How does a urine test after a back operation trigger a $17,850 bill?
When she was in her 20s and went to college in Texas, Elizabeth moreno suffered back pain from spinal deformity. “I can’t stand the pain,” she said. “I can’t dress myself, I can’t walk through my house, let alone class, nothing, no medicine for me, and even dull pain.”
Moreno said she also tried chiropractic and acupuncture, but they didn’t let the pain go away. Finally, a doctor at the student health center introduced her to an orthopedic specialist who tested it and concluded that a plate had blocked the nerves in her legs and needed to be removed. Moreno’s father, a retired Ohio doctor, saw many failures during his career, and he thought it was the best way to go.
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In late 2015, moreno underwent surgery in Houston, which she described as “a complete success”. When the operating room asked her to leave a urine sample for a drug test, she hardly thought of it.
Then the bill comes.
Patient: Elizabeth moreno, then 28, a student at the university of Texas at SAN marcos.
Total bill: $17,850 for urine detection in January 2016.
Service provider: Sunset Labs LLC in Houston.
Medical: moreno took a disk from her back in December 2015. Her surgeon prescribed an opioid analgesic. During a follow-up visit to mid-january 2016, she was asked to leave a urine sample, which she considered routine. In March 2017, the laboratory sent $17850 bill to her, and her urine is used in the detection of cocaine, methadone, anti-anxiety drugs and other kinds of she had never heard of drugs.
What makes it: the urine drug test has been reported to have been triggered by an explosion of opioid overdose deaths in the past decade. Many prescription drug doctors rely on urine tests to help reduce drug abuse and keep patients’ chronic pain safe. However, these tests have become a cash cow for the emerging testing industry, and critics point out that needless, often expensive tests are sometimes made for profit rather than patient care. Doctors can decide whether to test patients who take opioids in the short term, such as after surgery. Dr. Moreno’s surgeon will not discuss her urine test – why he ordered it, and why the sample tested so much material.
The three experts contacted by Kaiser Health News questioned the need for such extensive testing and were shocked to hear the price of the lab. These tests rarely cost more than $200, they say, and often much less, depending on the complexity and technology used. Some doctors’ offices use simple cup tests that can detect several types of drugs on site and can be purchased for about $10. As the lab does here, the cost may go up when the lab tests to detect the number of specific drugs and the cost of each drug.
Experts say individual tests in the lab are too expensive, such as $1,700 to check for amphetamine or $425 to determine the illegal hallucinogenic drug phenopeclidine, also known as PCP. They also criticised $850 for two tests to confirm that her urine samples were not adulterated or tampered with.
Blue Cross, Moreno’s insurance company, and Blue Shield, Texas, refused to pay any bills, saying the lab had no network and was therefore not covered. If it had already cut prices, it would have covered $100.92, according to the insurance company’s explanation of benefits to moreno.
Sunset Labs says its price tag is “consistent” with its competitors in the region. It also says that doctors treating pain believe extensive urine testing is the “best action plan” and that the laboratory “is not appropriate” to challenge the doctor’s test.
The solution: Dr. Paul Davis, the father of moreno, worried that his daughter’s credit rating was damaged and paid $5,000 in settlement fees to the lab in April 2017. He also filed a formal complaint with the Texas attorney general’s office, accusing the lab of “staggering price fraud”. The lab’s lawyer said he did not know the complaint. A spokesman for the Texas attorney general confirmed to KHN that the office had received complaints about the lab, but declined further comment.
Take-out: when a doctor asks for urine or blood samples, always ask about its use. Insist on sending it to your laboratory in your insurance network.