Surprise medical bills can leave you speechless. It probably didn’t help that Alexa Kasdan, 40, a public-policy consultant from New York City, already had a cold and a sore throat. Kasdan told “Bill of the Month,” a joint project between NPR and Kaiser Health News, that she went to a specialty care clinic on Manhattan’s Upper East Side to get checked out.
The office, according to NPR, took a swab from her throat and a vial of blood and gave her a prescription for antibiotics to take with her on vacation. She felt better in a matter of days. Last October, she got the bill: $28,395.50. Her health-insurance company wrote a check for $25,865.24. The reason? Both the clinic and the laboratory that conducted the tests were out of network. The laboratory, which conducted an array of tests for viruses and influenza and even DNA analysis, also had the same phone number and address as the doctor’s office Kasdan attended that day. “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,” she told NPR and Kaiser Health News. Listen to Kasdan’s story on NPR:
An in-network throat swab and tests would have cost her approximately $600. The average co-pay for a specialist is $30 to $50. The $25,000 bill even puts this $887 flu test in perspective. It’s getting more difficult to find in-network clinics. Office visits to primary-care physicians declined 18% over a four-year period for adults under 65, according to the independent nonprofit Health Care Cost Institute, which is partly funded by four health-insurance companies that provide claims data.
In sharp contrast, office visits to nurse practitioners and physician assistants spiked 129%. A primary-care physician is often more likely to have more knowledge of a patient’s family history. The proportion of physicians working in solo practice fell from 18.4% in 2012 to 14.8% in 2018, a benchmark survey from the American Medical Association found. Doctors often leave medical school with a large amount of student debt. Primary-care physicians face additional time and expense managing their practices, and often have a fluctuating income. More doctors with financially successful practices in areas with more high-income patients are transitioning to concierge services to help cover their rent and other costs. Also see: For the first time, physicians are less likely to operate their own practices Congressional lawmakers earlier this month struck a bipartisan deal to help end “surprise” bills, which often arise when patients receive emergency care from out-of-network providers. About one in four people (25%) in a recent survey by Gallup said that they or a member of their family had delayed treating a serious medical condition over the past year because of the cost.
That’s a six-point increase from 2018, and a record high for Gallup’s polling on this question dating back to 1991. One-third had put off medical treatment for any condition due to cost over the past year. “Since 2001, Gallup has tracked a near 50% increase in the percentage of Americans saying that they or a family member chose not to get medical care because of the costs they would have to pay,” the report’s authors wrote. “Such delays in medical treatment, whether for injuries, illnesses or chronic conditions, can have significant implications for the economy and health-care system,” they added. Americans borrowed a collective $88 billion to cover their health-care costs over the past year, according to a survey of 3,500 adults published in April by the nonprofit West Health and Gallup. (Meera Jagannathan contributed to this story.)
