By Daniela Munoz Maines
My name is Daniela. I am writing this [letter] because I am very frustrated and I would like my story to be known to others. Specially others that might be in our same situation.
My husband and I live in Oxford. Masshealth has qualified us to be on Health Safety Net Partial. Health Safety Net is a program for low or moderate income people who do not have access to health insurance or cannot afford it. In the case of HSN Partial, this means we are responsible for a portion, or all the costs of medical services till we meet our deductible, which is set by Masshealth according to our income. It is not clear to us in which circumstances we have to pay 100% of the costs, or a portion. It is also not clear how much of a portion that would be. The Health Safety Net help line informs that the hospitals and/or community centers are the ones that determine that. However, I can tell you that in a recent visit to UMASS Medical Center Hahnemman campus, I could hardly find any information at all.
Furthermore, when I tried to find out the price for an ultrasound, it was quite a challenge. My doctor’s office did not have access to prices, the billing department did not have access either and financial counseling directed me to a one single person who could give me that information. As you see, it took me phone calls to 3 different departments till I got to the right place. But this didn’t end here. This person needed a CPT code in able to give me a price. So there was I again on the phone, calling my doctor’s office, then radiology, to find out the code. In both instances they told me they did not have access to the CPT codes. I did some research online and found out that CPT codes are only available for a fee. After doing online searches for hours, I came across a report which had the CPT code for the ultrasound I needed.
Finally I got the price………. sort of. This person was able to give me the price for the hospital fee but wasn’t able to give me the price for the additional interpretation of the results. In any case, the price she quoted me was $706, when at other health centers was around $200. I decided to have the ultrasound done at a different facility, for which I needed the order from my doctor’s office at Hahnemman. And here we go again…………………2 days and several phone calls to make this happen. It is clear to me that the hospital makes a concerted effort not to disclose their prices while at the same time trying to keep you from going somewhere else.
In addition, I received a bill for the appointment, 2 lab tests and a flu shot for $759. After further scrutiny of each charge, I found them to be, again, 3 to 5 times more than fair market value, based on information provided by http://healthcarebluebook.com/. I also checked with Quest labs for pricing, which, I was informed, had bought the hospitals labs. The hospital charged me $450 for a TSH test for which Quest labs charges $120.60. They’ve also charged me $154 for a Vitamin D 25 test. When I confronted the hospital billing department with their pricing, the response, via email, was:” Umass goes by the Federal Law guidelines”. Interestingly, in a conversation with a financial lead, he said it was the state which regulated the prices. When I asked what that regulation exactly was, no one could give me a response. So I searched myself, and I could only find regulation 114.3 at http://www.mass.gov/eohhs/gov/laws-regs/hhs/regs.html#114_6_13. Specifically 114.3 CMR 20.00 lists a TSH test (CPT 84443) $17.98 and Vitamin D 25 (CPT 82306) $31.68. I sent an email to http://www.mass.gov/chia/ requesting additional information on any other regulations not posted in their website, but I don’t have an answer as of now.
I’ve also started a petition http://signon.org/sign/your-right-to-know-hospital?source=c.fwd&r_by=4767040 which, I am hoping will get more signatures in the near future.
So my point is: People on Health Safety Net, like us, are precisely the ones that should not be charged prices that are 3/5 times more than fair market value. But more importantly, these people have the right to know the prices before they accept them. There is no other business that can get away with not disclosing it’s fees prior to providing services…none. Why are hospitals different?
I do not know if all hospitals give you the round-around as UMASS does, but I do know that somebody should do something about this.