美国国家公共电台 NPR How A Urine Test After Back Surgery Triggered A $17,850 Bill

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RACHEL MARTIN, HOST:

We now have the story of a really large medical bill. It's a surprisingly common sort of charge, which is why we're examining it. Steve Inskeep spoke¹ with Dr. Elisabeth Rosenthal of Kaiser Health News about the story of a $17,000 urine test. And Steve asked her who had to pay the bill.

ELISABETH ROSENTHAL: Oh, it was a young woman named Elizabeth Moreno who had some back surgery, a very common kind of surgery, and the surgery worked. And of course after her back surgery, you get a little prescription² of opioids. People...

STEVE INSKEEP, BYLINE³: Because if you need painkillers⁴...

ROSENTHAL: Painkillers...

INSKEEP: ...You want to be careful with them.

ROSENTHAL: Right. And she took them for a few days - not very long. And then when she went for a follow-up visit about two months later, the surgery worked great. She was long off opioids. The doctor said, oh, well, we have to test your urine. Just pee into a cup. And boom - $17,850 bill.

INSKEEP: OK. So this is an extreme case. But it happens enough that NPR and Kaiser Health News have begun an investigation⁵. We're going to be looking at big medical bills in weeks to come.

ROSENTHAL: So we want to understand - how do those charges get generated? How do they add up? - and in the process help all of those consumers/patients out there be better at reading their bills, be forewarned that they can get these kind of bills and also know the questions to ask so they don't end up being a victim like Elizabeth Moreno was.

INSKEEP: Let's focus on this $17,850 test. First, was that covered by the patient's insurance?

ROSENTHAL: No, it wasn't covered, to add insult to injury, because the lab that it was sent to was out of her insurance network. So the insurer's first answer was - oh, just out of network. They didn't even pass judgment⁶ on the bill. So first question to always ask is, is my sample being sent to an in-network lab or radiology facility?

INSKEEP: There's an issue of consent here because she obviously consented to a urine test but didn't consent to that expensive of one. And nobody asked her about which lab it was being sent to.

ROSENTHAL: Well - and poor patient, who would have thought you had to ask that? Some doctors would have said there's no real reason to have a urine test at all. I mean, this is a woman postoperatively who got some opioids, used them as needed and then, as far as everyone else knew and she said, she'd stopped.

INSKEEP: When you reached out to the doctor in this specific case or reached out to the lab, did they offer any explanation for why they felt this charge made sense?

ROSENTHAL: Well, the doctor wouldn't talk to our reporter. And it's unclear to me as a former physician. Did he understand when he sent this test off for a screen that it was going to be tested for 5,000 different things? Did he understand that that lab was going to do what it did? I don't know that answer, and he wouldn't talk to us about it.

The lab did respond. They said, basically, it's - we feel our charges are reasonable. Now, part of the problem and part of the reason you see all these huge price disparities is in this country, we don't have any standard for what's reasonable.

INSKEEP: What's an initial piece of advice you would give people if they have received a really large medical bill that they can't understand?

ROSENTHAL: Don't write the check.

INSKEEP: Don't pay?

ROSENTHAL: Don't pay first. Don't be intimidated⁷. I mean, ultimately, you may be forced to pay more than you want. But first step is don't write the check.

INSKEEP: And another thing, of course, that you can do is share your stories with us. NPR and Kaiser Health News want to see some of your bills, whether they're sky high or just interesting, bills where there's a story to tell that we can investigate. If you'd like to participate, go to NPR's Shots blog, where you can tell us about your experiences and upload your bills. There's a form.

Elisabeth Rosenthal of Kaiser Health News, thanks very much.

ROSENTHAL: Thank you for having me.

(SOUNDBITE OF GIANTS' "WHILE THE AGES STEAL")