Some call the prices assigned to certain types of medical equipment arbitrary and completely inflated.
The chances are good that consumers will not learn about the medical markup until they get stuck with the bill.
Hospital rates have been regulated for nearly 50 years in Maryland. The idea was to create accountability, but costs associated with the care and services received in a physician’s office are a whole different story.
When Laurel Funk’s son broke his hand, she was glad it healed quickly, but she wasn’t glad when she got a medical bill that simply floored her.
“First thing I thought was, it must have been a mistake,” Funk said.
She got a $300 bill for a hand splint that her son received in the doctor’s office. Funk came to learn that even though the doctor is in her insurance network, the medical supplier he used is not.
“So, I was still smarting from this bill that I paid, and then my son and I got online and he said, ‘Mom, this thing only costs like $38,'” Funk said.
Funk’s son had found the very same splint made by Hely and Weber.
“They shouldn’t be allowed to charge so much. I did the math and it’s nearly eight times the retail value,” Funk said.
Professor Gerard Anderson, of the Johns Hopkins Bloomberg School of Public Health, is studying this issue of what he calls made-up medical pricing, which he said happens all the time.
“They completely have you over a barrel, and they know it,” Anderson said. “We’ve looked at hospitals, we’ve looked at doctors’ offices, there’s no rhyme, no reason as to how much they charge.”
What’s driving this? Anderson said there are no rules on pricing and no transparency when it comes to cost.
“In most cases, people don’t really care how much it costs, because insurance is going to pay that bill,” Anderson said.
The WBAL-TV 11 News I-Team spoke to the supplier of the splint, National Respiratory Care in Owings Mills. They acknowledged that the bill can be a shock and may seem a bit puzzling, but they said they are charging what is usual and customary, and take into consideration private insurers and Medicare will not reimburse the full amount.
“You’re not the only one out there feeling like you’ve been overbilled. There are millions of you out there, and we have to take our power back,” said Sarah O’Leary, a consumer health care advocate with a California-based company called ExHale.
O’Leary advises clients to ask for upfront pricing and an estimate for all non-emergency tests and procedures, make sure everyone’s in network, check with your insurer and find out what they will cover and call a local medical supply company where you can probably get the equipment directly for a lot less.
“Act like you’re going grocery store shopping. You wouldn’t go into a grocery store where there weren’t any prices on the shelves. Treat your health care the same way,” O’Leary said.
Funk said her son’s broken hand taught her a financial lesson and she is going to do whatever she can next time to avoid another case of sticker shock.
This past weekend, Funk noticed National Respiratory Care refunded her credit card nearly $200.
This content appears as it was originally published on WBALTV 110