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Retiree Residing the RV Dream Fights $12,387 Nightmare Lab Charge

From Victoria Knight, Kaiser Health News

Lorraine Rogge and her husband Michael Rogge tour the country in a recreational vehicle, a well-deserved retired adventure. That spring, they were parked in Artesia, New Mexico for several months.

That story ran on NPR too. It can be republished for free.

In May, 60-year-old Rogge began to experience pelvic pain and cramps. Since she had a total hysterectomy in 2006, the pain seemed unusual, especially because it lasted for days. She looked for a local gynecologist and found one who took out her insurance at Carlsbad Medical Center in Carlsbad, New Mexico, about 20 miles from the RV site.

The doctor asked if Rogge was sexually active and she replied yes and that she had been married to Michael for 26 years. Rogge felt that she was making it clear that she was in a monogamous relationship. The doctor then performed a pelvic exam and took a vaginal swab sample for laboratory tests.

The only lab test Rogge remembered after speaking to the doctor was to see if she had a yeast infection. She was not given any medication to treat her pelvic pain and it eventually went away after a few days.

Then came the bill.

The patient: Lorraine Rogge, 60. Her coverage was an Anthem Blue Cross retiree plan through her husband’s former employer with a deductible of $ 2,000 and a maximum deductible of $ 6,750 for network providers.

Entire invoice: Carlsbad Medical Center billed Anthem Blue Cross $ 12,386.93 for a test panel for vaginosis, vaginitis, and sexually transmitted infections (STIs). The insurer paid $ 4,161.58 at a negotiated price of $ 7,172.05. This left Rogge responsible for $ 1,970 of her deductible and $ 1,040.36 of co-insurance. Your total lab bill was $ 3,010.47. Rogge also paid $ 93.85 for the doctor’s visit.

Service provider: Carlsbad Medical Center in Carlsbad, New Mexico. It is owned by Community Health Systems, a large for-profit chain of hospital systems based in Franklin, Tennessee, just outside Nashville. Doctor Rogge saw work for Carlsbad Medical Center and his lab was processing her test.

Medical service: A bundled test panel that checked for bacterial and yeast infections, as well as common sexually transmitted diseases such as chlamydia, gonorrhea, and trichomoniasis.

What gives: There were two things Rogge didn’t know when she sought help. First, Carlsbad Medical Center is notorious for its high prices and aggressive billing practices, and second, she didn’t know she would be tested for a variety of sexually transmitted infections.

The latter bothered her very much as she was only sexually active with her husband. She has no recollection of being told about the STI tests. She was also not asked if she or her husband might have been sexually active with other people, which might have warranted wider testing. They have been traveling together for five years.

“I was outraged that they did these tests when they were saying they were going to do a yeast infection test,” said Rogge. “They did all of these tests that you would do on a very young person who had a lot of friends.” not a 60-year-old grandmother who has been married for 26 years. “

Although a doctor doesn’t need a patient’s approval to perform tests, it is not good practice to do so without informing the patient, said Dr. Ina Park, Associate Professor of Family Medicine at the University of California Medical School, San Francisco. This is especially true for tests of a sensitive nature such as STIs. It’s doubly true when the tests are going to cost thousands of dollars.

Park, an expert on sexually transmitted infections, also questioned the need for a full suite of tests on a patient who had had a hysterectomy.

In addition, the price for these tests was extremely high. “It shouldn’t cost $ 12,000 to get an assessment for vaginitis,” Park said.

Charles Root, an expert on laboratory accounting, agreed.

“To be honest, retail prices are further [the bill] are ridiculous, they don’t make any sense, “said Root.” These are tests that cost about $ 10 to run. “

In the fall of 2019, the New York Times and CNN examined the Carlsbad Medical Center and found that the facility had taken thousands of patients to court over unpaid hospital bills. Carlsbad Medical Center also has higher prices than many other facilities – a study by Rand Corp. from 2019 found that private insurance companies pay Carlsbad Medical Center 505% of the cost that Medicare would pay for the same procedures.

