Have you ever seen the costs your insurance company is asked to pay for your medical treatment?
An area college student went into sticker shock when he saw the price of treating a sprained ankle. While investigating the costly bill, Newswatch 16 was told many hospitals and clinics send out unexpectedly expensive bills and they don't have to involve surgery or a serious disease.
With exercise our ankles take a pounding with every step and every jump. Lock Haven University sophomore Greg Forstater's ankle twisted during a September pick-up basketball game. "I stepped on some kid's foot," said the 20-year-old Forstater," and my ankle turned over, and it was really bad."
And it hurt.
Forstater's buddies drove him to Lock Haven Hospital's emergency room. Doctor's treated him then three days later hospital doctors took a CAT scan image to see if his ankle was broken or sprained.
"And it turned out to be a third degree sprain," Forstater recalled. "So it's a good thing I went to the emergency room."
The hospital sent the bill to Forstater's insurance carrier. It was about three months later that he got a look at just how much Lock Haven Hospital was billing for a CT or CAT scan for an ankle sprain.
"The CT scan bill was around $10,000," Forstater said.
Lock Haven Hospital sent a bill to Blue Cross Blue Shield, Forstater's insurer for $9,825.80 for a lower extremity CAT scan.
"Consumers need to become more students of their own health care," said Derek Fitteron, a nationally-known expert in medical care pricing. He is the CEO of Medical Cost Advocate, a New Jersey company that negotiates to get health care bills reduced for patients and insurers.
Fitteron said Forstater's $10,000 CAT scan bill is not shocking.
"Five people can walk into the same doctor's office in the same hospital and pay radically different amounts," said Fitteron. He added more providers are sending off seemingly high bills because more patients are not paying. Also, government programs like Medicare in this era of tight budgets are reimbursing doctors and hospitals less and less.
"We typically end up paying more to subsidize those lower paying programs," said Fitteron
"I could see if it was a surgery," said Greg Forstater, who still is shocked by the initial bill six months after his ankle sprain. In his case, his insurer paid just $2,445 for the once costly CT scan.
Lock Haven Hospital "adjusted" the bill, knocking off $7,400.
Lock Haven Hospital Marketing and Public Relations Director Jeffrey Johns e-mailed the following written statement on behalf of the hospital: "Thank you for bringing this issue to our attention. At Lock Haven Hospital, our goal is to provide patients with high-quality care and the best possible hospital experience, from registration through discharge and billing. Unfortunately, in this case, there was a billing error, which was not immediately resolved. We have made the necessary corrections and we have apologized to our patient for the mistake.
Our goal is to answer questions about bills, resolve issues quickly, and to assist our patients however we can with complicated financial matters. Our team is being re-educated about the issues in this case to help ensure that errors will not occur in the future."
Greg Forstater said the medical care at Lock Haven Hospital was first rate. His complaint is the initial bill for of the CT scan, and not the treatment he received.