By Cara Anthony September 30,
2019
Brianna Snitchler was just figuring
out the art of adulting when she scheduled a biopsy at Henry Ford Hospital in
Detroit.
Snitchler was on top of her finances:
Her student loan balance was down and her credit score was up.
“I had been working for the past
three years trying to improve my credit and, you know, just become a
functioning adult human being,” Snitchler, 27, said.
For the first time in her adult life,
she had health insurance through her job and a primary care doctor she liked.
Together they were working on Snitchler’s concerns about her mental and
physical health.
One concern was a cyst on her
abdomen. The growth was about the size of a quarter, and it didn’t hurt or
particularly worry Snitchler. But it did make her self-conscious whenever she
went for a swim.
“People would always call it out and
be alarmed by it,” she recalled.
Before having the cyst removed,
Snitchler’s doctor wanted to check the growth for cancer. After a first round
of screening tests, Snitchler had an ultrasound-guided needle biopsy at Henry
Ford Health System’s main hospital.
The procedure was “uneventful,” with
no complications reported, according to results faxed to her primary care
doctor after the procedure. The growth was indeed benign, and Snitchler thought
her next step would be getting the cyst removed.
Then the bill came.
The Patient: Brianna Snitchler, 27, a user-experience
designer living in Detroit at the time. As a contractor for Ford Motor Co., she
had a UnitedHealthcare insurance plan.
Total Bill: $3,357.52, including a $2,170
facility fee listed as “operating room services.” The balance included a
biopsy, ultrasound, physician charges and lab tests.
Service Provider: Henry Ford Health System in Detroit.
Medical Procedure: Ultrasound-guided needle biopsy of a
cyst.
What Gives: When Snitchler scheduled the biopsy,
no one told her that Henry Ford Health System would also charge her a $2,170
facility fee.
Snitchler said the bill turned out to
be far more than what she budgeted for. Her insurance plan from
UnitedHealthcare had a high-deductible of $3,250, plus she would owe
coinsurance. All told, her bills for the care she received related to the
biopsy left her on the hook for $3,357.52, with her insurance paying $974.
“She shrugged it off,” Snitchler’s
partner, Emi Aguilar, recalled. “But I could see that she was upset in her
eyes.”
Snitchler panicked when she realized
the bill threatened the couple’s financial security. Snitchler had already
spent down her savings for a recent cross-country move to Austin, Texas.
In an email, Henry Ford spokesman David Olejarz
said the “procedure was performed in the Interventional Radiology procedure
room, where the imaging allows the biopsy to be much more precise.”
“We perform procedures in the most
appropriate venue to ensure the highest standards of patient quality and
safety,” Olejarz wrote.
The initial bill from Henry Ford
referred to “operating room services.” The hospital later sent an itemized bill
that referred to the charge for a treatment room in the radiology department.
Both descriptions boil down to a facility fee, a common charge that has become controversial
as hospitals search for additional streams of income, and as more patients
complain they’ve been blindsided by these fees.
Hospital officials argue that medical
centers need the boosted income to provide the expensive care sick patients
require, 24 hours a day, 365 days a year.
But the way hospitals calculate
facility fees is “a black box,” said Ted Doolittle,
with the Office of the Healthcare Advocate for Connecticut, a state that has
put a spotlight on the issue.
“It’s somewhat akin to a cover
charge” at a club, said Doolittle, who previously served as deputy director of
the federal Center for Program Integrity at the Centers for Medicare &
Medicaid Services.
Hospitals in Connecticut billed more
than $1 billion in facility fees in 2015 and 2016, according to state records. In 2015, Connecticut lawmakers approved a bill that forces all hospitals and medical
providers to disclose facility fees upfront. Now patients in Connecticut
“should never be charged a facility fee without being shown in burning scarlet
letters that they are going to get charged this fee,” Doolittle said.
In Michigan, there’s no law requiring
hospitals and other providers of health care services to inform patients of
facility fees ahead of time.
Brianna Snitchler’s procedure took
place on campus at Henry Ford’s main hospital site. When she got her bill, with
its mention of “operating room services,” she was baffled. Snitchler said the
room had “crazy medical equipment,” but she was still in her street clothes as
a nurse numbed her cyst and she was sent home in a matter of minutes.
With Snitchler’s permission, Kaiser
Health News shared her itemized bill, biopsy results and explanation of benefits
with Dr. Mark Weiss, a radiologist who leads MediCrew, a company in Flint,
Mich., that helps patients navigate the health system.
Weiss said it probably wasn’t
medically necessary for Snitchler to go to the hospital to receive good care.
“Not all surgical procedures have to be done at a surgical center,” he said,
noting that biopsies often can be done in an office-based treatment center.
Resolution: Hoping for a reasonable explanation
— or even the discovery of a mistake — Snitchler called her insurance company
and the hospital.
A representative at Henry Ford told
her on the phone that the hospital isn’t “legally required” to inform patients
of fees ahead of time.
In an email, Henry Ford spokesman
Olejarz apologized for that response: “We’ll use it as a teachable moment for
our staff. We are committed to being transparent with our patients about what
we charge.”
He pointed to an initiative launched
in 2018 that helps patients anticipate out-of-pocket expenses. The program
targets the most common elective radiology and gastroenterology tests that
often have high price tags for patients.
Asked if Snitchler’s
ultrasound-guided needle biopsy will be included in the price transparency
initiative, Olejarz replied, “Can’t say at this point.”
In addition to the pilot program to
inform patients of fees, Olejarz said, the hospital also plans to roll out an
online cost-estimator tool.
For now, Snitchler has decided not to
get the cyst removed, and she plans to try to negotiate on her bill. She has
not yet paid any portion of it.
“You should always negotiate; you should
always try,” Doolittle said. “Doesn’t mean it’s going to work, but it can work.
People should not be shy about it.”
“We are happy to work out a flexible
payment plan that best meets her needs,” Olejarz wrote when Kaiser Health News
first inquired about Snitchler’s bill.
The Takeaway: When your doctor recommends an
outpatient test or procedure like a biopsy, be aware that the hospital may be
the most expensive place you can have it done. Ask your physician for
recommendations of where else you might have the procedure, and then call each
facility to try to get an estimate of the costs you’d face.
Also, be wary of places that may look
like independent doctor’s offices but are owned by a hospital. These practices
also can tack hefty facility fees onto your bill.
If you get a bill that seems
inflated, call your hospital and insurer and try to negotiate it down.
Bill of the Month is a crowdsourced
investigation by Kaiser Health
News and NPR that dissects and explains medical bills. Do you have an
interesting medical bill you want to share with us? Tell us about it!
Cara Anthony: canthony@kff.org, @CaraRAnthony
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