There's a simple answer—it can't. Or at least it shouldn't. There's no way a simple throat swab intended to determine whether a patient has strep should cost more than a few hundred dollars (and in any other rich nation, it wouldn't). But in our health care system, the combination of doctors and labs and private insurance companies, has figured out how to make it so ridiculously expensive to get very basic care.
Alexa Kasdan is the patient in question. She went to her primary care doctor, Dr. Roya Fathollahi, in New York City, for a sore throat that hadn't gotten better in a week's time. She was preparing for a vacation and didn't want to have the trip interrupted, so she went to the doctor, had the strep test and a blood test, and was given antibiotics. She got better, went on her trip, and came home to find that her insurer, Blue Cross and Blue Shield of Minnesota, had been billed $28,395.50 for the out-of-network lab work on the throat swab. The insurance company paid $25,865.24. Fathollahi’s office told her that $2,530.26 of the bill was her responsibility.
"I thought it was a mistake," she told Kaiser Health News, which reported the story jointly with NPR as part of their crowdsourced investigation series, Bill of the Month. "I thought maybe they meant $250. I couldn't fathom in what universe I would go to a doctor for a strep throat culture and some antibiotics and I would end up with a $25,000 bill." The doctor's office waived Kasdan’s share of the cost, but still insisted that this was a reasonable amount for an out-of-network lab to charge for analyzing a throat swab.
Here's how it happened: Dr. Fathollahi, for reasons that are murky, ordered what KHN called "a sophisticated smorgasbord of DNA tests looking for viruses and bacteria that might explain Kasdan's cold symptoms." DNA tests. For a sore throat. Also, the lab the doctor used was not in Kasdan's insurance network. Had the tests been conducted by LabCorp—the in-network lab—it would have charged her insurance around $650 for everything that the doctor had ordered, the lab told KHN. There's one more part to this, though, and that’s where the murkiness comes in. KHN reported, "Kasdan's bill shows that the lab service was provided by Manhattan Gastroenterology, which has the same phone number and locations as her doctor's office." Manhattan Gastroenterology is also registered in New York state as a professional corporation, which means it is owned by physicians.
Which makes it kind of a stinky situation all around, giving all appearances of a doctor ordering unnecessary and expensive tests at a lab outside of the patient's network, at lab in which he has a financial interest, in order to make a profit off of the insurance company. That's sure what it looks like, at any rate. Reported KHN, "Fathollahi, the Manhattan Specialty Care physician, didn't respond to requests for comment. Neither did Dr. Shawn Khodadadian, listed in state records as the CEO of Manhattan Gastroenterology."
Surprise medical bills? How about grossly obscene medical bills? Never mind the fact that Kasdan didn't end up having to pay $2,500 for her part of the test; she and everyone else in the Blue Cross and Blue Shield of Minnesota network is going to have to pay one way or another, through premiums and deductibles and copays. And this is why there are physician and hospital groups creating organizations to fight against Medicare for All.
Published with permission from Daily Kos.