The bundled test panel that was run with Rogges Probe was a Quest Diagnostics SureSwab Vaginosis Panel Plus. It comprised six types of tests. Quest Diagnostics did not provide the cost of the bundled tests, but Kim Gorode, a company spokesman, said that if the tests had been ordered directly through Quest rather than the hospital, it would likely “have been significantly less patient responsibility. “”

Under the Medicare Clinical Laboratory Fee Schedule, Medicare would only have reimbursed the laboratories about $ 40 for each run of Rogge’s sample. And Medicaid would similarly reimburse hospitals in New Mexico, according to Russell Toal, superintendent of the New Mexico insurance division.

However, hospitals and clinics can add significant surcharges for clinical tests sent to commercial laboratories.

Although private health insurance does not typically reimburse hospitals at Medicare or Medicaid rates, private insurance reimbursement rates rarely go well above 200% to 300% of Medicare rates, according to Root. Assuming a reimbursement rate of 300%, all private insurance would have reimbursed $ 720 for the six tests.

That $ 720 is less than what Carlsbad Medical Center billed Rogge for their chlamydia test alone: ​​$ 1,045. And for some of the tests, the medical center charged multiple amounts – presumably based on the number of species being tested – and increased the cost of the yeast infection test to over $ 4,000.

Toal, who was checking Rogges bill, described the prices as “outrageous”.

Resolution: Rogge reached out to Anthem Blue Cross and spoke to a customer service representative who was filing a fraud and garbage lawsuit and an appeal that the charges were inflated.

The appeal was denied. Anthem Blue Cross told Rogge that as part of their plan, the insurance company paid the amount it was responsible for and that it was responsible for the remainder based on its deductibles and co-insurance amounts.

Anthem Blue Cross said in a statement to KHN that all tests performed on Rogge were approved and “paid for according to the agreed tariff established by Anthem with Carlsbad Medical Center.”

When Rogge’s appeal was denied, she had been examining Carlsbad Medical Center and reading the stories of patients brought to court over medical bills they couldn’t pay. She had also received a message from the hospital that if she failed to pay the remaining $ 3,000, her account would be sent to a collection agency.

Afraid of getting sued or ruining her credit, Rogge agreed to a plan to pay the bill over three years. She made three payments in September, October, and November of $ 83.63 each for a total of $ 250.89.

Following a call and email from KHN on Nov. 18, Carlsbad Medical Center called Rogge on Nov. 20 and said the rest of her account balance would be held.

Rogge was delighted. We’re “not the kind of people who have payment plans over our heads,” she said, adding, “That’s a relief.”

“I’m going to go on a bike ride now,” to celebrate, she said.

Take away: Especially when visiting a doctor with whom you have not had a long-standing trustworthy relationship, do not be afraid to ask: How much does this test cost? Also ask what exactly are you being tested? Don’t be comforted by the network status of the facility. With co-insurance and a deductible, you can still travel a lot.

If it’s a blood test that is being sent to a commercial lab like Quest Diagnostics anyway, ask the doctor to only give you the requirement to have the blood drawn at the commercial lab. This way you avoid the markup. Obviously, this advice is not possible for a vaginal smear collected in a doctor’s office.

Patients should always fight bills they believe are inordinately high and escalate the matter if necessary.

Rogge started with her insurer and provider, as did most patients with a billing issue. But as she learned, in American medicine it can seem logically absurd what is legal and what corresponds to an insurance contract. However, if you are not satisfied with your initial inquiries, you should be aware of the possibilities to further process your complaints.

Every state and territory has a department that regulates the insurance industry. In New Mexico, this is the office of the Superintendent of Insurance. Consumers can look up their state’s department on the National Association of Insurance Commissioners website.

Toal, the insurance superintendent in New Mexico, said his office lacks the power to tell a hospital that prices are too high (and no state office he knows about). But he can review a bill like Rogge’s when a complaint is filed with his office.

“If the patient so wishes, they can request an independent review so that the bill goes to an independent organization that can see if it is medically necessary,” Toal said.

This was not required in this case, as Rogge’s invoice was waived. And after Melissa Suggs, a spokeswoman for Carlsbad Medical Center, was contacted by KHN, she said the facility is revising its lab fees.

“Prices for these services will be lower in the future,” Suggs said in a statement.

Bill of the Month is a crowdsourced study by KHN and NPR that breaks down and explains medical bills. Do you have an interesting medical bill that you would like to share with us? Tell us about it!

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KHN (Kaiser Health News) is a non-profit health news service. It is an editorially independent program of the KFF (Kaiser Family Foundation) that is not affiliated with Kaiser Permanente.

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