Our Nightmare Health Care System in One Doctor’s Bill

Strep throat tests are usually quick and painless. Sure, there are a few seconds of discomfort during the throat swab, but after that, and maybe another related test, you’re out the door. Hopefully, the results offer some relief and peace of mind, two qualities none of us should have to put a price on.

Unfortunately, Alexa Kasdan’s doctor and her insurance company did: $28,395.50. That is not a typo. Bill of the Month, a joint project of NPR and Kaiser Health News, reported Monday that  Kasdan, a New York City public policy consultant, went to get a strep test from her primary care doctor before a vacation. When she got home from the trip, she was greeted by multiple messages from her insurance company and doctor’s office, including one informing her the insurance company would send a check for more than $25,000 that she should then bring to her doctor’s office. The office told the insurance company it was waiving Kasdan’s portion of the bill: $2,530.26.

Unfortunately, Kasdan is not the only American struggling with eye-popping medical bills. “The number of patients whose medical care cost at least a million dollars over the course of a year rose by nearly 90% between 2014 and 2017, according to a new report conducted by Sun Life Financial,” Marketwatch reported in 2018. Sun Life pointed to expensive injectable drugs, particularly for rare diseases, as a major culprit of these bills.

“We’re seeing drug claims that can be in the millions of dollars,” Dan Fishbein, president of Sun Life Financial, explained to MarketWatch last year. He added, “Most people don’t imagine getting an $80,000 prescription, but that’s relatively common now.”

Insurance companies assume people will cough up. “There is this new group of people who, on paper, look like they should be able to afford their bills,” Craig Antico, founder of RIP Medical Debt, a nonprofit that buys and forgives medical debt, told The New York Times in November.

That America even requires a nonprofit to tackle medical debt is disheartening, but not surprising, in an era in which others turn to crowdfunding platforms like GoFundMe to pay for lifesaving treatments. A third of the money raised by GoFundMe is for medical bills.

When patients are unable to pay, the Times’ Sarah Kliff reports, “Hospitals across the country are increasingly suing patients for unpaid bills, a step many institutions were long unwilling to take.”

Fortunately, unlike the people in The Times’ article, Kasdan was able to dispute the charges immediately. The cause of her high bill wasn’t related to medication. Instead, further research showed that far from a normal throat culture, the doctor sent Kasdan’s swab for a variety of complicated DNA tests, searching for a variety of viruses and bacteria. At least one doctor NPR spoke to was highly skeptical of this move: “In my 20 years of being a doctor, I’ve never ordered any of these tests, let alone seen any of my colleagues, students and other physicians order anything like that in the outpatient setting,” Dr. Ranit Mishori, professor of family medicine at the Georgetown University School of Medicine, explained to NPR.

The doctor also ended up sending the tests to an out-of-network lab, a facility that NPR found just happened to be affiliated with the doctor’s office, further raising the costs.

Kasdan disputed the bill immediately, telling her doctor that she would report the office to New York State’s Office of Professional Medical conduct. She then brought it to the attention of Bill of the Month. After the project started asking questions, Blue Cross Blue Shield said it would stop payment on the check.

If there’s anything to be gained from the situation, it’s an excellent reminder to ask your doctor which tests they’re ordering and whether the labs they’re using are in your network, and, even if NPR doesn’t pick up your story, to not be afraid to contest your medical bills.

Read Kasdan’s full story here.