https://www.npr.org/sections/health...9/for-her-head-cold-insurer-coughed-up-25-865
For Her Head Cold, Insurer Coughed Up $25,865
Alexa Kasdan had a cold and a sore throat.
The 40-year-old public policy consultant from Brooklyn, N.Y., didn't want her upcoming vacation trip ruined by strep throat. So after it had lingered for more than a week, she decided to get it checked out.
Kasdan visited her primary care physician, Roya Fathollahi, at Manhattan Specialty Care just off Park Avenue South and not far from tony Gramercy Park.
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The visit was quick. Kasdan got her throat swabbed, gave a tube of blood and was sent out the door with a prescription for antibiotics.
She soon felt better, and the trip went off without a hitch.
Then the bill came.
Patient: Alexa Kasdan, 40, a public policy consultant in New York City, insured by Blue Cross and Blue Shield of Minnesota through her partner's employer.
Total bill: $28,395.50 for an out-of-network throat swab. Her insurer cut a check for $25,865.24.
Service provider: Dr. Roya Fathollahi, Manhattan Specialty Care.
Medical service: lab tests to look at potential bacteria and viruses that could be related to Kasdan's cough and sore throat.
What gives: When Kasdan got back from the overseas trip, she says there were "several messages on my phone, and I have an email from the billing department at Dr. Fathollahi's office."
The news was that her insurance company was mailing her family a check — for more than $25,000 — to cover some out-of-network lab tests. The actual bill was $28,395.50, but the doctor's office said it would waive her portion of the bill: $2,530.26.
"I thought it was a mistake," she says. "I thought maybe they meant $250. I couldn't fathom in what universe I would go to a doctor for a strep throat culture and some antibiotics and I would end up with a $25,000 bill."
The doctor's office kept assuring Kasdan by phone and by email that the tests and charges were perfectly normal. The office sent a courier to her house to pick up the check.
How could a throat swab possibly cost that much? Let us count three reasons.
First, the doctor sent Kasdan's throat swab for a sophisticated smorgasbord of DNA tests looking for viruses and bacteria that might explain Kasdan's cold symptoms.
Dr. Ranit Mishori, professor of family medicine at the Georgetown University School of Medicine, says such scrutiny was unnecessary.
"In my 20 years of being a doctor, I've never ordered any of these tests, let alone seen any of my colleagues, students and other physicians order anything like that in the outpatient setting," she says. "I have no idea why they were ordered."
The tests might conceivably make sense for a patient in the intensive care unit or with a difficult case of pneumonia, Mishori says. The ones for influenza are potentially useful, since there are medicines that can help, but there's a cheap rapid test that could have been used instead.
"There are about 250 viruses that cause the symptoms for the common cold, and even if you did know that there was virus A versus virus B, it would make no difference because there's no treatment anyway," she says.
(Kasdan's lab results didn't reveal the particular virus that was to blame for the cold. The results were all negative.)