Company’s “Transparent Pricing Tool” Reveals Charging Deviated from Sentara’s Own List Prices
Most hospitals charge uninsured patients more for certain services, like lab tests or diagnostic scans, than they bill insurance companies for the same services. But a review of Sentara Healthcare records and a bill from a recent patient shows the company overcharged at least one uninsured patient.
Take the December 2020 case of a patient treated for a kidney stone at Sentara’s Virginia Beach Hospital. The patient provided his invoice from Sentara to C&BP.
Guidance from the prestigious Cleveland Clinic and NYU medical school indicates that kidney stones are detected by blood tests, urinalyses, kidney tests and a “noncontrast” CT scan of the abdomen and pelvis.
The Sentara patient’s bill shows he was charged $6,317 for the CT scan and a total of $1,157 for lab tests.
Sentara’s Price List
But Sentara’s own price list posted on the company’s website shows something different. A noncontrast CT scan of the abdomen and pelvis, which the Cleveland Clinic calls the “most accurate imaging modality to detect kidney stones and to direct management,” costs $2,885 for a patient without insurance.
Even with the 50% discount granted to uninsured patients who seek financial aid, the cost of the patient’s scan was $3158.50. That’s $343.50 more than the listed price of $2885 for uninsured patients.
So, not only does the Sentara price transparency tool show that it charges uninsured patients more for services. It also charges those patients even when they are actually billed, as the kidney stone patient’s bill shows.
The Sentara kidney stone patient was also charged $1157 for lab tests related to his diagnosis and treatment. Guidance from NYU Langone Health in New York indicates the best tests used to diagnose a kidney stone are blood tests and urinalyses. We added a test for basic kidney function to that list.
- Sentara lists these prices for uninsured patients:
- Blood test, comprehensive group of blood chemicals, code 80053: $197.50.
- Kidney function panel test, code 80069: $169.
- Automated urinalysis test, code 81003: $49.50.
- Total: $398.
Given these prices, it appears the kidney stone patient was charged $759 more for lab tests than the Sentara price guide for uninsured patients indicates. Sentara records for its Virginia Beach hospital indicate it bills insurance for 28% of the rate charged uninsured patients. That comes to $111.44 or less than 10% of what the kidney stone patient was charged for lab tests.
In a note to C&BP, the patient described the experience this way:
“Blood was drawn, an IV was started and I was taken to have a CT scan and later told by a urologist, who I saw for about 2 minutes, that it was a kidney stone. I was given something for pain, then given 2 prescriptions… for pain and the other to dilate my urethra tube, and sent home. All of this took about 4 hours.”
C&BP asked Sentara spokeswoman Danya Bushey for an explanation of the possible discrepancies between what the kidney stone patient was charged and the company’s listed for prices for the services. She did not respond.
Sentara’s Prices Are Hard to Find and Decipher
Medical charges are often difficult to decipher and hospital chains have long resisted disclosing the cost of their services. A 2019 executive order by President Donald Trump led to the creation of a rule that hospitals had to reveal their prices by Jan. 1, 2021. The Transparent Pricing Rule made the review of Sentara’s price structure possible.
But finding the information isn’t easy.
- A visitor to the Sentara home page has to know to click on the “Pay your bill” link at the bottom of the page.
- That takes you to a link on the left side of the page called “Understanding prices.”
- At the bottom of the next page is another link called “Understanding Health Care Costs.”
- That page contains another link called “Estimating Hospital Charges” and a menu of links to the Sentara hospitals in the Hampton Roads area. The link to the various hospitals takes a patient to this site: https://carepricer.nthrive.com/#/home
- Once there, a patient needs to know the precise term for the procedure or service to be provided. That can be complicated since there are hundreds of terms to sort through.
But navigating these sites is essential to learning more about how much a hospital charges for a service. And the downsides to not knowing of these details are significant and expensive.
The combination of different charges for services that cost insurance companies less than uninsured individuals and aggressive collection tactics can mean uninsured patients are hounded by collection agencies and taken to court to force payment.
“The patient’s account may be moved to bad debt and the delinquent account turned over to Sentara’s collections department.” These steps “may include the outsourcing of the account to a collections agency that may report the delinquent account to one or more consumer reporting agencies (credit bureaus). In addition, a Hospital Facility may file lawsuits, take judgments, record judgments or deeds of trust, place liens on realty, and garnish wages and other assets.”
Extraordinary Collection Actions
Hospitals calls these “extraordinary collection actions” or ECAs. After the last 15 months of the COVID-19 pandemic, at least one state, Colorado, has imposed a moratorium on ECAs, while Sen. Chris Van Hollen, D-Md., has introduced a bill to create a national moratorium.
Sentara registered with the IRS as a tax-exempt nonprofit charity but has net assets of $6 billion. We’ve been probing how the healthcare giant that’s seeking to expand into North Carolina uses lobbying and influence to crush competitors, the lengths it goes to do that and the impact on average citizens.
Do you want to show us your bill? Or do you have information to share? Send us a note through our tip line.
Ray Locker is enterprise and investigative editor of Checks and Balances Project, an investigative watchdog blog holding government officials, lobbyists, and corporate management accountable to the public. Funding for C&BP is provided by Renew American Prosperity and individual donors.
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