Hospitals are price gougers to be avoided at all costs, especially if you don’t need to be in a hospital. A good rule of thumb is to never get services performed at a hospital unless you are too sick to go anywhere else. Ms. Ahmed, a woman who lives near Fort Worth, Texas, recently went to her doctor for her first prenatal visit. While there she got a standard panel of prenatal tests at a hospital lab down the hall from her physician’s office. Her tests included a complete blood count, blood type and common prenatal tests for sexually transmitted diseases (STD). There were also pathology results from a pap smear. Then she got a huge bill. Kaiser Health News broke the story:
The hospital charged $9,520.02 for the blood tests and pathology services. The insurer negotiated that down to $6,700.50 and then paid $4,310.38, leaving Ahmed with a lab bill of $2,390.12.
Seriously? Routine prenatal lab tests have a list price of nearly $10K? One expert even wondered why the negotiated prices, totaling $6,700, were so high. That’s a good question: negotiated prices tend to be around 33% to 40% of list prices.
“You just wonder, is the insurance company really negotiating with this provider as aggressively as they should to keep the reimbursement to a reasonable amount?” Corlette said.
Ahmed’s situation reveals how hospital-based labs often charge high prices for tests. Even when providers are in network, a patient can be on the hook for thousands of dollars for common blood tests that are far cheaper in other settings. Research shows hospitals typically charge much more than physicians’ offices or independent commercial labs for the same tests.
In November Walk-In Lab (where I buy tests) are 20% off the prices listed below. A complete blood count (CBC) with comprehensive metabolic panel is $44 to $46. STD tests range from $139 to $459, with a panel that tests for nine different STD infections at $259. In the KHN article photo Ms. Ahmed is wearing a headscarf typical of devout Muslim women. I wonder if she even knew she was agreeing to a battery of STD tests. KHN had this to say:
In Texas, the same lab tests were at least six times as expensive in a hospital as in a doctor’s office, according to research from the Health Care Cost Institute, a nonprofit that examines health spending.
“It is convenient to get your lab done right in the same building,” said Jessica Chang, a senior researcher at HCCI, but “many patients are not thinking about how highly marked up these lab tests are.”
In theory this all could have been avoided if Ms. Ahmad had known to get lab tests elsewhere, but I doubt if she was really given a choice. This is where the details get murky. Her doctor must be employed by the hospital for the lab to be conveniently located “down the hall” (inside a hospital). Ms. Ahmed said a nurse suggested she get the tests just down the hall. Clinical office staff often wear scrubs, which Ahmed may gave confused with a nurse. Office staff sometimes discuss locations when doctors order tests for patients. Getting the tests in the doctor’s office was apparently not an option since the hospital lab was suggested. If both doctor and office staff are employed by the hospital, they are probably required to steer patients to hospital labs.
This anecdote illustrates the risks of having physicians employed by hospitals. They are loyal first to their employers, who pay their salary. While this arrangement is not likely to adversely affect patients’ health, it could have an impact on the prices patients pay for medical care and possibly increase the number of unnecessary services. In the end Ms. Ahmed refused to pay and the hospital later dropped the charges when contacted by KHN. The problem is that most patients cannot count on help from KHN every time they fall victim to hospital price gouging. Also, patients trust their doctors when directed to a lab and don’t realize prices vary and they (may) have options.