Fort Myers patient surprised by $13K charge for CT scan
A CT scan, or a computed tomography scan, can see into your body and help diagnose medical problems, but the cost can change drastically depending on where you have it done.One Gulf Coast News viewer said he was billed $13,223 for a scan earlier this year.“Easter night, I had severe stomach pain,” David Stokrocki explained. He said that pain led him to the emergency room at Gulf Coast Medical Center.“I get in there and get prepped for the CT scan,” Stokrocki said. It’s a simple procedure that lets doctors see inside you without going under the knife. “A nurse did come in about 15 or 20 minutes after the scan and said, ‘You have an infected stomach. We do have medication for that,’” Stokrocki added. After a few days on some medication, Stokrocki said, “I was back to normal.”It was not until he got the bill for that scan that he felt ill all over again. “Oh, it’s sickening. The word ‘sickening’ because it’s just crazy,” Stokrocki said. He said he was sick over a charge of more than $13,000. A short time after the emergency scan, he got another at a different facility and was only billed $79.Stokrocki asked, “Why? That’s what I want to know. Why?”I went directly to Lee Health to ask that question. In an emailed response, a Lee Health spokesperson wrote: “Due to HIPAA regulations, we are unable to comment on any specific patient’s care or charges. However, we can provide general information about how emergency department (ED) imaging is priced.”It’s not unusual for a CT scan performed in the emergency department to be more expensive than one done at an outpatient imaging center. That’s because emergency departments operate 24/7/365 and are staffed and equipped to handle any medical emergency at any time, from minor injuries to life-threatening conditions. This level of readiness contributes to higher overall costs. In addition to preparedness, emergency departments must comply with the Emergency Medical Treatment and Labor Act (EMTALA), which mandates a screening examination for all patients seeking medical care, regardless of their ability to pay. Freestanding imaging locations have no similar regulation. “Additionally, not all CT scans are the same. Costs can vary based on the complexity of the scan, the technology used, and whether contrast is required. For example, a scan to detect a brain aneurysm has a different cost than one for a kidney stone.”It’s important to note that what a hospital charges is not always what it is paid. The Explanation of Benefits (EOB) a patient receives often shows that insurers negotiate a significantly lower rate, and a patient’s out-of-pocket cost depends entirely on their insurance coverage.”We encourage patients to visit the Billing section of our website, where they can find resources to get a price estimate, compare our charges to other hospitals, and learn about financial assistance programs. Our prices are generally lower than those of many other hospitals in Florida, and we remain committed to transparency and helping patients understand their options.”I took Stokrocki’s dilemma to the Patient Advocate Foundation. I asked its senior director, Caitlin Donovan, “Are you surprised by the price differences we’ve found?”Donovan replied, “I wish I was surprised, but I was not surprised at all.”The foundation is a national 501(c)(3) nonprofit organization that provides professional case management services to Americans with chronic, life-threatening and debilitating illnesses.Donovan added, “Unfortunately for patients, it’s always going to be more expensive to get any service at a hospital. Hospitals will tell you that it’s because they have to have a certain amount of staff on standby and that the amount of time it takes to bring in people for those regular procedures is going to be relatively higher.”But there are ways to keep costs down even ahead of any emergencies.“The best thing you can always do is know your home plan, know what hospitals are in network, know which urgent cares are in network,” Donovan said. You can also check out prices within hospital networks thanks to a law that went into effect in 2021. Lee Health has its own website dedicated to this, but Donovan said, “Things have a tendency to get more complicated in health care, and it got complicated fast. Sometimes it’s hard, even if you’re looking at a straight spreadsheet or list of what the prices are, to know what you will actually be paying because of things like bundled payments or what your specific insurance plan covers and how it’s being coded.”Thanks to insurance, Stokrocki said he will not have to pay the full $13,000 for his CT scan. “My out-of-pocket now is $3,000,” he explained. Despite any unavoidable costs, Stokrocki, Donovan and Lee Health recommend doing your homework before any potential medical procedures.There are more ways you can save on CT scans. The health care company GoodRx recommends you call multiple imaging facilities for quotes.You can also search for facilities that are freestanding and focus only on imaging tests, and use in-network facilities if you have insurance.DOWNLOAD the free Gulf Coast News app for your latest news and alerts on breaking news, weather, sports, entertainment, and more.
