Tuesday, November 30, 2010

Cost-awareness anecdote: Blood Test Surprise (contest finalist)

The following anecdote is from Brad Wright, a graduate student from Durham, NC

In the spring of 2005, the sinus infection returned. I awoke severely congested with a pounding forehead and pain around my eyes that grew worse when I bent to tie my shoes. The feeling was familiar. Two years earlier, I had similar symptoms, but was uninsured and endured a miserable week with nothing but over-the-counter medication. Now they were back.

Fortunately, when I started graduate school, my father insisted that I have health insurance. As a healthy 24 year old, I didn’t see the need, but he agreed to foot the bill for a high-deductible insurance policy to cover me in the event of catastrophic illness. Except for four physician office visits subject only to a $35 co-payment, my policy offered no benefits until I spent $3,000 out of my own pocket. With my sinuses throbbing, I knew I needed to use one of those visits. Overwhelmed by the list of “in-network” providers on the insurer’s website, I picked an internist based on convenience—his practice was located in a medical complex near my home.

Arriving for my appointment, I checked in and presented my insurance card to the receptionist. “Your visit today will be $35,” said the woman behind the desk. I was relieved to hear that my coverage was working as promised. A nurse ushered me to an exam room, where the physician promptly entered, half-heartedly listened to my complaint, and confidently asserted that I did not have a sinus infection because I had no fever. I wanted to say “Really? Mind handing me a tissue so that I can show you what’s been coming out of my head?” but resisted the urge. Instead, I clarified that fever or no, I didn’t feel well, and believed my sinuses were the culprit. At this, the internist lost patience. He ordered some lab work and a sinus CT scan to rule out infection, and said that I could have everything done downstairs.

Despite my $35 office visit, I knew my insurance wouldn’t cover anything else until I met my deductible, so I needed to find out the cost of the CT scan. Doing so was much more difficult than I expected. Admissions didn’t know the cost, so they called the imaging department. Imaging had no idea, and threw it back to admissions where, after much searching, a big black binder full of prices was located in a cabinet, alongside packets of coffee creamer, some paper clips, and a couple of dried up ink pens. The sinus CT would cost roughly $900, which I could not afford. I headed instead to the lab to get my blood drawn, not knowing that I was about to make a costly mistake.

I worked as a phlebotomist during college, so I knew that lab tests were expensive, but that most insurers negotiated discounted rates that were only a fraction of the sticker price. Besides, the lab work was routine—a comprehensive metabolic panel and complete blood count—so I didn’t think to ask how much it would cost. My mistake was assuming that the lab was in-network, because the in-network internist I had just seen worked in the same building and referred me to the lab.

A month later, the bad news came in the mail. The lab was out-of-network, and I owed $478. While this wasn’t the five-figure medical bill many families face, everything is relative. For me, a graduate student living almost entirely on borrowed money, the bill changed how I bought groceries, socialized with friends, and commuted to school. For six months, I fought to scrape together enough money to make monthly payments. The experience, while costly, taught me a lot about our fragmented health care system, how little patients or providers know about the real cost of health care, and how hard it is for patients to make price-based decisions when the system isn’t designed with that in mind.

I had learned my lesson. Later, when a dermatologist put me on medication requiring monthly blood tests, I took out the yellow pages, looked up laboratories, and dialed the phone. “I’m uninsured,” I said (not far from the truth given my coverage) “and I need to have a lipid panel and a liver function test. How much will this cost?” Some labs knew, and some labs didn’t, and the answers varied widely. Needless to say, I chose the least expensive option. Making the decision was easy, getting the information on which to base the decision was—and is—the real challenge.


  1. Nice job, Brad. Shopping around and gathering health care costs sure isn't easy...if only they made "an app for that!" ;)

  2. I wonder whether Brad's health insurance was through his university or not. My experience with university health plans has been positive in terms of the expanse of coverage. It can be pricey, but is ALWAYS covered by additional student loan funds. I wonder if Brad opted out of his university's plan given its expense in the interest of taking out less loan money...

  3. Chances are you didn't have a sinus infection. You probably had a migraine headache. Sinus disease does not cause severe headaches.

  4. We are all consumers of healthcare and these stories are just a small illustration of how difficult it is navigate both the psychological and financial challenges of our system.

    The insurance, drug and medical supply companies, and even some healthcare institutions view the provision of healthcare as a profit center.

    Raising provider awareness of costs to patients is at least a step-

    March on....

  5. I made a similar mistake when I first got my own insurance. My mom's insurance plan required me to go to the lab at my local hospital for blood tests, or they wouldn't pay. The hospital was in my network when I got my own health insurance, so I figured everything would be fine. Not so muchs. After the $400 bill for my lab work, I looked up the "recommended" independent lab for my insurance plan. The next year, I went there and paid $22.70. Wish i had known that ahead of time.

  6. Good job Brad. I want to point out that your story leaves me with the impression that these decisions, like where to go and what tests are really necessary, should be left exclusively to doctors, not like in this case where the individual CUSTOMER has to hunt around to find out the intimate details of the medical system, which are more often than not unavailable to her! I believe this is what most people pay for with their premiums. A single payer system or an exclusively funded government health care system should be the ideal setup for us to get the health care and wellness which is all of our human right. It is pathetic that people are getting "dinged" because they didn't understand the intricacies of what will and will not be paid for with their numerous health conditions, which results in only enriching the insurance company executives and shareholders (which I read earn about 16% on their investment)! ??? What the? It is also completely pathetic that we, any of us, have to pick and choose which painful or debilitating illness we must decide NOT to treat because we can't afford it. The health care system as it is now is a travesty! I can't wait for the rest of the roll-outs of the new Health Reform Act of 2010. Many thanks to all involved in getting this passed!