美国国家公共电台 NPR Sticker Shock Jolts Oklahoma Patient: $15,076 For 4 Tiny Screws

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DAVID GREENE, HOST:

If you've ever read an itemized medical bill, you might have noticed that small things can come with these ridiculously high prices. Every month, NPR with Kaiser Health News has been taking a close look at some of these bills, and I sat down with Kaiser Health News Editor-in-Chief Dr. Elisabeth Rosenthal.

Thanks for coming back.

ELISABETH ROSENTHAL: Oh, thanks for having me.

GREENE: All right, so we've been asking people to send us their medical bills, and you've been analyzing¹ them. It sounds like a lot of it's been eye-popping. What have you been finding?

ROSENTHAL: Yeah, our bar is pretty high. We started off with a $17,000 bill for a urine test.

GREENE: Oh, my God.

ROSENTHAL: Then we went to two scans, one that cost 200, one the cost 9,000 - same scan, same city, just weeks apart.

GREENE: Different prices.

ROSENTHAL: Different prices. So this month, we're moving onto a new outrage², and it's about four little screws that a woman in Oklahoma got during toe surgery that ended up costing $15,000.

GREENE: Fifteen thousand dollars for four screws - I mean, those must be some screws. Well, we're going to hear her story here. Sherry Young, 57 years old - she lives in Lawton, Okla. And we sent a reporter named Jackie Fortier with StateImpact Oklahoma to hear her story firsthand.

JACKIE FORTIER: Hi.

SHERRY YOUNG: Hi. Nice to meet you. I'm Sherry.

FORTIER: I'm Jackie. Thank you so much for having me.

All Sherry Young wanted was to live without pain. She's had osteoarthritis for years.

YOUNG: I have arthritis³ in multiple areas of my body. And I was having sharp, stabbing pains in two different parts of my shoulder, and then I was having pain walking on the bottom of my foot.

FORTIER: She and her doctors came up with a plan - have two surgeries on the same day, one on her foot and one on her shoulder, both at the University of Oklahoma Medical Center in Oklahoma City. Due to her arthritis, she'd had surgeries before but had never really scrutinized⁴ the bill.

YOUNG: The insurance company paid their part of it, and my - I paid my part. I didn't pay much attention to it.

FORTIER: She was in the hospital for three days, and the surgeries were a success. But a few days later, back home recuperating⁵, Young went to the mailbox.

YOUNG: Blue Cross sent me a letter saying that the surgery costs were denied because I had been put into the hospital. And the bill for all of it was about a $115,000.

FORTIER: Her insurance company had only approved an outpatient procedure, and so suddenly, Young found herself on the hook for the cost of the hospital stay and both the surgeries.

YOUNG: Well, I was shocked. I was still trying to recover from my surgery. I had my shoulder in a sling⁶, and my foot was in a boot. So I started thinking about what it would do to me if I had a $115,000 debt that I would have to deal with for years and years.

FORTIER: With a bill about five times her annual income and more than the cost of her house, the retired⁷ university librarian started asking questions

YOUNG: I asked for an itemized bill because then I was extremely interested in why all of that added up to $115,000.

FORTIER: When the itemized bill arrived, she was stunned⁸. One charge stood out - $15,000 for four tiny screws that were used to hold the bones of her foot together.

YOUNG: Unless the metal the screws are made of was mined on an asteroid⁹, I don't know why tiny pieces of equipment should cost over $3,000 each.

FORTIER: The screws weren't the only shock - a drill bit for $2,000 dollars; a saw blade for more than 600. She showed me the itemized bill.

YOUNG: And then here's some kind of a surgical¹⁰ blade or something for over $5,000.

FORTIER: Young contacted the hospital. She even called the manufacturer who made the screws, but she couldn't get straight answers as to why they cost so much, so she sent her bill in to us. For NPR News, I'm Jackie Fortier in Oklahoma.

GREENE: Fifteen thousand dollars for four screws - how does this happen?

ROSENTHAL: First of all, the basic answer is, there's no market for these little pieces of medical equipment - no real market. So...

GREENE: You can charge anything you want if...

ROSENTHAL: You can - I mean, there's no price at all, effectively. So basically, the manufacturer takes a screw that might not be that different than what you buy at Home Depot¹¹, they can mark it up to whatever they want, and then the hospital can mark it up however much they want. So what we discovered is that the manufacturers said they normally charged $300 to a thousand dollars for a screw. They wouldn't give us the exact estimate. So that means the hospital, in charging about $4,000 for a screw, is marking it up maybe a thousand percent.

GREENE: Even more, yeah.

ROSENTHAL: Even more. However, what we also did - we took the next step. We went back and said to someone who manufactures generic¹² orthopedic parts, what would it cost to make this? His estimate was about $30.

GREENE: What about these tools that she was paying for, like $4,000 for a drill, $600 for a saw. Can't those be reused? Does every patient have to pay for a new piece of equipment?

ROSENTHAL: Well, what's happened is, over time, we've moved towards more and more disposables, which makes sense with infection risks. But the problem is, there's no market for that, either. You can charge whatever you want for a saw blade or a drill bit.

GREENE: Did she get this resolved somehow or she - she didn't have to pay this, did she?

ROSENTHAL: Well, no, she didn't in the end, but it's not because she herself really got a resolution. I mean, I think the wonderful thing she did, which is so smart, is when she saw this massive charge - a hundred and thirteen or $15,000 - she said, I want to see an itemization. And that's when she noticed the screws were that much. So basically, she didn't get any answers herself. We went on our investigation¹³, and when a reporter called the hospital and the insurer and said, what gives? - they said, oh, it's just a mistake; she doesn't have to pay any of that.

GREENE: So is that the lesson here - we can't trust the hospital; we can't trust our insurance; we have to double-check everything and make sure we're not having to pay mass amounts of money we shouldn't be paying?

ROSENTHAL: Sadly, at this moment in time, I think yes, you always have to have your antenna¹⁴ up. You have to do what you would do in any other part of your life, which is ask for itemization. If there's something you see that looks outrageous¹⁵ to you, complain about it. Complain to your employer, your insurer, to the hospital. Oftentimes, these prices are set assuming that no one will ever see them.

GREENE: Elisabeth Rosenthal from Kaiser Health News, thanks a lot.

ROSENTHAL: Thank you.

(SOUNDBITE OF TEEN DAZE'S "SPIRIT")

GREENE: Now, here's another thing you can do - share your bills with us. Whether they're sky-high or just sort of interesting, NPR and Kaiser Health News would like to see them. You can go to NPR's Shots blog to upload your bill.