Sandy Brown, MD


November 03, 2006

My patient, Bert, with sky-high prostate specific antigen levels (PSAs), had come in for his annual exam. The previous year, having run PSAs in the 30s, he had undergone his third prostate biopsy, this one at a university medical center. Like all the others, it, too, was benign.

Finally, I figured out that only 1 test kit was delivering grossly abnormal numbers. Kits by other manufacturers gave him normal PSAs. It was a reportable case, but it didn't assuage Bert much, since his last biopsy bill totaled more than $7000.

"You've got to be kidding," I said. "They didn't take you to the operating room to do it, did they?"

The procedure had been done in the urologist's office. It was a puzzle, until Bert brought me the bill. The prostatic biopsy procedure was billed out at $791, which included the transrectal echo exam and echo guide for the biopsy. However, the pathology charges totaled $6112. There was both a technical fee for slide preparation of $310 per slide and a professional fee of $454 per slide for the pathologist's interpretation. Eight biopsies were taken, hence the outrageous fee.

Bert had primary and secondary insurance. His primary paid $2300 without adjusting the bill, and his secondary kicked in another $700. Bert was left with a balance of $3400.

"I had to borrow from my life insurance to pay it," Bert told me.

"Bert, I wish you would have come to me first," I said. "I only have catastrophic insurance, but my insurer would have written off 80% of these charges. Even with both of your insurers paying , you will still be left owing half. These pathology fees are arbitrary and unreasonable!"

Here was the irony. As many as 45 million Americans have no health insurance, while millions more pay ever increasing premiums, don't understand their bills, and still have to come up with big bucks because their insurers don't have the clout to get the hefty discounts that the big players do.

Bert's former job was in a local sawmill that closed. He had taken a job at lower pay just to get the health benefits. Now, he had to come up with three grand to pay for his biopsies.

People talk about healthcare disparities. What about fixing the health cost disparities in this broken system?


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