Getting a sore throat checked out resulted in a massive $28,395.50 bill for one woman in New York. Alexa Kasdan, 40, got checked out at a specialty care clinic on Manhattan’s Upper East Side for a cold and a sore throat prior to leaving the city for a vacation. The bill she received for those services, which included a throat swab and testing a vial of her blood, was $25,865.24 from her health-insurance company and $2,530.26 that she was responsible for.
Kasdan questioned her physician about the massive charge for what should have been a routine procedure. She says, “I thought it was a mistake. 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.” When the doctor’s office continued to claim that the bill was valid, she reported the bill to New York’s Office of Professional Medical Conduct.
Turns out there were several reasons why the bill was so massive. The doctor sent Kasdan’s throat swab for a sophisticated smorgasbord of DNA tests looking for viruses and bacteria. Also, even though the laboratory that conducted the tests had the same phone number and address as the doctor’s office Kasdan attended that day, it was considered out of network by her insurance provider. Out-of-network labs can set their own prices for tests, which in this case was 20 times higher than average for other labs in the same ZIP code.
If the doctor had sent the throat swab off to LabCorp, Kasdan’s in-network provider, it would have billed her insurance company about $653 for the ordered tests. The average co-pay for a specialist is $30 to $50. New York state laws require doctors to inform patients when they use out-of-network providers, so Kasdan’s doctor should have alerted her that she might receive outsize bills as a result. That apparently did not happen in this case.
This type of massive overcharge for basic services doesn’t seem to be all that unusual and practices like this run up the cost of medical care for everyone. An investigation into two health insurance providers in New York state in 2012 found that taxpayers had paid $11 million in medical overcharges. According to a survey by the nonprofit West Health and Gallup, Americans borrowed a collective $88 billion to cover their health-care costs over the past year.