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Family receives $881 medical bill for flu swab

Chris Ramirez
June 21, 2017 01:36 PM

ALBUQUERQUE, N.M. -- It was supposed to be a simple doctor’s visit -- in and out, without too much hassle and too much strain on the wallet.

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14-year-old Braden MacKay of Rio Rancho recently got a sore throat – an issue his mother, Andrea MacKay, was never too concerned about, but also something that wasn’t going away.

“So we took him to the pediatrician,” Andrea said. “They said to bring him in because his symptoms happened so quickly.”

The nurse tested Braden for strep, Andrea said. After that, the nurse determined the best course of an action would be something seemingly routine in the healthcare field: a flu swab, done at a separate part of the clinic, in a TriCore lab.

The lab technician performed the test, and days later Braden got better. The medical bill Andrea received, however, was unexpected.

“A couple of weeks later, we got this outrageous bill for $881 for the test, and I was just shocked,” she said. “I just knew there had to have been a mistake.”

Andrea said she called Presbyterian’s billing department and they confirmed the bill was accurate. The $881 bill was what she was stuck with for a test whose only consequence, seemingly, was “stinging really bad,” as Braden described it.

The hospital’s reasoning for the hefty price tag? Presbyterian staff told her it was to be competitive with other healthcare providers in the region. For comparison, Andrea said the strep test cost $85.

“I thought it was the same thing. You stick a Q-tip in the throat for the strep test and up the nose for the flu,” she said. “I had no reason to believe that it would have been anywhere near this.”

According to TriCore, the flu swab itself cost $487. One possible reason for the $400 upcharge could be because Braden got the test done at a TriCore lab inside the Presbyterian clinic, instead of going to a standalone lab in another part of town.

“There’s just not much transparency,” Andrea said. “If a test is going to be this expensive, at least the nurses and the doctors can say, ‘Hey, I hear the test is pretty expensive. You might want to double-check before you have it.’”

In a statement from Presbyterian Healthcare Services, hospital staff acknowledged that medical bills can be tough to understand, partially due to the number of parties involved, including doctors, patients and insurers.

“Presbyterian continues to support initiatives to improve the experience of our patients and members, such as a price estimator that will allow us to provide estimated out-of-pocket expenses upon request,” the statement reads. “Our goal is to communicate clearly and accurately to help our patients and members.”

Andrea said the situation is a frustrating one. It’s also not uncommon. According to KUSA 9 News in Denver, several of their viewers in the region faced similar bills that seemed too high when considering what they were covering.

One viewer, Zdenek Novak, for example, had to pay $690 for a brace that he wore for only one day after falling off his bike. After doing some digging around on his own, Novak found the same exact brace online for less than $200.

According to experts, it can be a good decision to shop around for the best deals when considering up-charges and confusing medical bills.

KOB 4 Investigates found that there’s not always a clear answer, even for something like a flu swab.

4 Investigates also learned that, when it comes to Braden and his flu, there were 12 options -- different swabs ranging in price from $20 to $900. That doesn’t include different amounts covered by insurance for each one.

That’s why the best thing patients can do before choosing a medical procedure is to talk to their doctor thoroughly about the options, instead of expecting them to initiate that conversation.

“I think there should be some kind of transparency,” Andrea said. “Some kind of warning (that says), ‘You might want to check with your insurance before we administer this test because it’s kind of expensive.’”

Once KOB’s investigative team questioned Presybterian about the cost of the swab, Presbyterian staff alerted the patient’s insurance carrier of a billing error. Presbyterian informed KOB on Monday it was not an error made by them, but they say Andrea’s insurance carrier corrected the error. This resulted in an adjustment in the amount Andrea had to pay. In the end Andrea’s flu swab cost was reduced to $111.

If you have received a medical bill that just seems outrageous, we want to hear your story. Email cramirez@kob.com.

Credits

Chris Ramirez

Copyright 2017 KOB-TV LLC, a Hubbard Broadcasting Company. All rights reserved

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