I am sitting in the radiology department reception area at Mt. Sinai Hospital waiting for my name to be called. Two weeks ago, my doctor ordered a CT scan to explore some back pain she assumed would turn out to be an ovarian cyst or a stress fracture. Instead, it turned up kidney cancer.
Now, I am about to undergo a test to map out the topography and blood flow of my kidneys, which my surgeon will use to guide him to the lesion and safely remove it. When the nurse calls my name, I head up to the check-in desk.
"I'm sorry," she says as she lowers her eyes and hands me the phone.
On the other end of the line, a woman identifies herself as a "third-party intermediary" for my insurance company. She says she is calling to inform me that the procedure I am scheduled to have in just a few minutes has been approved and the facility I have selected is in network. However, my chosen provider is more expensive than other options and may result in a higher co-payment.
"You may cancel your test and reselect a cheaper provider," she tells me.
I am stunned. Then, I ask the obvious question: "If I stay, how much will it cost me?"
Her answer is that she is not authorized to give me that information and, no, she cannot tell me the price differential between staying and going somewhere else. For that, I will have to speak to my insurance company directly.
I decide to do just that. As the nurse behind the reception desk dials the number for me, she mentions how these third-party calls have been escalating in frequency.
"What do most people do?" I ask her.
"A lot of them hang up and walk out," she says.
I am disconnected from the electronic voice response system of the insurance "customer care" line twice before I finally reach a voice owned by an actual human. The representative uses a much less menacing tone than the third-party intermediary but admits he can't reveal my out-of-pocket responsibility, either. The best he can do is read from a script describing my benefits and provide an estimated average cost for the procedure. Except that my procedure isn't listed. So basically, he can't tell me anything.
State of Affairs
Welcome to the American health care system. If you're looking to sail off on a Kafkaesque journey, you've come to the right place. There is a separate rabbit hole for diagnosis, treatment, second opinions -- and above all else, cost of care. It's not like a restaurant where the prices are printed on the right hand side of the menu so you know what you're getting into. Even if you're lucky enough to have insurance -- which can cost more each month for a family of three than a mortgage -- it's virtually impossible to determine what you will pay to avail yourself of services that are necessary and, in many cases, lifesaving.
You can spend hours, as I have, trying to unravel the byzantine pricing arrangements put in place by insurance companies. A test can cost four times more when done in one hospital versus another, even when both are in network. And the same services delivered in the same facility are sometimes priced differently depending on your reason for seeking care. Recently, for example, a woman in Houston was billed $4,850 for a four-hour emergency room visit. When the hospital discovered her injuries were the result of a car accident, they jacked up the price to $20,211.