By Consumers for Quality Care, on December 13, 2023
Reesha Ahmed was eight weeks pregnant when she visited her OB-GYN at Texas Health Hospital Mansfield for a prenatal check-up. She was told to get some lab work done just down the hall from the office. Everything seemed routine, but as she learned later, the hospital charged her $2,400 for the lab work, according to KFF Health News. Her situation is shining a light on the exorbitant prices charged by hospitals for tests that are far cheaper in other settings.
Having her bloodwork done at the same place as her checkup originally seemed like a convenience, but quickly turned into a costly experience. Unfortunately, Ahmed’s experience is not unique to her. Studies have found that hospitals often charge more for lab tests as compared with physician offices or commercial labs. In Texas, the Health Care Cost Institute (HCCI) found that the prices hospitals charged for lab tests were more than six times the median price for the same at a physician’s office.
“It is convenient to get your lab done right in the same building,” said Jessica Chang, a Senior Researcher at HCCI, but “many patients are not thinking about how highly marked up these lab tests are.”
Ahmed, an Anthem customer, was also charged for tests that are usually deemed preventive care and therefore covered at no cost to the consumer. Experts interviewed for KFF’s story agreed that her lab work should have been deemed preventive care under the Affordable Care Act (ACA), meaning that the cost should be fully covered by her insurer.
Ahmed attempted to work with both the hospital and her insurer for almost a year to no avail. It was not until KFF Health News got involved that the dispute was finally resolved in her favor.
Ahmed’s situation underscores the urgent need for comprehensive reform. CQC urges hospitals to stop charging absurd fees for procedures and services that can be done for far less money in other facilities. Additionally, insurers must be held accountable for covering needed treatments without sky-high out-of-pocket costs, and lawmakers must take on these predatory practices.