Posted on Aug 23, 2022
An $18,000 biopsy? Paying cash might have been cheaper than using her insurance
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https://www.npr.org/sections/health-shots/2022/08/23/ [login to see] /an-18-000-biopsy-paying-cash-might-have-been-cheaper-than-using-her-insurance
When Dani Yuengling felt a lump in her right breast last summer, she tried to ignore it.
She was 35, the same age her mother had been when she received a breast cancer diagnosis in 1997. The disease eventually killed Yuengling's mom in 2017.
"It was the hardest experience, seeing her suffer," said Yuengling, who lives in Conway, South Carolina.
After a mammogram confirmed the lump needed further investigation, Yuengling scheduled a breast biopsy for Valentine's Day this year at Grand Strand Medical Center in Myrtle Beach.
Among many concerns she had ahead of that appointment — the first being a potential cancer diagnosis — Yuengling needed to know how much the biopsy would cost. She has a $6,000 annual deductible — the amount her health plan requires she pay before its contribution kicks in — and she wasn't close to hitting that. Whatever the procedure cost, Yuengling knew she'd be on the hook for most of it.
But the hospital wouldn't give her a price. She was told her providers wouldn't know what type of biopsy needle they needed until the procedure was underway and that would impact the price.
When Dani Yuengling felt a lump in her right breast last summer, she tried to ignore it.
She was 35, the same age her mother had been when she received a breast cancer diagnosis in 1997. The disease eventually killed Yuengling's mom in 2017.
"It was the hardest experience, seeing her suffer," said Yuengling, who lives in Conway, South Carolina.
After a mammogram confirmed the lump needed further investigation, Yuengling scheduled a breast biopsy for Valentine's Day this year at Grand Strand Medical Center in Myrtle Beach.
Among many concerns she had ahead of that appointment — the first being a potential cancer diagnosis — Yuengling needed to know how much the biopsy would cost. She has a $6,000 annual deductible — the amount her health plan requires she pay before its contribution kicks in — and she wasn't close to hitting that. Whatever the procedure cost, Yuengling knew she'd be on the hook for most of it.
But the hospital wouldn't give her a price. She was told her providers wouldn't know what type of biopsy needle they needed until the procedure was underway and that would impact the price.
An $18,000 biopsy? Paying cash might have been cheaper than using her insurance
Posted from npr.org
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Posted >1 y ago
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PO1 William "Chip" Nagel
..."In some cases, paying a cash price for a procedure might not make financial sense in the long run because none of it would be applied toward the deductible. Patients might save money on one procedure but end up paying their full deductible if unexpected medical expenses mount later during the calendar year.
Insured patients should reach out to their health plan for a good-faith estimate before a procedure. Under the No Surprises Act, health plans are supposed to give members an idea of their total out-of-pocket costs upon request. Ask for an "Advanced Explanation of Benefits," said Sabrina Corlette, a research professor at the Georgetown University McCourt School of Public Policy, though she points out this part of the law isn't being enforced yet.
The No Surprises Act also allows patients to file complaints with the federal government regarding their medical bills — whether or not they carry health insurance.
Yuengling filed her complaint in June."
..."In some cases, paying a cash price for a procedure might not make financial sense in the long run because none of it would be applied toward the deductible. Patients might save money on one procedure but end up paying their full deductible if unexpected medical expenses mount later during the calendar year.
Insured patients should reach out to their health plan for a good-faith estimate before a procedure. Under the No Surprises Act, health plans are supposed to give members an idea of their total out-of-pocket costs upon request. Ask for an "Advanced Explanation of Benefits," said Sabrina Corlette, a research professor at the Georgetown University McCourt School of Public Policy, though she points out this part of the law isn't being enforced yet.
The No Surprises Act also allows patients to file complaints with the federal government regarding their medical bills — whether or not they carry health insurance.
Yuengling filed her complaint in June."
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