A CT scan, or a computed tomography scan, can see into your body and help diagnose medical problems, but the cost can change drastically depending on where you have it done.
One Gulf Coast News viewer said he was billed $13,223 for a scan earlier this year.
“Easter night, I had severe stomach pain,” David Stokrocki explained. He said that pain led him to the emergency room at Gulf Coast Medical Center.
“I get in there and get prepped for the CT scan,” Stokrocki said. It’s a simple procedure that lets doctors see inside you without going under the knife. “A nurse did come in about 15 or 20 minutes after the scan and said, ‘You have an infected stomach. We do have medication for that,’” Stokrocki added.
After a few days on some medication, Stokrocki said, “I was back to normal.”
It was not until he got the bill for that scan that he felt ill all over again. “Oh, it’s sickening. The word ‘sickening’ because it’s just crazy,” Stokrocki said.
He said he was sick over a charge of more than $13,000. A short time after the emergency scan, he got another at a different facility and was only billed $79.
Stokrocki asked, “Why? That’s what I want to know. Why?”
I went directly to Lee Health to ask that question. In an emailed response, a Lee Health spokesperson wrote:
“Due to HIPAA regulations, we are unable to comment on any specific patient’s care or charges. However, we can provide general information about how emergency department (ED) imaging is priced.
“It’s not unusual for a CT scan performed in the emergency department to be more expensive than one done at an outpatient imaging center. That’s because emergency departments operate 24/7/365 and are staffed and equipped to handle any medical emergency at any time, from minor injuries to life-threatening conditions. This level of readiness contributes to higher overall costs. In addition to preparedness, emergency departments must comply with the Emergency Medical Treatment and Labor Act (EMTALA), which mandates a screening examination for all patients seeking medical care, regardless of their ability to pay. Freestanding imaging locations have no similar regulation.
“Additionally, not all CT scans are the same. Costs can vary based on the complexity of the scan, the technology used, and whether contrast is required. For example, a scan to detect a brain aneurysm has a different cost than one for a kidney stone.
“It’s important to note that what a hospital charges is not always what it is paid. The Explanation of Benefits (EOB) a patient receives often shows that insurers negotiate a significantly lower rate, and a patient’s out-of-pocket cost depends entirely on their insurance coverage.
“We encourage patients to visit the Billing section of our website, where they can find resources to get a price estimate, compare our charges to other hospitals, and learn about financial assistance programs. Our prices are generally lower than those of many other hospitals in Florida, and we remain committed to transparency and helping patients understand their options.”
I took Stokrocki’s dilemma to the Patient Advocate Foundation. I asked its senior director, Caitlin Donovan, “Are you surprised by the price differences we’ve found?”
Donovan replied, “I wish I was surprised, but I was not surprised at all.”
The foundation is a national 501(c)(3) nonprofit organization that provides professional case management services to Americans with chronic, life-threatening and debilitating illnesses.
Donovan added, “Unfortunately for patients, it’s always going to be more expensive to get any service at a hospital. Hospitals will tell you that it’s because they have to have a certain amount of staff on standby and that the amount of time it takes to bring in people for those regular procedures is going to be relatively higher.”
But there are ways to keep costs down even ahead of any emergencies.
“The best thing you can always do is know your home plan, know what hospitals are in network, know which urgent cares are in network,” Donovan said.
You can also check out prices within hospital networks thanks to a law that went into effect in 2021. Lee Health has its own website dedicated to this, but Donovan said, “Things have a tendency to get more complicated in health care, and it got complicated fast. Sometimes it’s hard, even if you’re looking at a straight spreadsheet or list of what the prices are, to know what you will actually be paying because of things like bundled payments or what your specific insurance plan covers and how it’s being coded.”
Thanks to insurance, Stokrocki said he will not have to pay the full $13,000 for his CT scan. “My out-of-pocket now is $3,000,” he explained.
Despite any unavoidable costs, Stokrocki, Donovan and Lee Health recommend doing your homework before any potential medical procedures.
There are more ways you can save on CT scans. The health care company GoodRx recommends you call multiple imaging facilities for quotes.
You can also search for facilities that are freestanding and focus only on imaging tests, and use in-network facilities if you have insurance.
DOWNLOAD the free Gulf Coast News app for your latest news and alerts on breaking news, weather, sports, entertainment, and more.
link
