$18,000 biopsies? Cash was cheaper than her insurance. Dani Yuengling initially disregarded a tumor she discovered in her right breast last summer.
She was 35 when her mother was also diagnosed with breast cancer in 1997. In 2017, Yuengling’s mother succumbed to the illness.
“It was the roughest experience,” Yuengling, from Conway, South Carolina, said.
Yuengling had a breast biopsy scheduled for Valentine’s Day at Grand Strand Medical Center in Myrtle Beach after mammography showed the lump warranted additional study.
Yuengling needed to know how much the biopsy would cost because it was one of many things on her mind leading up to the visit (the first being a possible cancer diagnosis).
Her health insurance plan has a deductible of $6,000 per year before it begins contributing, and she hadn’t even come close to meeting it. Yuengling anticipated paying a significant portion of the total cost of the surgery.
There was no cost estimate from the hospital. She was warned that the cost of the biopsy could rise if her doctors didn’t know beforehand what kind of needle they would require.
An online “Patient Payment Estimator” provided by the hospital estimated that an uninsured patient would have to pay around $1,400 for the operation.
“No problem there. It’s not that serious of a situation, “Because she had insurance, she reasoned, she could expect to pay less. A quick Google search suggests it could cost closer to $3,000, although either amount is acceptable in Yuengling’s book. As she went through with the operation, she didn’t give any thought to her financial situation.
The results came back quickly, and they were good: she did not have cancer.
Next, I received the bill.
Dani Yuengling, now 36 years old, is a Cigna patient thanks the human resources firm that employs her.
Breast biopsy assisted by ultrasonography.
Service provider: Grand Strand Medical Center, a 403-bed, for-profit hospital in Myrtle Beach, South Carolina. It’s one of the 182 facilities owned by HCA Healthcare, a Nashville-based corporation that posted $58.7 billion in sales in 2016.
The total cost of the operation, including all necessary supplies and labor, was $17,979. The discounted in-network fee for a hospital stay from Cigna was $8,424.14, and the insurance company paid the hospital $3,254.47. The remaining deductible amount owed by Yuengling was $5,169.67.
Why is it that cash-paying individuals, or those without health insurance, are often charged far less than their insured counterparts? Using insurance can result in a much larger expense for the approximately 30% of American workers with high-deductible plans, like Yuengling, than if they were uninsured or simply paid in advance using a credit card.
Associate professor of public health at Johns Hopkins University Ge Bai has recently released research on this topic, stating that cash charges at U.S. hospitals are typically cheaper than the prices charged to customers with commercial insurance.
In a statement, Bai stated, “We can very confidently say this is very prevalent,” and suggested that all patients, regardless of insurance status, find out the cash costs of an operation before committing to it. It ought to be the standard.
Yuengling’s insurance company was hit with a very hefty bill from Grand Strand for her surgery. A Medicare patient who requires an ultrasound-guided biopsy, as the one Yuengling received, would pay only around $300, their minimum 20% coinsurance for outpatient care, according to the federal government’s website. Medicare would cover the remainder of the hospital charge, which would be around $1,200. The hospital wanted Yuengling and her insurance company to pay more than five times the Medicare premium.
Fair Health Consumer, a group that studies health insurance claims, found that the average cost to privately insured patients in Conway who were treated at hospitals other than Yuengling was nearly $3,500.
If you need an ultrasound-guided breast biopsy and don’t have health insurance, you’ll likely only have to pay roughly $2,100 at the nearby Conway Medical Center, according to Allyson Floyd, a hospital spokesperson.
Caroline Preusser, a spokesperson for Grand Strand Medical Center, explained that the incorrect information Yuengling received was due to “a glitch” in the hospital’s online calculator and that the actual cash price for a breast biopsy at the hospital is between $8,000 and $11,500 “depending on the exact procedure and equipment used.”
The hospital withdrew certain operations from the payment estimator until they can be fixed, Preusser stated. She did not provide a time estimate.
Yuengling attempted to resolve the situation by challenging the hospital’s charges. She called the billing department and was offered a 36% discount, cutting the amount she needed to pay to $3,306.29. Even though Yuengling had the option to set up a payment plan at Grand Strand Medical Center, she opted to charge the entire sum on her credit card and forget about it.
“For some reason, I just couldn’t get to sleep. This was seriously stressing me out. Migraines had begun to plague me. I was sick to my stomach,” she stated. “It’s terrible being indebted to people. I tried not to dwell on it. Seeing as how I’m still considering the possibility, obviously, that didn’t work.”
Her hospital bill was audited by an external business, Parallon after she repeatedly requested to talk to the hospital’s patient advocate. The Revenue Integrity Department of the hospital wrote her on May 26. The letter concluded that the charges on the patient’s account were reasonable after looking into the matter and reviewing the patient’s medical history.
“I don’t know why I actually expected a different conclusion,” she admitted.
The hospital wants Yuengling to come back for a follow-up appointment after the biopsy. Basically, she flat-out said no.
In an email to KHN, Harlow Sumerford, a spokeswoman for HCA Healthcare, said, “We apologize for any misunderstanding the payment estimator may have caused, and we are working to resolve the situation.”
Lesson: Yuengling was wise to follow up with her doctor after discovering a lump due to her family history of breast cancer. She may have looked into the prices of competing hospitals in the area when Grand Strand Medical Center avoided giving her a straight response on her costs. Though her doctor suggested Grand Strand, she was under no obligation to go there. If she had gone to a different country for the surgery, she may have saved a lot of money.
Patients with high-deductible health plans, like Yuengling, may want to consider paying the full cash fee for some operations instead of filing claims with their insurer.
Professor of Law at the University of South Carolina and practicing health care attorney Jacqueline Fox said she was unaware of any legislation that would prohibit such conduct on the part of a patient. After all, she argued, people with health insurance regularly pay cash for prescription drugs. It’s reasonable to assume that the same could be done for surgical procedures.
However, this is made more complicated by some establishments. Grand Strand Medical Center, for example, offers “self-pay” patients an “uninsured discount,” but that discount is limited to people who have “no third party payer source of payment or do not qualify for Medicaid, Charity or any other discount program the facility offers,” according to the hospital’s website. Patients who have been verified as lacking health insurance will only be given information about their savings.
The fact that the cash price of a procedure will not count against the deductible means that it may not be the most cost-effective option. Patients could end up paying their complete deductible despite saving money on one surgery if they incur other unexpected medical bills during the year.
A good faith estimate can be obtained from a patient’s health insurance provider. After a member requests it, their health insurance provider must provide an estimate of their out-of-pocket costs in accordance with the No Surprises Act.
Research professor at Georgetown University’s McCourt School of Public Policy Sabrina Corlette recommends requesting an “Advanced Explanation of Benefits,” though she emphasizes that this provision of the law is not yet being enforced.
Patients, regardless of whether they have health insurance, have the right to register complaints with the federal government under the No Surprises Act.
In June, Yuengling lodged her formal complaint.
