Margaret O’Neill hadn’t expected to have her 5-year-old daughter’s ears pierced the day she took her to Children’s Hospital Colorado for mouth surgery. Tissue connecting her daughter’s tongue to the floor of her mouth was too tight, a condition referred to as being “tongue-tied”. But, she the surgeon, Peggy Kelley, offered it to her and she thought, “Why not?” She had assumed it would be free. She would just need to bring along a pair of earrings with her the day of the procedure, Kelley said. Imagine O’Neill’s surprise when she found out the surgeon wasn’t just being nice – she had upsold her.
Months later, O’Neill discovered the “nice gesture” the surgeon had offered her ended up costing her $1,877.86 for “operating room services” related piercing her child’s ears. As an elective procedure, it wasn’t covered by O’Neill’s insurance provider. The surgeon never discussed this possibility with her, and O’Neill would have never agreed to the ear piercing had she known she would receive such an astronomical bill.
O’Neill immediately called the hospital and even wrote a complaint letter, but the facility wouldn’t hear her rebuttal. Instead, she was informed she would have to submit a prompt payment or her bill would be sent to collections. “There are a lot of things we’d pay extra for a doctor to do,” she said. “This is not one of them.”
Health Care Cost Institute, a nonprofit organization that is responsible for housing a database of commercial health insurance claims, says surgical piercings are rare and O’Neill’s case constitutes as an example of health care overuse. Dr. Vikas Saini, president of The Lown Institute, agrees that wasteful use of medical care has “become so normalized that I don’t think people in the system see it. We need more serious studies of what these practices are,” he said. In fact, it has been estimated that the U.S. health care system wastes $765 billion annually.
Christina Arenas, 34, feels she was also taken advantage of by a corrupt system. She has a history of noncancerous cysts in her breasts so last summer when her gynecologist found lumps, she was sent in for an ultrasound to rule out cancer. On the day of scan, the sonographer started the ultrasound, then stopped, and along with a radiologist, told her she needed a mammogram before the ultrasound could be done. Arenas is an attorney married to a doctor. She denied the mammogram, because she didn’t want to be exposed to the radiation or pay for an additional procedure.
But, she was in a vulnerable position sitting there in her gown, and they insisted, so she finally agreed to have the mammogram, followed by an ultrasound. Luckily no cancer was found. The radiologist told her to come back in two weeks so they could drain the cysts that were present with a needle. When she returned she got two more ultrasounds. The radiologist then sent the fluid from the cysts to pathology to test it for cancer – again. Her insurance covered some of the excessive testing, but the final bill she received was still $2,361.
“It was just kind of, ‘Take it or leave it.’ The whole thing. You had no choice as to your own care,” Arenas said. In discussing what she’d gone through with a family friend who is a gynecologist, Arenas confirmed the process could have been much more simple and affordable.
She complained to The George Washington Medical Faculty Associates and her request to have the bill reduced was denied. Then, it was sent to collections, so she demanded a refund and threatened legal action. She said she never spoke with anyone. Her demand was routed to an attorney, who declined her request because there was “no inappropriate care.”
The American College of Radiology recommends an ultrasound for a woman of Arenas’ age with an unidentified breast mass. Mammograms are also an option, but “most benign lesions in young women are not visualized by mammography,” the guidelines state. “I was taken advantage of because I was a captive audience,” she said.
Experts suggest patients push for detailed answers up front about the costs of their care. If there’s a billing dispute it can take months of phone calls and emails to get a case resolved. “The whole system is broken,” said Missy Conley, an employee of Medliminal, a company that routinely challenges medical bills on behalf of consumers in exchange for a share of the savings.
“Providers are getting constant messages from superiors or partners to maximize revenue,” Dr. Saini said. “In this system we have, that’s not a crime. That’s business as usual.”