Her Biopsy Report Was Benign. But The Bill Is A Spot Of Contention.
Brianna Snitchler was just figuring out the art of adulting when she scheduled a biopsy at Henry Ford Hospital in Detroit.
Snitchler was on top of her finances: Her student loan balance was down and her credit score was up.
鈥淚 had been working for the past three years trying to improve my credit and, you know, just become a functioning adult human being,鈥 Snitchler, 27, said.
For the first time in her adult life, she had health insurance through her job and a primary care doctor she liked. Together they were working on Snitchler鈥檚 concerns about her mental and physical health.
One concern was a cyst on her abdomen. The growth was about the size of a quarter, and it didn鈥檛 hurt or particularly worry Snitchler. But it did make her self-conscious whenever she went for a swim.
鈥淧eople would always call it out and be alarmed by it,鈥 she recalled.
When the cyst on Snitchler鈥檚 abdomen was found to be benign, she thought her next step would be getting it removed. Then she received a $3,357.52 bill for her biopsy, ultrasound, physician charges and lab tests.(Callie Richmond for KHN)
Before having the cyst removed, Snitchler鈥檚 doctor wanted to check the growth for cancer. After a first round of screening tests, Snitchler had an ultrasound-guided needle biopsy at Henry Ford Health System鈥檚 main hospital.
The procedure was 鈥渦neventful,鈥 with no complications reported, according to results faxed to her primary care doctor after the procedure. The growth was indeed benign, and Snitchler thought her next step would be getting the cyst removed.
Then the bill came.
The Patient: Brianna Snitchler, 27, a user-experience designer living in Detroit at the time. As a contractor for Ford Motor Co., she had a UnitedHealthcare insurance plan.
Total Bill: $3,357.52, including a $2,170 facility fee listed as 鈥渙perating room services.鈥 The balance included a biopsy, ultrasound, physician charges and lab tests.
Service Provider: Henry Ford Health System in Detroit.
Medical Procedure: Ultrasound-guided needle biopsy of a cyst.
What Gives: When Snitchler scheduled the biopsy, no one told her that Henry Ford Health System would also charge her a $2,170 facility fee.
Snitchler said the bill turned out to be far more than what she budgeted for. Her insurance plan from UnitedHealthcare had a high-deductible of $3,250, plus she would owe coinsurance. All told, her bills for the care she received related to the biopsy left her on the hook for $3,357.52, with her insurance paying $974.
鈥淪he shrugged it off,鈥 Snitchler鈥檚 partner, Emi Aguilar, recalled. 鈥淏ut I could see that she was upset in her eyes.鈥
Snitchler panicked when she realized the bill threatened the couple鈥檚 financial security. Snitchler had already spent down her savings for a recent cross-country move to Austin, Texas.
In an email, Henry Ford spokesman said the 鈥減rocedure was performed in the Interventional Radiology procedure room, where the imaging allows the biopsy to be much more precise.鈥
鈥淲e perform procedures in the most appropriate venue to ensure the highest standards of patient quality and safety,鈥 Olejarz wrote.
The initial bill from Henry Ford referred to 鈥渙perating room services.鈥 The hospital later sent an itemized bill that referred to the charge for a treatment room in the radiology department. Both descriptions boil down to a facility fee, a common charge that has become controversial as hospitals search for additional streams of income, and as more patients complain they鈥檝e been by these fees.
Hospital officials argue that medical centers need the boosted income to provide the expensive care sick patients require, 24 hours a day, 365 days a year.
But the way hospitals calculate facility fees is 鈥渁 black box,鈥 said , with the Office of the Healthcare Advocate for Connecticut, a state that has put a spotlight on the issue.
鈥淚t鈥檚 somewhat akin to a cover charge鈥 at a club, said Doolittle, who previously served as deputy director of the federal Center for Program Integrity at the Centers for Medicare & Medicaid Services.
Hospitals in Connecticut billed more than $1 billion in facility fees in 2015 and 2016, according to . In 2015, Connecticut lawmakers that forces all hospitals and medical providers to disclose facility fees upfront. Now patients in Connecticut 鈥渟hould never be charged a facility fee without being shown in burning scarlet letters that they are going to get charged this fee,鈥 Doolittle said.
Snitchler plays with her dogs, Alas (left) and Luna.(Callie Richmond for KHN)
In Michigan, there鈥檚 no law requiring hospitals and other providers of health care services to inform patients of facility fees ahead of time.
Brianna Snitchler鈥檚 procedure took place on campus at Henry Ford鈥檚 main hospital site. When she got her bill, with its mention of 鈥渙perating room services,鈥 she was baffled. Snitchler said the room had 鈥渃razy medical equipment,鈥 but she was still in her street clothes as a nurse numbed her cyst and she was sent home in a matter of minutes.
With Snitchler鈥檚 permission, Kaiser Health News shared her itemized bill, biopsy results and explanation of benefits with Dr. Mark Weiss, a radiologist who leads MediCrew, a company in Flint, Mich., that helps patients navigate the health system.
Weiss said it probably wasn鈥檛 medically necessary for Snitchler to go to the hospital to receive good care. 鈥淣ot all surgical procedures have to be done at a surgical center,鈥 he said, noting that biopsies often can be done in an office-based treatment center.
Resolution: Hoping for a reasonable explanation 鈥 or even the discovery of a mistake 鈥 Snitchler called her insurance company and the hospital.
A representative at Henry Ford told her on the phone that the hospital isn鈥檛 鈥渓egally required鈥 to inform patients of fees ahead of time.
In an email, Henry Ford spokesman Olejarz apologized for that response: 鈥淲e鈥檒l use it as a teachable moment for our staff. We are committed to being transparent with our patients about what we charge.鈥
He pointed to an initiative launched in 2018 that helps patients anticipate out-of-pocket expenses. The program targets the most common elective radiology and gastroenterology tests that often have high price tags for patients.
Asked if Snitchler鈥檚 ultrasound-guided needle biopsy will be included in the price transparency initiative, Olejarz replied, 鈥淐an鈥檛 say at this point.鈥
The bill threatened the financial security of Snitchler and her partner. She had already spent down her savings for a recent cross-country move from Detroit to Austin, Texas.(Callie Richmond for KHN)
In addition to the pilot program to inform patients of fees, Olejarz said, the hospital also plans to roll out an online cost-estimator tool.
For now, Snitchler has decided not to get the cyst removed, and she plans to try to negotiate on her bill. She has not yet paid any portion of it.
鈥淵ou should always negotiate; you should always try,鈥 Doolittle said. 鈥淒oesn鈥檛 mean it鈥檚 going to work, but it can work. People should not be shy about it.鈥
鈥淲e are happy to work out a flexible payment plan that best meets her needs,鈥 Olejarz wrote when Kaiser Health News first inquired about Snitchler鈥檚 bill.
The Takeaway: When your doctor recommends an outpatient test or procedure like a biopsy, be aware that the hospital may be the most expensive place you can have it done. Ask your physician for recommendations of where else you might have the procedure, and then call each facility to try to get an estimate of the costs you鈥檇 face.
Also, be wary of places that may look like independent doctor鈥檚 offices but are owned by a hospital. These practices also can tack hefty facility fees onto your bill.
If you get a bill that seems inflated, call your hospital and insurer and try to negotiate it down.
Bill of the Month is a crowdsourced investigation by Kaiser Health News and that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!