The cost of passing a kidney stone

Andrew Sullivan is running a series of reader-submitted reports on run-ins with the health care system, entitled “The View from Your Sickbed”. Here is one from a student who knew before going to the emergency room that he was passing a kidney stone. The ER workers took an X-Ray, saw two kidney stones, decided to take a CT scan just to be sure, and found the same two kidney stones.

After about 3 hours I passed one of the stones, and with a prescription for heavy-duty painkillers in tow, we left the hospital.  Everything was fine until I received a bill 3 months later itemized as follows:

X-Ray: $765
CT Scan: $4294
Emergency Room visit: $4924
Total: $10063

The bill was a shock to me for two reasons.  First, my insurance was supposed to cover this.  After a long round of phone calls – during which a very rude hospital employee could not understand why I was upset at being charged $10,000 when I had insurance – I figured out that my insurance company’s check had literally gotten lost in the mail.  They sent another check and my bill was cleared.  But this led to my second shock.

From my insurance company I received the following "explanation of benefits":

Total charge: $10063.00
Provider discount: $9571.00
Amount Payable: $442.00

How can something that would have cost me $10,063 cost my insurance $442.00 (not counting the $50 deductible that I chipped in).  That’s a 96% discount!

Five thousand dollars for an IV painkiller drip, a three hour stay, ten minutes of doctor time, and thirty minutes of nurse time. Plus another forty-three hundred dollars to confirm what the $765 X-Ray had told them, something the patient knew before he arrived. And here’s the kicker:

If I had been told that the CT Scan and the Emergency room care cost $5000 each, I’d have asked for a prescription and been off to the pharmacy.  I wasn’t told, however.  I wasn’t even give the option.

Exactly. When Peter was doing poorly a couple of weeks after he was born, I knew we had one—and only one—decision to make, namely whether to take him to the pediatrician or not. After we did, the system made choice after expensive choice for us, having absolutely no concern about how it would all be paid for.

Three days and eleven thousand dollars later we were told that the tests had found nothing wrong with him, and that he seemed to be well enough to go home. Our “provider discount” was only about half the bill, and insurance covered a few hundred of the rest, leaving us to pay about $5000. We eventually worked out an E-Z payment plan. And then a year-end review by the hospital led them to pay most of the rest out of charity funds, leaving us slightly less than a thousand dollars poorer.

This is the reality that has me completely uninterested in how we fund modern healthcare. Fussing about how to pay for such an oppressive, ridiculous, and broken system is akin to rearranging the deck chairs on the Titanic. Better to be making concrete, tangible arrangements for how you yourself will proceed once the big ship goes down.

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7 thoughts on “The cost of passing a kidney stone

  1. If this wasn’t legally sanctioned by the government the technical term for this is racketeering.

    It should not cost me more to pay cash then it does for the insurance company to pay for things over time. I understand that they are bringing a large block of people but the administrative cost has to be more than paying cash.

    It’s just wrong.

  2. Rick wrote: I knew we had one—and only one—decision to make, namely whether to take him to the pediatrician or not. After we did, the system made choice after expensive choice for us, having absolutely no concern about how it would all be paid for.

    If you don’t mind explaining, why was that? I can think of half a dozen instances within the last couple of years of expensive health care for me, my kids and my parents, under circumstances in which it was clear that insurance wasn’t going to cover some or all of it. When the providers were aware of those circumstances I never had one balk (and neither did my parents, from what they’ve said) at discussing the options and the cost/benefit tradeoffs. That resulted in some very tough choices to make, but they were clearly our choices to make, and the providers all seemed to be helping us make decisions in our best interests, taking both the medical issues and the the insurance situations into account. Some of this was in Washington state, some in Missouri, but a similar experience across quite a few different cases.

    James wrote: It should not cost me more to pay cash then it does for the insurance company to pay for things over time. I understand that they are bringing a large block of people but the administrative cost has to be more than paying cash.

    Why? Volume discounts are pretty standard in lots of industries. And FWIW my guess is that the employee time spent in arranging for a cash payment from an individual is significantly more than the average per-patient cost in employee time spent in managing bulk payments via an insurance company (much of which just happens electronically according to pre-negotiated rules). But if it’s the other way around, the negotiated price takes that into account. Both sides are trying to maximize profits and negotiating on that basis.

    I don’t understand the comment about government. This is just the sort of pricing structure arise naturally in the absence of government regulations. I.e., it’s the result of negotiations between the company providing the services and the company providing the insurance, both trying to maximize profit. When Costco buys computers ten thousand at a time they negotiate a better price than I could get buying one at a time. I’m better off buying a computer via Costco than buying one directly from HP. When my health insurance company is paying my hospital for a a thousand MRIs each year, they can negotiate a better price than I can get for just one. I’m better off buying the MRI from the insurance company than trying to buy it directly from the hospital.

    I’m fuzzy on a lot of the details, but isn’t one of the objections to the proposed reforms that this negotiated pricing would be forbidden, to the detriment of insurance company profits? That’s not an argument in favor of the proposed regulations, just an observation about the natural effect of negotiations between two private companies in a b2b kind of setting.

  3. dj,

    If you don’t mind explaining, why was that?

    Mostly because of the emergency room environment. Nobody discussed the cost of any test with us, or the possibility of going without it, before running it. My undstanding (and my experience) is that emergency room doctors and nurses err on the side of overtesting and overtreating, to make sure that all possibilities are explored and to fend off later lawsuits. Our pastor, who is also an emergency room nurse, says he has a list of emergency rooms not to go to with heart attack symptoms—because at the first excuse they will order a “clot-buster” shot—just to be sure—at a cost of $10,000.

    The other reason is that a child was involved, a case where the authorities are much less prone to give you a real choice, i.e. one that differs from their own recommendation.

  4. “This is the reality that has me completely uninterested in how we fund modern healthcare.”

    My first inclination is to agree, but what’s currently being discussed in Washington goes beyond mere funding. The sole fact that it will be illegal to not have health insurance – and those who choose to forgo it will be fined by the feds – seems to be an indicator of such. It’s shaping up to be yet another method of forced mass dependency on the system.

  5. Don’t have any non-emergent studies in the emergency room.

    For kidney stones, either get the xray confirm that there are stones, ie nothing life threatening. Get your pain pills and followup with a urologist as an outpatient.

    OR

    if they insist then have ONLY the CT scan done, since it will show you everything the xray will, get the pills and followup as an outpatient.

    Try to get diagnostic tests done as an OUTPATIENT.

    Ask the Drs. and nurses to share the thought processes behind getting all your studies done.

  6. Hi,

    Just out of curiosity I was searching for CT Scan prices for kidney stones and found your blog. I just had a CT Scan done for this in Rabat, Morocco. Imagine that the CT Scan (using a Siemens Somatom Sensation 16 machine) cost a grand total of 1500 MAD (USD $171.)
    Their service was excellent and I’m awaiting confirmation that there are stones present. A few years ago I had lithotripsy done here in the same clinic for about USD $700 total.

    As an American it is very depressing to find so much affordable care outside the US. (And this is not a socialized medicine country, I was in a private pay-for-what-you-get clinic.)

    -CD

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