NOEL KING, HOST:
Every month, NPR and Kaiser Health News take a close look at a medical bill that you send us because there is so much craziness in the world of medical billing. Here to tell us about the latest one is Elisabeth Rosenthal. She's the editor-in-chief at our partner Kaiser Health News. Hey, Elisabeth. How are you?
ELISABETH ROSENTHAL: Good. Thanks for having me.
KING: All right, Elisabeth, what's this month's bill?
ROSENTHAL: This one is about a simple little test that generated a huge lab fee. Listeners may recall that our very first Bill of the Month three years ago touched on a similar theme. And it's still happening. Dan Weissmann of "An Arm And A Leg" podcast talked to Lorraine Rogge, who sent us this bill. Let's listen.
DAN WEISSMANN: For years, Lorraine Rogge's husband had nursed a fantasy of selling the house, buying an RV and hitting the road together full-time. She thought...
LORRAINE ROGGE: This is not going to happen. We can't afford this. He's crazy.
WEISSMANN: Suddenly, her husband got super sick. Doctors said he had a 20% chance of living.
ROGGE: I was scared. I thought I was going to - I mean, 20%. That means, like, an 80% chance of dying.
WEISSMANN: He had a request.
ROGGE: He says, if I survive this, can we go on the road? I got out my little spreadsheet, did all my calculations. And I said, if we stick to this budget, we can do it.
WEISSMANN: He pulled through. Since 2015, the RV has been their only home all across the country. Last spring, they holed up at a remote spot in New Mexico to wait out the coronavirus surge. And in May, Lorraine had a medical problem.
ROGGE: Well, it's kind of a woman thing. I was using a prescription commonly used by women. And immediately, I experienced cramps, pain.
WEISSMANN: When it didn't go away after a few days, she decided to see a gynecologist. She made sure to find someone who took her insurance. The doc took a sample to test for a yeast infection. Lorraine never got a call with results, but the cramping went away on its own. She figured she was in the clear - until she got the bill from Carlsbad Medical Center.
ROGGE: They billed my insurance over $12,000.
WEISSMANN: And she was on the hook for more than 3,000.
ROGGE: In my RV budget, I have a category for [expletive] happens. This year has been a really bad year, and that category has almost been used up. I did not have 3,000 extra dollars this year to pay this.
WEISSMANN: So she called her insurance company.
ROGGE: The girl on the phone, she started telling me what tests were run. And that's when I hit the roof because they're running all these STD tests. Are you kidding me?
WEISSMANN: Lorraine distinctly remembered telling her doctor that she and her husband have been monogamous for 26 years. The woman from Lorraine's insurance was surprised, too.
ROGGE: And then she's looking at the prices. And even she said, this is a lot for these.
WEISSMANN: And some tests had been run more than once.
ROGGE: So she filed a fraud, waste and abuse claim.
WEISSMANN: Which went nowhere and left Lorraine on the hook for that 3,000 bucks. By the time that became official, Lorraine had Googled Carlsbad Medical Center and found out that they were notorious for high prices and for suing patients over unpaid bills.
ROGGE: And I don't want to have them decide to take me to court - and I'm like, God only knows where in the United States - and get a summons.
WEISSMANN: She reluctantly set up a payment plan and started paying $83 a month until a reporter started digging around.
ROGGE: One morning, bright and early, I get a call from, like, some VP of finance at Carlsbad Medical Center. We're waiving your balance - no reason why, nothing. Your balance is waived.
WEISSMANN: She made sure to get that in writing. For NPR News, I'm Dan Weissmann.
KING: OK, so things ended up fine for Lorraine. But it's not like everyone who gets a surprise medical bill can ask a reporter to try to track down what happened.
ROSENTHAL: Right. This is a national tragedy, in fact. Why should it take a reporter's call for a hospital to do the right thing billing-wise? And actually, last year, Carlsbad Medical Center got absolutely slammed in the media, featured in The New York Times for their high billing practices. But, of course, Lorraine didn't know that at the time. And it appears it hasn't changed its ways.
KING: Why was she billed $12,000 for what sounds like a simple lab test?
ROSENTHAL: That's a good question. This was the hospital's sticker price on a bundle of lab tests for every known vaginal infection and then some. And the markup is in the stratosphere. I think patients should know tests are like booze in restaurants. They can be marked up as much as the hospital wants. Experts here we contacted said the bill should've been hundreds of dollars at the most, not thousands.
KING: And it also sounds like Lorraine had made clear to her doctor that she didn't need some of these tests, particularly for sexually transmitted infections. She was not concerned that that was what was happening.
ROSENTHAL: Yeah, she was pretty shocked. She said, look; I'm a happily married grandmother. You know, it's reasonable for a doctor to order tests for any sexually active person. But the doctor really should've had a sensitive conversation with Lorraine about that. And she says that didn't happen.
KING: Is there anything that you would've advised her to do differently?
ROSENTHAL: Well, what I tell everyone is when a doctor says, I'm just going to send off this little test, stop and say, what is it for, and how much will it cost? The best defense here is a good offense. So it may cause the doctor to rethink, do I really need to order this test or the entire battery, which, of course, wasn't necessary in this case.
KING: And then you have an update on the hospital and their lab fees?
ROSENTHAL: That's right. They told us they would be revising their sticker prices. But we'll be following up to make sure.
KING: All right, it's December, and so that means it's our last Bill of the Month for 2020. Is there any optimistic news for listeners, anything we should look forward to in 2021?
ROSENTHAL: Well, patients got a present recently in the big spending bill that Congress passed. There was a provision that banned surprise medical billing. It's not perfect, but it's a win for patients.
KING: It's something. All right, Elisabeth Rosenthal, editor-in-chief at our partner Kaiser Health News. Thanks so much, Elisabeth.
ROSENTHAL: Thank you.
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KING: Bill of the Month will continue in 2021. If you have a bizarre medical bill, go to NPR's Shots blog and tell us about it.
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