The stomach cramp and nausea began one hot Friday evening in August, midway through a vacation on Martha’s Vineyard. The next morning, nearly doubled over in pain, a patient who we’ll call "Nancy" walked gingerly into the emergency room at Martha’s Vineyard Hospital.
Nancy is a 55-year-old former nurse who would prefer not to use her real name because she works with the hospitals in this story.
Even Nancy, who spends hours every day focused on health care costs, would gasp when she saw the bill for this visit.
In the ER, a doctor poked at Nancy’s tender belly and took blood for tests and a urine sample. The doctor ordered a CT scan of Nancy’s abdomen and pelvis, using contrast. It showed bulges, inflammation and thickening in Nancy’s colon. The diagnosis: uncomplicated diverticulitis. Nancy filled a prescription for an antibiotic, took some Advil, and felt better after a few days on a clear liquid diet.
Five weeks later, the diverticulitis monster invaded Nancy’s intestines again. This time she went to an urgent care center closer to home, run by Beth Israel Deaconess Medical Center (BIDMC). A doctor there ordered the same single CT scan of the abdomen and pelvis, again with contrast.
Nancy says the care she received at both places was great. But a month later, when she received the bills and her insurance company's explanation of benefits for both visits on the same day, she was stunned.
The explanation of benefits show Blue Cross had paid Martha’s Vineyard Hospital almost seven times what it paid BIDMC’s urgent care center for the same CT scan — $3,888.76 vs. $574.97.
Total CT scan cost at Martha's Vineyard Hospital: $3,888.76 vs. Total CT scan cost at Beth Israel Deaconess Medical Center urgent care: $574.97
(Have a look at the explanation of benefits here. We compare the payment for the test, listed as “Technical Component,” and the payment to the radiologist, listed as “Professional Component.”)
Why a nearly seven-fold difference in payment for one test and the payment to read it?
I posed that question to Martha’s Vineyard Hospital (MVH). A spokeswoman said via email that MVH’s procedures and costs are very different from an urgent care center. The spokeswoman noted MVH is open 24/7 and must comply with lots of state and federal regulations that don’t apply to an urgent care center. MVH also said that Nancy had two scans at its facility, vs. one at BIDMC — that’s even though the Blue Cross summary only shows payment for one CT scan.
MVH also said it's planning to open a walk-in clinic next year that would have a different, lower cost structure than the MVH emergency department.
The Blue Cross corporate office agreed with MVH that care in a hospital is more expensive than in an urgent care clinic. And a spokeswoman for Blue Cross said that MVH would be even more expensive because it's an island hospital.
(A side note: If you're sick on Martha's Vineyard but you feel well enough to get on a ferry, a CT scan of the abdomen and pelvis, with contrast, goes for $1,398.35 at Falmouth Hospital. That’s the cash rate, which I got from the hospital. My Blue Cross representative said she did not know the Blue Cross negotiated rate.)
Martha’s Vineyard Hospital is part of the Partners HealthCare network, which includes some of the most expensive hospitals in the state. Neither the hospital nor Blue Cross mentioned this as a reason for the nearly seven-fold payment difference.
BIDMC declined a request to comment for this story.
Just for fun, I called the member line at Blue Cross to ask how much this CT scan would cost at BIDMC — the hospital, not their urgent care clinic. The member rep told me Blue Cross would pay BIDMC $1,276 for a CT scan of the abdomen and pelvis with contrast at any facility owned by that network. She said the hospital and urgent care center would receive the same payment for the test. She’s wrong, according to the summary Nancy received from Blue Cross, but this illustrates how tricky it can be to unravel the mysteries of this -- or any — health care bill.
If you have more tales from the rabbit hole of health care bills and price, do share. Maybe we can find our way out together.