For Thomas Schroeder, yearly abdomen-pelvic CT scans are part and parcel of monitoring his highly-recurrent, rare malignant cancer. As it’s the only way of managing his disease beyond future surgeries, CT scan checkups have become so routine that his wife, Kathy Schroeder, even knows the exact medical CPT code: 74177.
So, when Kathy went to pay her husband’s medical bill for this January’s CT scan—expecting to see a number similar to last year’s $551—and saw a $6,293 charge on his MyChart, she was astounded.
“I thought it had to be a mistake. I know it’s a mistake,” Kathy said, recalling how her husband’s employer-provided insurance only covered $53.24, leaving the Schroeders responsible for the remaining $6,240. “That’s a 1032% increase for our portion, and I just thought ‘this can’t be.’”
Since Thomas deals with both his rare form of cancer and Parkinson’s disease, the Schroeders pay for good health insurance. Prior to the CT scan, Kathy noticed that she couldn’t find a way on the hospital’s website to estimate what the final cost would be, so she checked in with their insurance carrier, who let them know that the procedure was in-network and authorized.
“We have health insurance that we pay a good amount of money for. But to find out that it’s worthless? I mean we would’ve done better without insurance at this point,” said Kathy, explaining how she was able to find the cash price, $1,993, after receiving the $6,293 bill.
Healthcare labor shortages and rising costs for medical supplies have caused a spike in health insurance premiums, but this doesn’t explain why the Schroeders’ insurance provider negotiated a price three times higher than the cash price. Each time Kathy called the hospital and her insurance providers to get any amount of clarity, she would spend over an hour on the line with representatives who sent her from department to department chasing answers.
During one of her phone calls, a hospital billing representative dismissed Kathy’s concerns, saying the hospital would not negotiate with patients and insisted that she had been provided an estimate before the CT scan — an estimate that Thomas allegedly signed off on.
“That did not happen. If we would’ve ever seen that the procedure was going to cost that much, we would’ve walked out of there,” she said. “There was an electronic signature for Tom to sign that he agreed to treatment, but they didn’t give us an estimate.”
A recent study by the Pioneer Institute found that 33 states have weak transparency laws, or, in the case of Kansas, where the Schroeders call home, there are no price transparency laws at all. Healthcare price transparency regulations are supposed to be followed by hospitals nationwide after the 2021 Hospital Price Transparency rule, but only one-quarter of hospitals are fully compliant in providing patients with prices ahead of their procedures.
After spending a couple of months working with her insurance providers and the hospital billing department, Kathy was offered a 30% discount to bring the bill down to $4,368 and then a 50% discount, dropping the bill to $3,120, but she still refused to pay. From Kathy’s own research, the exorbitant charge “didn’t have a basis in reality” compared to the cost of this routine CT scan in Kansas or even nationwide. Ultimately, she said she would not pay for a charge disparity that was negotiated in secret between her insurance and the hospital.
“I think it’s wrong, and people need to at least be aware that this could happen to them,” Kathy said. “I mean, we’re trying to save for Tom’s medical future here and be prepared for things, but this knocks the socks right off of that because he’s saying he won’t go back for future scans. He said he would not have done this. We didn’t know a CT scan could cost that much.”