美国国家公共电台 NPR Bill Of The Month: A $48,329 Allergy Test Is A Lot Of Scratch

 

DAVID GREENE, HOST:

Each month, NPR and Kaiser Health News take a close look at a medical bill that you send to us. And today we're going to hear about an unexpectedly expensive bill for a skin allergy¹ test. From KQED in San Francisco, reporter April Dembosky has the story.

APRIL DEMBOSKY, BYLINE²: When Janet Winston goes to the doctor, she fills up on gas and packs a sandwich and two big thermoses of black tea.

JANET WINSTON: And that's what I need to make the 300-mile drive.

DEMBOSKY: Winston is an English professor in rural Eureka, Calif. When she needs to see a specialist, she often drives six hours one way to Stanford Health Care, just south of San Francisco.

WINSTON: I had this rash that wouldn't go away.

DEMBOSKY: She got that rash last winter after horseback riding. And it lasted four months.

WINSTON: It was itchy and, like, weepy, like poison oak.

DEMBOSKY: She made the trek³ to see a dermatologist⁴ at Stanford. And she suspected Winston was allergic⁵ to something in the skin cream she was prescribed, maybe her shampoo.

WINSTON: I started going back over my whole life and all the things that I had reacted to - lip balm, Neosporin.

DEMBOSKY: The doctor suggested coming back for a comprehensive skin allergy test.

WINSTON: Benzocaine, colophonium...

DEMBOSKY: They tested her for 119 substances usually found in beauty products.

WINSTON: ...Bacitracin, thimerosal...

DEMBOSKY: They put each substance into a tiny plastic capsule, then they drew a grid⁶ on Winston's back in magic marker...

WINSTON: So that they know what substance is going where - and then they use some kind of medical tape, and they tape these plastic capsules to your back. That's it.

DEMBOSKY: Winston left and came back two days later.

WINSTON: And they take everything off my back. And then they, quote, unquote, "read my back.'

DEMBOSKY: Turns out - Winston was allergic to 11 substances they tested. She was so relieved to have answers. But then, 2 1/2 months later, the bill came.

WINSTON: I was in total shock - $48,329.

DEMBOSKY: To tape some plastic capsules to her back.

WINSTON: I didn't have any needles stuck in me. I had no scalpels stuck in me. I had no anesthesia.

DEMBOSKY: In a statement, Stanford said the procedure was highly specialized⁷ and required extensive technical resources and knowledge. But medical billing expert Michael Arrigo says there's not enough information to understand the charges. Imagine buying a car for $48,000.

MICHAEL ARRIGO: We'd want to know if it had a four-cylinder, six-cylinder or eight-cylinder engine. Does it have the top-of-the-line Bluetooth stereo system? Does it have the more comfortable seats? We want to know what we're paying for. And here we don't have any of that.

DEMBOSKY: Winston's insurer, Anthem⁸ Blue Cross, agreed to a negotiated rate of $14,000. The company says it tries to strike a balance between affordability⁹ and provider choices. But Arrigo says that's still really high.

ARRIGO: The math just doesn't add up.

WINSTON: Arrigo says the customary charge for this test is $35. That includes a 26-percent markup¹⁰ for the expensive San Francisco Bay Area. Even if you charge the fee 119 times for each allergen...

ARRIGO: I just did the math on that. It's $4,165, less than 10 percent of this entire bill and only slightly more than this patient is being left with to pay out of pocket. So the math still doesn't make sense to me.

DEMBOSKY: In the end, Winston was personally on the hook for about $3,000. She negotiated that down to 1,500, and she put it on a credit card. But she thinks of all the people who couldn't afford that or don't have insurance like hers.

WINSTON: When I walk into the clinic and I see a grand piano - and on this last visit, I saw monogrammed, embroidered¹¹ pillowcases - I thought, hmm, that $48,000 is going to pay for those monogrammed pillowcases and that grand piano.

DEMBOSKY: Winston says if all that money went to pay for the care of low-income patients, maybe it would be worth it - but for a lobby befitting a five-star hotel, maybe not.

GREENE: All right, that reporting coming from April Dembosky from member station KQED in San Francisco. But we wanted to take an even closer look at how a simple allergy test can produce such an expensive bill. Dr. Elisabeth Rosenthal is editor-in-chief of our partner Kaiser Health News, and she spoke¹² to our co-host Noel King.

NOEL KING, BYLINE: That was a lovely image at the end of the story, this grand hospital lobby - but $48,000 for a skin test?

ELISABETH ROSENTHAL: Yeah. You know, it's nice to have a grand piano in the lobby. But that's a fairly simple test. I mean, basically, what we're seeing here is a kind of test at a sophisticated level that you could do at a more rudimentary level in your home. I mean, I have skin allergies¹³. So a lot of products come with something advising you to put a little on your arm the night before and to make sure you don't react to it. This is a much more sophisticated version of that - but $48,000 more? - uh-uh.

KING: Was part of the reason that this bill was so expensive because she was going to a hospital in the Bay Area, which is just an expensive place to live?

ROSENTHAL: Well, no. The Bay Area's an expensive place to live, but it's also an expensive place to get medical care. Many markets are highly consolidated¹⁴. That means there are few hospital systems in the Bay Area. There are four. They can compete with each other. And you would think that would bring down prices. But instead, basically, high prices become the norm because insurers look at what's usual and customary. So if everyone is charging high prices, they all get away with charging high prices.

KING: It's not about competition. It's about what's customary. That's interesting. For people who find themselves in this position, what should they do?

