After receiving a typhoid shot at his primary care doctor’s office, Jeff Blatt was caught off guard when his insurance didn’t cover it, and he was left with a bill double what other facilities charge.
Blatt got the shot at Scarsdale Medical Group in Westchester, New York, back in February to prepare for a vacation to southeast Asia. Then in March, he was hit with a $432.88 bill on top of his $30 copay after Cigna denied his claim.
However, for the same typhoid shot administered at Mount Sinai Medical Group in New York City, Blatt’s daughter’s insurance paid $221, resulting in $40.68 in out-of-pocket costs. And an online search showed a local CVS would charge $184.99 without insurance for a typhoid shot.
Blatt — who previously worked for MedPage Today‘s parent company Ziff Davis — called Scarsdale Medical Group, explained his situation, and asked for an adjustment. He said, “Look, I’ll pay for the shot, but I will not pay $430,” he told MedPage Today.
Based on his relationships with the medical practice, his determination to get a fairer deal, and his comfort in taking a risk, Blatt was confident the price would be lowered.
The representative said they’d resubmit the case for review, but Blatt didn’t hear back in the 8 to 10 days he’d been told it would take. Then a few weeks later, he got another bill for the same amount without any changes.
This time, Blatt reached out to a Scarsdale Medical patient representative he had worked with before and told her that he’d pay something reasonable for the shot, but not the price he was being billed for. That representative wrote back immediately and adjusted his bill to $163.50, which Blatt paid when the bill arrived last week.
With just a few hours of phone calls, emails, and waiting on hold — and several weeks of waiting — Blatt reduced his bill by nearly 40%. Blatt said he has been a long-time patient of Scarsdale Medical and values the relationships he has with providers at the practice, so he was relieved.
“They did the right thing. They didn’t hassle me about it. They recognized that the charge was too high, and they adjusted it to something fair,” he said.
Had the practice not agreed to a lower price and had Blatt continued to refuse to pay, the bill could have eventually ended up in collections — though last year, the Biden administration proposed a federal regulation that was finalized in January to remove medical debt from credit scores.
“My main conclusion is that, unfortunately, you need to treat medical services in this country like any other consumer good — you need to shop, you need to be vigilant, you need to ask questions — or you have a high chance of being billed for something you should not be billed for. That’s the unfortunate reality,” Blatt said.
Anupam Jena, MD, PhD, a healthcare policy professor at Harvard Medical School in Boston, told MedPage Today that like other consumer goods and services, healthcare is not immune to the phenomenon of the same product costing different amounts at different retailers.
In fact, services provided by the same doctor might have a different price depending on whether the recipient of the services has private insurance, Medicaid, or no insurance at all.
“So it’s not even just that there’s variation across providers — there’s actually a lot of variation in price, even within providers,” Jena told MedPage Today. On top of that, healthcare businesses have different strategies for attracting patients. A pharmacy like CVS, for example, may be seeking to attract uninsured people and thus advertise their lower price.
These price differences often stem from negotiations between providers and insurers. Uninsured patients will be charged some kind of list price while insurers have negotiated to pay a lower amount. The clinicians delivering care may not know the list price, though patients can find out by calling the facility.
Jena said, ideally, patients and providers alike would know the cost of a service beforehand so there are no surprises, though it’s not as simple as it sounds. He said to think of medical billing like a home renovation.
“There’s some things that you can expect, but then there’s some things that you don’t expect, and it’s very unpleasant to have to deal with that, both for the purchaser of the services … but also probably for the contractor,” he said.
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