来不知道准确的时间因为她的表不准。

14 decided   

adj.决定了的，坚决的；明显的，明确的

参考例句：

• This gave them a decided advantage over their opponents.这使他们比对手具有明显的优势。
• There is a decided difference between British and Chinese way of greeting.英国人和中国人打招呼的方式有很明显的区别。

15 audit   

v.审计；查帐；核对；旁听

参考例句：

• Each year they audit our accounts and certify them as being true and fair.他们每年对我们进行账务审核，以确保其真实无误。
• As usual,the yearly audit will take place in December.跟往常一样，年度审计将在十二月份进行。

16 opting   

v.选择，挑选( opt的现在分词 )

参考例句：

• What courses are most students opting for? 多数学生选什么课程？ 来自《简明英汉词典》
• Wells doesn't rule out opting out and then re-signing with Houston. 威尔斯没有排除跳出合同再与火箭重签的可能。 来自互联网

17 pointed   

adj.尖的，直截了当的

参考例句：

• He gave me a very sharp pointed pencil.他给我一支削得非常尖的铅笔。
• She wished to show Mrs.John Dashwood by this pointed invitation to her brother.她想通过对达茨伍德夫人提出直截了当的邀请向她的哥哥表示出来。

18 prescription   

n.处方，开药；指示，规定

参考例句：

• The physician made a prescription against sea- sickness for him.医生给他开了个治晕船的药方。
• The drug is available on prescription only.这种药只能凭处方购买。

19 applied   

adj.应用的；v.应用，适用

参考例句：

• She plans to take a course in applied linguistics.她打算学习应用语言学课程。
• This cream is best applied to the face at night.这种乳霜最好晚上擦脸用。

20 dissects   

v.解剖（动物等）( dissect的第三人称单数 )；仔细分析或研究

参考例句：

• Meltzer dissects the penile skin free of the underlying erectile tissue. Meltzer将阴茎表皮与其下的勃起组织分割。 来自互联网
• This paper dissects the process to analyse arsenic in test method and operative skills. 本文从实验方法、操作技巧等方面剖析了砷测定方法的机理。 来自互联网

21 journalism   

n.新闻工作，报业

参考例句：

• He's a teacher but he does some journalism on the side.他是教师，可还兼职做一些新闻工作。
• He had an aptitude for journalism.他有从事新闻工作的才能。