This month’s bill: two CT scanner stories – a rich man, a poor man.
Last fall, Benjamin Hynden, a financial adviser in fort myers, fla., didn’t feel good for a few weeks. He has a pain in his abdomen.
In October, he finally made an appointment to see his doctor. “It’s not serious,” he said. “It’s really annoying. It bothers me during the day.”
Doctor John Ardesia examined him and guided him to a nearby imaging center for a CT scan, or CAT scan. The radiologist did not see any errors on the image, and Ardesia did not recommend any treatment.
A few weeks later, Hynden, which was signing up for a hefty deduct from Cigna, received a bill of $268. He paid and went on.
But three months later, in mid-january, Haydn still felt bad. He called Ardesia’s office again. This time the doctor is not here. Worried that henin might have appendicitis, he was advised to go to the hospital immediately.
“I was a little worried,” Hahn recalled. “When he asked me to go to the emergency room, I felt compelled to take his advice.”
Hayden arrived at the gulf coast medical center that night, one of several hospitals in fort myers, Florida. The nurse told him that the problem was not his appendix, but she suggested that he insist on some extra tests – including another CT scan – to ensure safety.
‘it’s the same scanner,’ he says. “It’s the exact same test.”
The results were the same as those in October: Hynden was sent home without a diagnosis.
Then the bill comes.
Patient: Benjamin Hynden, 29, financial adviser, fort myers, Florida.
Total cost: $10,174.75, including $8,897 abdominal CT scan.
Service provider: the gulf coast medical center owned by Lee Health, a leading Health care system in southwest Florida.
Medical procedures: CT scans that use x-rays to create cross-sectional images of the body. Hynden conducted an October scan at the Summerlin imaging center, an independent factory in fort myers, which offers a range of diagnostic tests, including x-rays, MRI and CT scans.
Benjamin Hayden was surprised that he received a CT scan that was 33 times higher than the number he had received at an imaging center a few months earlier.
‘his center is small and independent, so he doesn’t have much bargaining power,’ says rick Davis, a co-owner of Summerlin. That means insurance companies almost decided he could charge for the scans. In the case of Hynden, this is $268, including the cost of a radiologist reading an image.
Eventually, medicare decided to pay for the scans. “The health insurance bill is a guide for all other companies,” Davis told me, and he asked me to visit the summers. “It’s basically the bible. It’s something everyone has experienced.”
Kimberly Papiska, Summerlin’s office manager, says the center plans to spend up to $1,200 on a CT scan. But insurance companies typically pay less than $300.
Hynden was struck by the second CT scan in January, when he paid 8,897 to 33 times the price he paid for the first test.
The gulf coast medical center is part of his Cigna insurance program approved supplier network. But even with a negotiated discount, Haynes has a scan hook of $3394.49. The additional ER cost added $261.76 to the bill.
The results are as follows: we call it the gulf coast medical center and its parent company, Lee Health, to see why they charge nearly $9,000 for a single test. No one in a health center or hospital would agree to an interview.
Lee health spokesman Mary briggs responded to an email statement saying:
“In general, the cost of providing CT scans in the emergency department is not uncommon,” the statement said. “Emergency department charge reflects the maintain staffing, medical professional knowledge, the high cost of equipment and infrastructure, 24/7 is necessary, in order to satisfy the demands of any possible health care – from mild damage to a gunshot wound or a heart attack to the mass casualty incident”.
Is the cost and preparation of the hospital worth much more than the nearby imaging center TAB? We asked some medical bills and management experts.
Health care and drug management program at New York’s Columbia business school Bunny Ellerin said, emergency room often to people with insurance premium of earning huge fees, to make up for their free care for uninsured patients. “Usually these people are what they call a frequent-flier term,” says Ellerin. “They come back again and again.”
She says the hospital is also trying to get as much money as possible from private insurers to offset the lower reimbursement for medicare and medicaid.
Even in this case, the price of CT scans at heinton hospital is high.
In fort myers, Hynden’s contrast range is between $474 and $3,700, according to Healthcare Bluebook, an online pricing tool. Its fair price is $595.
Health policy and management professor Gerard Anderson at Johns Hopkins university, said the gulf coast and its parent company’s high prices may be due to its huge pricing power in fort myers.
According to its website, li has four major hospitals in fort myers and a children’s hospital and a rehabilitation hospital. It also has several medical practices in the region. When you drive near fort myers, the blue-green lee health logo appears on buildings everywhere.
“Anyone in fort myers wants to be taken care of in these hospitals, so by taking the lead, they have a lot of bargaining power,” Mr. Anderson said. “So they can raise interest rates, they can still.”
Anderson says his research shows that hospital integration has been pushing prices higher in recent years. And because more and more people, like Haydn, have high deductible plans, they are more likely to face huge bills.
As a result, Lee Health and other dominant hospital systems mark most of their services on their main price list – $8,897 for CT scans at Lee Health. Mr Anderson calls these lists “fairytale prices” because few people actually pay them.
“Everyone who has seen it agrees – including the organization’s chief financial officer – this is a fairy tale, but it does have relevance,” Mr. Anderson said.
The correlation is that insurers usually negotiate the price they will pay for the discounted price.
As a result, from $8,897 in the main price, Cigna reduced the price of Hynden’s bill to $5,516.14 – nearly 40% of the discount. Then cigna paid $2864.08 to pay for the rest.
“If it wasn’t for CT scans, I don’t think the whole thing would be so difficult, and it’s very clear that they’re charging extremely high fees for the service,” said Hynden.
Solution: Hynden never got a clear diagnosis from a CT scan. A few weeks after his second test, however, he went to a nearby emergency care center, run by Lee Health, who carried out an ultrasound examination of his abdomen. The test, which cost about $175, showed that his doctor said some benign cysts might disappear on their own.
Takeaway: tests and services are almost always more expensive in emergency rooms or hospital Settings. If your doctor advises you to go to the emergency room, it may be worth asking whether the imaging center, emergency care or walk-in clinic is adequate.
This month’s bill: two CT scanner stories – a rich man, a poor man.