Bill Of The Month: Costly Knee Brace In Doctor's Office, Much Cheaper Online : Shots - Health News After a sports injury, Esteban Serrano owed $829.41 for a knee brace purchased with insurance through his doctor's office. The same kind of brace costs less than $250 online.
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Soccer-Playing Engineer Calls Foul On Pricey Knee Brace

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Soccer-Playing Engineer Calls Foul On Pricey Knee Brace

Soccer-Playing Engineer Calls Foul On Pricey Knee Brace

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DAVID GREENE, HOST:

All right. It's time for our bill of the month. This is where we take a close look at medical bills that you send to us. And this month, we've got one that I bet a lot of people will relate to, especially those of you who play sports and have gone through an injury. Elisabeth Rosenthal is editor-in-chief of our reporting partner Kaiser Health News. And she joined us from our studios in New York City to tell us about who we're meeting.

ELISABETH ROSENTHAL: This month it's Esteban Serrano. He's a 41-year-old software engineer from the suburbs of Philadelphia.

GREENE: OK. And I think we have a little tape of him here describing exactly what happened to him.

ESTEBAN SERRANO: Last year around October, I got injured - my knee - playing soccer, or football. Yeah. It was a bad bruise. I got - my MCL got injured. But I went to the doctor to get an opinion to see what the problem was. And after the doctor saw me, did an exam and X-rays, he suggested I wear a brace to help with the healing and give me a little bit of support.

GREENE: All right. That doesn't sound that bad - nothing broken, has to wear a brace. I mean, that's the kind of thing a lot of people go through, right?

ROSENTHAL: Yeah. It's probably one of the most common sports injuries. But it can be a big deal financially because when Mr. Serrano went to the doctor, he got a hinged knee brace...

GREENE: OK.

ROSENTHAL: ...Purchased through the doctor's office for $882.

GREENE: Wow.

ROSENTHAL: And since he hadn't met his deductible, he paid most of that himself.

GREENE: Most of the $800. I mean, you say hinged knee brace. Is this some kind of special brace that would be a lot more expensive?

ROSENTHAL: Well, yeah. It is kind of a fancy brace. It has a hinge where your knee bends. But, you know, that's not really justified here. First of all, the company that makes it says the retail price is about $242. But it's not really clear why this patient needs a fancy knee brace. I mean, you know, we all know you can go into Target or Costco and buy a knee brace for about $20, and that probably would've done the trick.

GREENE: All right. Well, let's listen to a little bit more of his voice here.

SERRANO: This is a very simple - you know, your run-of-the-mill injury that anybody can, you know, twist their knee. They can twist their ankle, go to an orthopedist. And if, you know, they happen to give you this kind of a brace, then you're in for an $800 bill. I don't think that there's a reason why anybody should be paying $800 for a $100 or $50 brace.

GREENE: All right. So clearly it sounds like he feels like he's been taken for a ride here. So have we learned more about why this happened from, like, the doctor's office?

ROSENTHAL: Well, not exactly. The doctor's office didn't return our multiple phone calls. We actually got some info from another orthopedist who said, oh, yeah. You know, doctors' offices routinely up-charge two to three times what their wholesale cost is. And I like to point out for consumers that it's not just knee braces. It's everything that a doctor or a hospital might give you to go home. So crutches, a breast pump, a wheelchair - all of those things are up-charged heavily by these offices.

GREENE: So is there anything patients can do about that so they're not being up-charged by their doctors?

ROSENTHAL: Well, (laughter) you know, I think we tend to think of visits to the doctor as kind of all-inclusive resorts, but that's not how it works these days. These days, every item is likely to be charged and likely to be charged a lot. So I always tell people, don't take anything you don't feel you need or won't use. And I think you should also ask why you need a fancy version of this rather than the one you could get at your local pharmacy. You could even Google from the doctor's office and see, like, how much would this cost me if I bought it online? So you'll save a ton of money like that.

GREENE: Wow. OK. So - I mean, so besides actually finding a corner of the doctor's office to, like, Google for five or 10 minutes and make sure you're not being overcharged, is anyone out there trying to change this practice and put pressure on doctors' offices not to do this?

ROSENTHAL: It's kind of unseemly, but this one is not actually illegal. It's kind of like what restaurants do when they sell you cheap wine for $20 a glass, right? But this is one where being a good consumer can really make a difference. It takes advantage of patients who are unaware and vulnerable. But, hey, now that you know this happens, next time a doctor says, hey, your kid's elbow is injured - we'll give you a sling - say, uh-uh, I'm going to go buy one at Rite Aid.

GREENE: Just think about the number of people who get these kinds of ankle braces, knee braces, you know, like, the stuff you mentioned. I mean, this is a lot of money that doctors' offices are charging people.

ROSENTHAL: Well, and it's not like the half-million dollar bills we sometimes talk about. But...

GREENE: Right.

ROSENTHAL: ...As Mr. Serrano said, that $800 was unexpected, and it meant he couldn't buy his kid an iPhone for Christmas. So it can make a big difference in people's lives.

GREENE: It sure can. All right. Dr. Rosenthal, thanks as always for being here.

ROSENTHAL: Thank you.

GREENE: That is Dr. Elizabeth Rosenthal. She's editor-in-chief of Kaiser Health News. And if you have a medical bill that seems kind of inflated or kind of mysterious in some way, something that concerns you, and you want us to have a look at it, just go to our Shots blog at npr.org, and submit it to us online. Maybe we'll talk about it.

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