Woman Charged $28,395.50 for Sore Throat Exam by Primary Care Doctor
Alexa Kasdan, a 40-year-old public policy consultant from Brooklyn, New York, was charged $28,395.50 for a sore throat exam at her primary care doctor.
According to NPR, Kasdan went to get a lingering cough and sore throat checked out before she went on a vacation in October.
Under the suspicion that she had strep throat, Kasdan went to Manhattan Specialty Care, where her primary care physician, Dr. Roya Fathollahi, swabbed her throat, took a sample of her blood and gave her a prescription for some antibiotics.
However, the bill did not reflect the casual nature of her visit. The bill for Kasdan’s trip to the doctor was $28,395.50.
The doctor’s office waived a sum of $2,530.26, but it still left Kasdan’s insurance company to cut a check for $25,865.24.
“I thought it was a mistake,” Kasdan said. “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.”
Kasdan had to pay a total of only $34.61 for a copay and a separate lab fee; the size of her bill was another matter.
“I made it very clear [to the doctor’s office] that I was unhappy about it,” Kasdan said. She told Manhattan Specialty Care that she was going to report Dr. Fathollahi to the New York Office of Professional Medical Conduct.
NPR offered a number of reasons why Kasdan’s doctor’s visit cost so much.
The biggest charges came from the lab tests that were performed to discover what bacteria or viruses might have been causing Kasdan’s symptoms.
Dr. Fathollahi had the throat swab analyzed by a lab that was out of Kasdan’s insurance network. Out-of-network labs set their own prices for tests, as opposed to the contract rates that in-network labs settle with insurers.
NPR reported that the lab used in Kasdan’s case settled on prices that were 20 times higher than other labs that had the same ZIP code.
If Dr. Fathollahi had sent the throat swab to Kasdan’s network provider, LabCorp, the bill would have been around $653 for the tests or equivalents of the test.
Dr. Ranit Mishori, a professor at Georgetown University School of Medicine, told NPR that the complex DNA tests used were not necessary within the context of Kasdan’s visit.
“In my 20 years of being a doctor, I’ve never ordered any of these tests, let alone seen any of my colleagues, students and other physicians order anything like that in the outpatient setting,” she said. “I have no idea why they were ordered.”
Mishori said that such intense tests would be far more appropriate for a patient who had severe pneumonia or was in the ICU. The influenza tests could have been useful to help identify what medicines could help, but according to Mishori, a far less expensive test could have been used.
Images of Kasdan’s lab results included in NPR’s article showed that none of the viruses and bacterias tested for causing her initial cold came back positive.
Another reason the bill may have been so high is the link between the doctor’s office and the lab; the lab, Manhattan Gastroenterology, has the same locations and phone number as the doctor’s office.
Manhattan Gastroenterology is owned by doctors and may be the parent company of Manhattan Specialty Care, though state fillings are not clear.
High bills like the one Kasdan was charged with increase the cost of medical care because insurance companies base their premiums on patients’ expenses; the higher the bills, the more that people will have to pay.
“She may not be paying anything on this particular claim,” said Richelle Marting, a medical billing lawyer who looked into the case for NPR. “But overall, if the group’s claims and costs rise, all the employees and spouses paying into the health plan may eventually be paying for the cost of this.”
The problem is a common one for insurance companies, Martin said, because the claiming process is completely automated.
Kasdan’s insurance company, Blue Cross and Blue Shield of Minnesota, started investigating the case and stopped payment on the check after a reporter started asking about it.
BCBS of Minnesota public relations director Jim McManus said that the company has a process that looks for excessive charges. “Unfortunately, those necessary reviews did not happen in this case,” McManus told NPR in an email.
Kasdan said she was not informed that her throat swab and blood were being sent to an out-of-network lab, though New York law requires that doctors do so. However, Kasdan may have unknowingly signed papers that said some services may not be in her network.
Patients should ask questions about why certain labs must be done and where they are being sent to protect themselves from high bills like Kasdan’s.
“It is OK to ask your doctor, ‘Why are you ordering these tests, and how are they going to help you come up with a treatment plan for me?'” Mishori said. “I think it’s important for patients to be empowered and ask these questions, rather than be faced with unnecessary testing, unnecessary treatment and also, in this case, outrageous billing.”
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