JACKSONVILLE, Fla. — Linda Foley has been an ultrasound technician for 23 years, but says nothing prepared her for what she saw with her own ultrasound bill when she had stomach pain.
“My insurance was billed over $2,200,” said Foley. “My portion came out to $1000. I was outraged. I am being charged as if I was in the hospital.”
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Foley was indeed charged that way, even though she went to Optimal Imaging in Middleburg, which — unbeknownst to Foley — is a joint venture with Ascension St. Vincent’s.
It was a costly decision, similar to going to a stand-alone ER, instead of urgent care.
Last July, Florida lawmakers passed legislation that required each stand-alone ER to “clearly identify itself as a hospital emergency department using certain signage.” However, the bill didn’t address imaging centers owned or partnered with hospitals.
Foley also wasn’t aware she could have been billed a lot less by paying cash.
“I wasn’t given the option to self-pay, which was $190 per ultrasound,” says Foley.
According to an analysis published by the Healthcare Financial Management Association, “Average prices for MRI and CT scans range from 70 percent to 149 percent higher at hospitals.”
It didn’t help in Foley’s case, she had a $5,000 deductible, but that doesn’t fully explain why her insurance was billed so much.
“How do you fix the system?” Becker asked Lisa Berry-Blackstock, who is a private patient advocate. “That’s an almost impossible task,” said Berry-Blackstock.
She blames the Affordable Care Act which led insurers to increase deductibles, premiums, co-pays and negotiated rates to cover the cost of people with pre-existing conditions.
“Basically the Affordable Care Act was passed with very good intentions,” says Berry-Blackstock. “But by the time the health care lobby groups got their fingers in it, looked like a piece of Swiss cheese.”
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Figuring out specific pricing before a procedure can practically be brain surgery.
Becker first reported in 2021 that the federal government mandated hospitals across the country post prices for the insured and uninsured on their websites in two ways — first, at least 300 shoppable services in a “consumer-friendly” style. This includes procedures like CT scans, knee replacements and childbirth.
The second part involves “machine-readable files” — usually a spreadsheet — of all standard charges for all items and services provided, which includes everything from the cost of aspirin to a bandage.
While Ascension St. Vincent’s is meeting or exceeding those standards, hospital websites can be confusing and the spreadsheets may spread your patience thin over hundreds of thousands of lines.
Becker emailed Ascension St. Vincent’s to get Foley some answers and was told it would adjust her charge as a courtesy:
“I’m glad we were able to help the viewer who reached out to you! As a faith-based, nonprofit healthcare system, Ascension is committed to making care affordable and accessible to all. We know billing can be complex and include external variables beyond our control. We work to address questions or concerns patients may have directly with our patients.
For some time now, we have posted gross charges and discounted cash prices in both our price estimator tool and our machine-readable files. We continue to enhance our transparency tools to assist our patients in understanding the cost of commonly purchased healthcare services. Our price estimator tool (https://price-estimator.ascension.org/) includes more than the required 300 shoppable services, and we were among the first health systems to post pricing information.
We have also built a strong system of care across our ministry that provides patients with options in obtaining care in the right setting that helps reduce out-of-pocket costs. Ascension was compliant on January 1, 2021 and we have continued to expand our price transparency efforts beyond what is required by the Affordable Care Act.”
A few weeks later, Foley was sent a new bill for the self-pay charge of $190 total and texted Becker, “Thought I was being charged $190 x 2 (each ultrasound). This is even better.”
The bottom line: If you’re having a planned procedure, call your insurance company and the provider ahead of time to find out the price difference or go to their websites so you can make the most informed decision.