Cost estimator gone wrong
by jerry on August 29, 2022
Kaiser Health News posted a story in their Bill of the Month series about a patient who used a provider's cost estimator and ended up receiving a bill from the same provider that was for much more. The cost estimator estimated that an uninsured patient would owe about $1,400 for the procedure, and the bill for the individual (who was insured) came out to almost $18,000. Since the patient had a high-deductible plan, her out-of-pocket bill exceeded $5,000.
It certainly seems odd that the price for an insured patient (almost $18,000) should be about twice the price for an uninsured patient. One issue is that the service provider claims that the cost estimator tool should have estimated a price "between $8,000 and $11,500," not the $1,500 that was shown. It seems that when a patient relies on the cost estimator tool of a specific provider and ends up being billed a very different number by that same provider, the provider should bear liability for giving incorrect information and at least reduce the charge. There appears to be an additional complication where the provider was unable to give a price before the procedure. In this case, the service organization cited not knowing which procedure would be used (and therefore being unable to provide a price). The individual clinician performing this particular procedure would know which procedure would be used before starting the procedure, but likely would not have pricing information available to the patient so the patient could then decide whether or not to continue with the procedure. The inability for a patient to know how much will be owed for a standard procedure before agreeing to the procedure seems bizarre and unfair to the patient. As more of these stories surface in the public consciousness, perhaps regulators will have more of an appetite to require changes so that patients can make informed choices.