A 10-minute doctor’s visit — and a $1,315 bill

Source: Asbury Park Press
With her doctor unable to see her one day last March, Patricia Schaub decided to drive to Ocean Care Center in Point Pleasant to get treated for a cough, headache, and overall blahs.
She was diagnosed with an upper respiratory infection, and given a Motrin and prescription for cough medicine and antibiotics. Ten minutes later, she was on her way home.

What did the visit cost? $1,315.00.

“I can’t even tell you how I felt when I opened the bill,” Schaub, 63, said. “So I called them and I said, ‘Are you kidding me? You’re charging $1,315? I was there 10 minutes. You gave me a prescription. This is ludicrous.’ So they said, ‘This is what the fee is.’”
…Schaub has her insurance through Verizon Communications, where she worked in the purchasing department until she retired in 2003…She has no deductible, and she only had to pay $75 for her visit; her insurance company ultimately paid $1,108. (The statement from the facility showed that the Motrin itself was free).

At Verizon, Schaub purchased everything from manhole covers to telephone poles. “You can’t just call up and say, ‘Send me 100 telephone poles’ — You need to know what the price is. If you don’t like their price, you shop around until you get the best price.”

Ocean Care Center in Point Pleasant…was the state’s first free-standing emergency department. It looks like an urgent care center…(I)t operates around the clock and has all of the high-tech bells and whistles – and operating costs – that come with the designation of an emergency department.
But a health care waiting room isn’t like, say, the counter at Smashburger, where prices are on full display. The health care industry has a tangled web of prices often determined through negotiations with insurance companies. Consumers generally learn of the cost long after their visit.
The scramble is on to bring transparency to the process:
• New Jersey lawmakers have introduced a bill that would require health care providers to tell patients in advance if their procedure isn’t part of their insurance companies’ network. Out-of-network procedures are more expensive. It also would publish a Healthcare Price Index that would list median prices of in-network insurance claims.
• Some insurance companies have begun to offer their members a chance to comparison shop online. New Jersey’s biggest insurer, Horizon Blue Cross Blue Shield, this month is rolling out an online tool that lets its customers see what providers charge for procedures.
• Other companies and researchers are compiling data to shed light on costs. Among them: Guroo, created by the nonprofit Health Care Cost Institute, is working on a website that would allow consumers to see the average cost of dozens of procedures.
• Some practices are taking steps on their own. Kristy Caldarella, owner of Abilities in Action, a pediatric therapy provider with offices in Shrewsbury and Wall, described a complicated system in which prices vary depending on the patient’s insurer.
“Unfortunately it’s not one-stop shopping right now,” said Kerry McKean Kelly, spokeswoman for a hospital association trade group. “We know we need to find a way for the industry to make this easier for consumers.”
Patricia Schaub said she was so steamed that she briefly considered not paying the $75 for the visit…

“If no one makes a stink about this, it will continue. Someone’s going to get the fallout from this. This $1,315, somebody’s going to be paying for this somewhere.”

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