Dani Yuengling from Conway, South Carolina, knew she had to follow up after a mammogram found a lump. But she had no idea how expensive the biopsy for Gavin McIntyre would be, and she died of breast cancer. It was her mom’s death.
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Gavin McIntyre for KHN.
Dani Yuengling, from Conway, South Carolina, had the idea of how expensive a biopsy would be if she had not found a lump in her breast and her mom had died of breast cancer.
Gavin McIntyre for KHN.
When Dani Yuengling discovered a mass in her right breast last summer, she attempted to disregard it.
In 2017, the illness ultimately took the life of Yuengling’s mother. Her mom was 35 at the time, which was also the age she was diagnosed with breast cancer back in 1997.
“It was the most difficult experience, witnessing her endure,” stated Yuengling, who resides in Conway, South Carolina.
At Grand Strand Medical Center in Myrtle Beach, Yuengling arranged a breast biopsy for Valentine’s Day this year following a mammogram that verified the necessity for additional examination of the lump.
Among the many concerns she had, one of them was the cost of the potential cancer diagnosis, as she knew how much a biopsy would cost. Before her appointment, she knew that the annual deductible for her health plan required her to pay $6,000 out of pocket. Additionally, she was aware that the cost of Yuengling, the procedure she needed, was not cheap.
She was informed that the hospital declined to provide her with a price. The healthcare professionals were unaware of the specific biopsy needle required until the procedure was in progress, and this would affect the overall cost.
The hospital’s online “Patient Payment Estimator” demonstrated that a patient without insurance would be responsible for approximately $1,400 for the medical procedure.
She wasn’t fretting too much about the procedure she underwent. She thought the price of Yuengling seemed reasonable, but a search on Google indicated that it could be closer to $3,000. She thought it would be cheaper for her because she had insurance, and she was confident that it would be a big deal. That’s fine.
It quickly delivered the positive news that she did not have cancer.
Then the invoice arrived.
The patient: Dani Yuengling, now 36, who is covered by Cigna through her employer, a human resources contractor for the Mayo Clinic.
Medical service: A breast biopsy guided by ultrasound.
In the previous year, HCA Healthcare, headquartered in Nashville, produced a total revenue of $58.7 billion. It possesses a collection of 182 hospitals, which includes Grand Strand Medical Center, a for-profit hospital with 403 beds located in Myrtle Beach, South Carolina.
The total bill for the lab work procedure, including sterile supplies and charges from the pharmacy, amounted to $17,979. The hospital company’s insurance, Cigna, paid a negotiated rate of $8,424.14. The remaining balance of $3,254.47, which was Yuengling’s deductible, was billed, resulting in a total of $5,169.67.
It’s not uncommon for uninsured patients to be charged far less for a procedure than patients with health insurance, if they had been uninsured or had insurance plans with high deductibles, like Yuengling. Using insurance can lead to a far bigger expense than using cash to pay for a procedure, if patients are willing to pay the price. For American workers with high-deductible plans, nearly 30% of them are uninsured. What gives?
Bai Ge, an associate professor at the Johns Hopkins Bloomberg School of Public Health, recently published research on this topic, stating that hospitals in the U.S. Often set lower prices for patients insured commercially compared to the prices they charge in cash.
Bai, who recommended that all patients, irrespective of their insurance status, ask about the cost in advance of undergoing a medical procedure, expressed, “We can assert with great confidence that this is highly prevalent. It ought to be the standard.”
Yuengling and her insurer anticipated that the hospital would reimburse more than five times the Medicare rate. The hospital would reimburse approximately $1,200, the remaining amount of the bill, to Medicare for the ultrasound-guided biopsy comparable to the one Yuengling underwent. According to the federal government’s website, Medicare patients in need of the biopsy would only need to pay around $300, which is their mandated 20% coinsurance for outpatient care. Grand Strand invoiced an exceptionally exorbitant fee for the procedure to Yuengling’s insurance.
Fair Health Consumer, an organization that examines health insurance claims, reports that individuals in Conway who have private health insurance and receive treatment at different medical facilities generally incur lower charges compared to what Yuengling paid for the identical medical procedure, with an average difference of approximately $3,500.
