Patient Charged $10,322 For Overnight Sleep Test For Sleep Apnea : Shots - Health News The University of Miami Health System charged truck driver José Mendoza six times what Medicare would pay for an overnight test. He got trapped by his high-deductible health plan and sky-high billing.

A $10,322 Tab For A Sleep Apnea Study Is Enough To Wreck One Patient's Rest

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AILSA CHANG, HOST:

There are two trends in American health care that cause a lot of financial pain - health insurance with high deductibles and hospitals with astronomical prices. Our latest medical Bill of the Month looks at both of these problems. Dr. Elizabeth Rosenthal from our partner Kaiser Health News is here to talk to us about it. Hey, Elizabeth.

ELIZABETH ROSENTHAL, BYLINE: Hi, Ailsa. It's nice to be here again.

CHANG: Nice to have you again. Tell us who we're meeting today.

ROSENTHAL: Today, we're meeting Jose (ph) and Nancy Mendoza (ph) from Miami. Jose is a truck driver for a construction company. Nancy's a social worker. And Jose needed what's a very common diagnostic test. And now he's stuck with and also all-too-common extremely high bill.

CHANG: Right. And reporter Dan Weissman, who's the host of the podcast An Arm And A Leg, spoke to Nancy and Jose. Let's take a listen.

(SOUNDBITE OF PODCAST, "AN ARM AND A LEG")

DAN WEISSMAN, BYLINE: Jose Mendoza says he fell in love at first sight, standing in the lobby of the building where he worked.

JOSE MENDOZA: I saw actually the elevator. And when the elevator closed, I said, she's got to be the one.

WEISSMAN: For Nancy, it took more than a single look.

NANCY MENDOZA: It was more of knowing him as a person to start falling in love with him.

WEISSMAN: They've been together for about 20 years, living in Miami. And from the start, Jose snored really loud. Nancy learned to sleep through that, and she learned to wake up when it stopped.

N MENDOZA: Because when he stopped snoring, he also stopped breathing.

WEISSMAN: Stopped breathing. It's a condition called sleep apnea, where your airways close up while you sleep, actually pretty common. And Jose had it bad.

N MENDOZA: We had some episodes that are very scary. It looks like he cannot start breathing again.

WEISSMAN: But eventually, he always would. It was just something they lived with.

J MENDOZA: She's been through a lot with me.

WEISSMAN: Then, one time, he got a headache so bad, Nancy took him to the ER. His blood pressure was super high, too.

N MENDOZA: And they say that all of the symptoms, the headache, the - all of the symptoms that he went in, it was related because of the sleep apnea.

WEISSMAN: A specialist sent him for an overnight stay at a sleep lab, where techs monitored his breathing, his brainwaves, his vitals all night, which helped doctors fine-tune a treatment plan. Now, Jose sleeps with a machine that blows air up his nose. It keeps his airways open and prevents snoring. Great. Soon, Jose got a message on his phone, the bill from the sleep lab, more than $5,00.

J MENDOZA: I told my wife, look at this.

N MENDOZA: I was like, no, that must be an error.

WEISSMAN: Nancy called the billing department and asked for an itemized statement.

N MENDOZA: And I told her, if you use a Band-Aid, I need to see how much you're charging for the Band-Aid.

WEISSMAN: Nancy says she hasn't gotten anything much, but billing notices kept coming. She started worrying about getting sent to collections. Meanwhile, Jose's insurance had paid $262.

N MENDOZA: I start reviewing his insurance paperwork.

WEISSMAN: It says Jose has a $5,000 deductible. He has to pay that much each year before insurance pays anything. And after that, they only pay half.

N MENDOZA: And the total balance that we are responsible - 5,100.

WEISSMAN: The billing department suggested a payment plan, but first, Nancy asked about something she had noticed on the back of the bill - the option to apply for financial assistance, a discount based on your income. There was a chart with numbers.

N MENDOZA: So I told her, well, you know, according to this chart for what I see here, we qualify.

WEISSMAN: Nancy says the woman on the other end was nice but did not offer to reduce the bill.

N MENDOZA: We do not want to have to deal with collections. And I told the lady, well, you know, for the moment, do the repayment plan.

WEISSMAN: Which means paying more than $200 a month for the next two years. For NPR News, I'm Dan Weissmann.

CHANG: Wow. So let me get this straight. The Mendozas owe $,500 even after insurance paid? That's incredible.

ROSENTHAL: Yeah. Well, and Jose's insurance only paid $262, not much. And the point is everyone who shops for insurance should keep in mind that if you select a plan with a cheap premium, it almost always means you're going to be expected to pay out of pocket for way more of your medical costs. And people just don't realize how much way more that can be.

CHANG: Right. But isn't this a pretty high price for a sleep study in general?

ROSENTHAL: Well, yes. And the hospital tried to bill over $10,000 for his poor night's sleep. The insurer knocked it down to a bit over 5,000. But even then, it's a very high price. It's nearly six times what Medicare would pay for this study.

CHANG: How does the hospital even justify that?

ROSENTHAL: Well, they say this is just about average for Miami. And that's another problem with our system. In some places, everyone charges a high price, so providers can argue, well, it's just normal. So what I suggest is if you're prescribed an elective test, you should look at the cost of that test, maybe in the next-door county or two counties over. It could be a fraction of the price.

CHANG: So what options do the Mendozas have right now?

ROSENTHAL: Well, it looks to us like they should qualify for some relief under the hospital's financial assistance policy, even though so far, the hospital has said no. We think they should keep trying to negotiate even as they start their payment plan.

CHANG: Well, we wish them the best of luck with that. In the meantime, what should other listeners do if a doctor says you need a sleep study, go get one right now?

ROSENTHAL: Well, more generally, over the years, sleep studies are one of those expensive tests that researchers have dinged as overprescribed. Mr. Mendoza clearly needed one with his history. Sleep apnea can lead to things like heart problems and hypertension. But not everyone who snores has sleep apnea. So ask the provider, why are you recommending this test for me?

CHANG: Note to self. That is Dr. Elizabeth Rosenthal of Kaiser Health News. Good advice, as always. Thank you so much for being with us again.

ROSENTHAL: Thanks for having me.

CHANG: And if you have an outrageous or confusing medical bill, go to NPR's Shots blog and tell us about it.

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