ROSENTHAL: Well, there are a couple of things they can do. First, don't write the check. That's the general advice for health care. Second, if your provider says - hey, this might get expensive - ask what expensive means to them because expensive in health care - you might think, well, the allergy test - oh, how could it - expensive could it be, a thousand bucks¹⁵? But here, we see it can be $48,000. And the other thing is I would say, when you look for comparison prices to bargain to say that's unreasonable¹⁶, don't just look in your area. I mean, the expert in the piece says that $35,000 per skin test is normal in the Bay Area. Well, in other places, it might be $4 or $6 or $10. So I think we have to look nationally for references.

KING: Dr. Elisabeth Rosenthal of Kaiser Health News, thank you so much.

ROSENTHAL: Thanks.

(SOUNDBITE OF GEOTIC'S "TIME SQUARE")

1 allergy   

n.(因食物、药物等而引起的)过敏症

参考例句：

• He developed an allergy to pollen.他对花粉过敏。
• The patient had an allergy to penicillin.该患者对青霉素过敏。

2 byline   

n.署名；v.署名

参考例句：

• His byline was absent as well.他的署名也不见了。
• We wish to thank the author of this article which carries no byline.我们要感谢这篇文章的那位没有署名的作者。

3 trek   

vi.作长途艰辛的旅行；n.长途艰苦的旅行

参考例句：

• We often go pony-trek in the summer.夏季我们经常骑马旅行。
• It took us the whole day to trek across the rocky terrain.我们花了一整天的时间艰难地穿过那片遍布岩石的地带。

4 dermatologist   

n.皮肤科医师

参考例句：

• I think you should see a dermatologist first.我想你应当先看皮肤科大夫。
• The general practitioner referred her patient to a dermatologist.家庭医生把她的病人交给了皮肤科医生。

5 allergic   

adj.过敏的，变态的

参考例句：

• Alice is allergic to the fur of cats.艾丽斯对猫的皮毛过敏。
• Many people are allergic to airborne pollutants such as pollen.许多人对空气传播的污染物过敏，比如花粉。

6 grid   

n.高压输电线路网；地图坐标方格；格栅

参考例句：

• In this application,the carrier is used to encapsulate the grid.在这种情况下，要用载体把格栅密封起来。
• Modern gauges consist of metal foil in the form of a grid.现代应变仪则由网格形式的金属片组成。

7 specialized   

adj.专门的，专业化的

参考例句：

• There are many specialized agencies in the United Nations.联合国有许多专门机构。
• These tools are very specialized.这些是专用工具。

8 anthem   

n.圣歌，赞美诗，颂歌

参考例句：

• All those present were standing solemnly when the national anthem was played.奏国歌时全场肃立。
• As he stood on the winner's rostrum,he sang the words of the national anthem.他站在冠军领奖台上，唱起了国歌。

9 affordability   

可购性

参考例句：

• Performance-Based Logistics Affordability: Can We Afford Categorical Conversion to Performance-Based Acquisition? 基于性能的后期的可承受性：能否担负得起向基于性能的采办的无条件的转变？
• There would be no crisis of affordability, as't for food or clothing. 就想食物与服装一样，因为供给没有危机。

10 markup   

n.加价，涨价，利润

参考例句：

• This mean that international delivery will line markup from today.这意味着国际快递将从今天起全线涨价。
• Our products are expensive,and distributors and retailers always want a large markup.我们的产品很贵，经销商和零售商总是要求高额利差。

11 embroidered   

adj．绣花的

参考例句：

• She embroidered flowers on the cushion covers. 她在这些靠垫套上绣了花。
• She embroidered flowers on the front of the dress. 她在连衣裙的正面绣花。

12 spoke   

n.（车轮的）辐条；轮辐；破坏某人的计划；阻挠某人的行动 v.讲，谈（speak的过去式）；说；演说；从某种观点来说

参考例句：

• They sourced the spoke nuts from our company.他们的轮辐螺帽是从我们公司获得的。
• The spokes of a wheel are the bars that connect the outer ring to the centre.辐条是轮子上连接外圈与中心的条棒。

13 allergies   

n.[医]过敏症；[口]厌恶，反感；（对食物、花粉、虫咬等的）过敏症( allergy的名词复数 )；变态反应，变应性

参考例句：

• Food allergies can result in an enormous variety of different symptoms. 食物过敏会引发很多不同的症状。 来自辞典例句
• Let us, however, examine one of the most common allergies; hayfever. 现在让我们来看看最常见的变态反应的一种--枯草热。 来自辞典例句

14 consolidated   

a.联合的

参考例句：

• With this new movie he has consolidated his position as the country's leading director. 他新执导的影片巩固了他作为全国最佳导演的地位。
• Those two banks have consolidated and formed a single large bank. 那两家银行已合并成一家大银行。

15 bucks   

n.雄鹿( buck的名词复数 )；钱；（英国十九世纪初的）花花公子；（用于某些表达方式）责任v.（马等）猛然弓背跃起( buck的第三人称单数 )；抵制；猛然震荡；马等尥起后蹄跳跃

参考例句：

• They cost ten bucks. 这些值十元钱。
• They are hunting for bucks. 他们正在猎雄兔。 来自《简明英汉词典》

16 unreasonable   

adj.不讲道理的，不合情理的，过度的

参考例句：

• I know that they made the most unreasonable demands on you.我知道他们对你提出了最不合理的要求。
• They spend an unreasonable amount of money on clothes.他们花在衣服上的钱太多了。