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For one woman, getting blood drawn at a hospital led to a surprise bill


It's time for November's Bill of the Month. Today we have a story about the importance of where you get blood tests done. Dr. Elisabeth Rosenthal is senior contributing editor with our partner KFF Health News. Welcome back, Dr. Rosenthal.

ELISABETH ROSENTHAL: Hi. Good to be here again.

SHAPIRO: Who are you going to introduce us to today?

ROSENTHAL: Well, today we're meeting Reesha Ahmed. She lives just south of Dallas. After a prenatal visit, she had some routine blood tests done. They were at a lab at the same hospital where her doctor's office is located. So, you know, she didn't think anything of it, and it sure was convenient. But - da, da, da (ph) - then the bill came and it didn't seem so great.

SHAPIRO: Yeah, cue the ominous music. Let's find out more from reporter Emily Siner.

EMILY SINER, BYLINE: In January, Reesha Ahmed was newly pregnant. It was an exciting time, and Reesha says at her first prenatal visit, everything looked good. She just needed to get some blood tests. The nurse pointed the way.

RISHA AHMED: She's like, go downstairs to our main hospital area, and you'll find the lab. So I just took it and went, and I didn't think anything of it.

SINER: But soon after, things started going wrong. Reesha had a miscarriage, ending the pregnancy, and then bills started coming, one after another.

AHMED: First it was, like, a $17 one. I was like, OK, that's not too bad. Then another one came for $361. And I was like, OK, that's a little more than what I anticipated. And then the big one came for $2,000. And I was like, OK, this can't be right.

SINER: Reesha knew people who'd barely paid anything for routine blood tests in the first months of pregnancy, and she had health insurance. And so she began...

AHMED: I talked to the doctor. She's like, no, that's crazy.

SINER: ...The month-long journey...

AHMED: I reached out to her office manager, who she referred me to...

SINER: ...To fight the bill.

AHMED: ...Precept the billing department. Every time I reached out to them, they just passed it back to the physician's office.

SINER: She called her insurance, escalated it to a supervisor.

AHMED: I don't even think I ever heard back from that.

SINER: Reesha's a licensed clinical social worker, so she has more experience than most when it comes to navigating medical bills. She even filed a complaint with the Texas Attorney General's Office, which sent it to the state's Health and Human Services Commission. She hasn't heard back.

AHMED: Every time you kind of hit a roadblock - OK, there must be someone else that I can talk to if you can't help me.

SINER: Reesha had stumbled into a pitfall of medical billing that many people don't know about. Research shows when you get your bloodwork done at hospitals, they tend to charge way more than a doctor's office or an independent lab. In Texas, one study found it can be six times as expensive. And then when the hospital submitted the claim to her insurance, they called it a diagnostic test, even though this kind of bloodwork would usually be considered preventive, meaning there should be no cost to patients under federal law. A day after Bill of the Month contacted the hospital, the hospital zeroed out the bill, although it didn't respond to detailed questions about the charges. But Reesha says that doesn't solve the underlying problem. Why was it so hard for her to fight the charge by herself?

AHMED: That's not OK. I mean, patient care doesn't end at the doctor's office. It continues. It includes insurance companies, and it includes the billing department and all the behind-the-scenes stuff. And that has a big impact on, you know, whether or not patients choose to seek care again.

SINER: For Reesha, the whole experience has made her more cautious, and she's going to pause and do more research, look for other lab options, next time she needs to get bloodwork done. For NPR News, I'm Emily Siner.

SHAPIRO: We're back with Dr. Elisabeth Rosenthal. Dr. Rosenthal, what an outrageous story. I'm infuriated just listening to it. Why are bills sometimes so much more expensive when patients get blood tests at a hospital than at a doctor's office or an independent lab?

ROSENTHAL: Yeah, and what a battle she fought. I often say that blood tests at a hospital are akin to booze at restaurants. The markup can be much higher than you'd expect - almost anything. Hospitals will often say they have to charge more because they're covering the overhead of maintaining their entire facility, like their ICUs. But that kind of cost-shifting, even if you buy into it, really doesn't justify the price patients end up paying. So something like a simple blood count test that costs about $6 at a standalone lab could cost 60 at a hospital.

SHAPIRO: And is there any pushback, any move to change that?

ROSENTHAL: Kind of. Lawmakers know it's a problem, and there are a couple proposals in Congress that are designed to lower some hospital prices. The idea is to set a site-neutral policy so the cost for a service provided to a patient is the same, regardless of the setting where the care is gotten. But hospitals, of course, don't like that idea. It takes away revenue. And some are lobbying to keep things the same.

SHAPIRO: Well, in the meantime, is there any way for a patient to make sure they don't experience what Reesha experienced, that they don't get charged $2,000 for bloodwork?

ROSENTHAL: Well, what I love about this kind of outrageous bill is that, yes, there is something patients can do to avoid them. If your doctor is in a hospital or even if her office is affiliated with a hospital, their computer is likely programmed to send test orders to the hospital lab. So what patients can do, and what I always do when I see my primary care doctor, is to ask that the request be sent to a commercial lab that's in your network, like Labcorp or Quest. And if they can't do it electronically, ask for one of those old-fashioned paper request forms. You may have to walk or drive a few blocks, but it'll be worth it for the hundreds or even thousands you'll save.

SHAPIRO: Annoying, but maybe potentially necessary. Good advice from Dr. Elisabeth Rosenthal there. Thank you very much.

ROSENTHAL: Thank you.

SHAPIRO: If you have a confusing or outrageous medical bill that you want us to review, please go to NPR's Shots blog and tell us all about it. Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Emily Siner is an enterprise reporter at WPLN. She has worked at the Los Angeles Times and NPR headquarters in Washington, D.C., and her written work was recently published in Slices Of Life, an anthology of literary feature writing. Born and raised in the Chicago area, she is a graduate from the University of Illinois at Urbana-Champaign.
Elisabeth Rosenthal - KFF Health News