Allyson Floyd, a representative for the hospital, states that uninsured individuals who choose to pay in cash and require an ultrasound-assisted breast biopsy at the nearby Conway Medical Center are expected to have a lower outstanding balance, approximately $2,100.
Meanwhile, Caroline Preusser, spokesperson for Grand Strand Medical Center, blamed a glitch involving the hospital’s online calculator for the inaccurate information received by Yuengling. She said that the correct estimate for the cash price for a breast biopsy at the hospital depends on the used equipment and the exact procedure, ranging between $11,500 and $8,000.
According to Preusser, the hospital eliminated specific procedures from the payment estimator until they can be rectified. However, she did not mention the duration it would require.
Yuengling decided to charge the full amount to a credit card because she wanted the entire thing to go away, but she set up payment plans to allow patients at Strand Grand Medical Center to pay. She called the billing department and was offered a 36% discount, lowering the amount she needed to pay to $3,306.29. Yuengling tried to dispute the charges with the hospital: Resolution.
She expressed, “I was unable to rest. It was making me insane. I was experiencing migraines. I felt nauseated.” “I detest being in debt. I didn’t wish to dwell on it. Evidently, that approach didn’t prove effective as I am still preoccupied with it.”
The fees on your account were suitable. The subsequent information was discovered: Following an assessment of the fees in question and your medical history, it was stated: “After reviewing the fees in question and your medical record, it was determined that the charges on your account were appropriate.” Eventually, she received a letter dated May 26 from the Revenue Integrity Department of the hospital. She mentioned that she had repeatedly requested to speak with the patient advocate at the hospital and was ultimately connected with an external firm, Parallon, which carried out an examination of her invoice.
“I’m not sure why I actually anticipated a different result,” she stated.
The medical center has asked for Yuengling to come back for a follow-up visit regarding the biopsy, but she has declined.
Harlow Sumerford, a representative for HCA Healthcare, informed KHN via email that the hospital system expresses regret for any perplexity resulting from the payment estimator “and we are actively resolving the problem.”
Dani Yuengling from Conway, South Carolina, had an annual deductible of $6,000 on her health plan because she was hooked on a costly biopsy that KHN tried to hide for McIntyre Gavin.
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Gavin McIntyre for KHN.
Due to the expensive biopsy, Dani Yuengling from Conway, South Carolina, had to bear a significant portion of the cost since her health plan had a $6,000 deductible per year.
Gavin McIntyre for KHN.
Despite having a family history of breast cancer, Yuengling felt the need to follow up with her doctor after failing to get a clear answer on the costs she would incur from Strand Grand Hospital. She could have taken an additional step to explore other hospitals in the area and potentially save a significant amount of money by opting for a different procedure elsewhere.
Furthermore, patients like Yuengling who have a high-deductible insurance plan should consider paying cash for certain procedures and not involving their insurance company at all.
It makes sense that they could perform the identical action for medical treatments. Jacqueline Fox, a health care attorney and professor at the University of South Carolina School of Law, highlighted that patients with health insurance frequently pay the full price for prescribed drugs. She mentioned that she is not familiar with any legislation that would forbid a patient from doing so.
Some facilities make it difficult, but the hospital’s website states that the program offers discounts to people who do not qualify for Charity, Medicaid, or any other payment source, and who have no third-party payer. This discount is limited to uninsured patients or those who are self-paying. Only patients who do not have health insurance are provided with information about the discount.
Throughout the course of the year, individuals may find themselves having to cover the entire amount of their deductible if unforeseen medical costs accumulate later on, despite the fact that they are able to save money on a single procedure. None of the money saved would count towards the deductible, therefore opting to pay for a procedure in cash may not be financially sensible in certain situations.
Patients insured should reach out to their health plan before the procedure to get a good-faith estimate. Health plans are supposed to provide members with an idea of their total out-of-pocket costs, under the No Surprises Act. However, Sabrina Corlette, a research professor at Georgetown University’s McCourt School of Public Policy, said that this part of the law is not being enforced yet. You can ask for an advanced explanation of benefits.
The No Surprises Act not only allows patients to file complaints with the federal government regarding their medical bills, but it also ensures that health insurance does not carry any surprises.
Yuengling lodged her grievance in June.
Stephanie O’Neill provided the audio depiction with this article.
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