Colleen Ryan beat breast cancer in 2011, but found herself in the middle of a different kind of fight when she moved to Southwest Florida in 2019.
Her bill for a bone density shot that used to cost $10 in Illinois, was $2,500.
“(I have to get the shot) Otherwise I’m going to be at higher risk for osteoporosis and broken bones,” said Ryan. She is supposed to get an injection of the drug Prolia three times a year as long as she is on cancer maintenance drugs.
But, because of her fear of another huge bill, she has decided to skip the shot until she finishes her maintenance next year.
Ryan said when she called Lee Health to find out why the charge was so high, they could not provide an explanation. The fee appears as part of the “facility” charge on the bill.
“In a hospital outpatient department, you do split out the physician or the care provider piece from everything else. So, it’s not just the cost of the building; it could be, you know, the drug that was administered to you or shot that you had, other things like that,” said Mary Briggs, system director for strategic communications for Lee Health.
Briggs would not provide specifics about Ryan’s bill. However, WINK News looked at a copy of the itemized bill for Ryan and discovered that the 60mg shot was listed with “60 quantities.” But according to a certified professional coder that handles medical billing for several physician’s offices, that quantity was not a billing mistake.
“It’s one of those tricky things that if you’re not in the field of medical billing, then it does look like 60 shots. It is billed by unit and it just so happens that this is an expensive drug,” said Lindsay Horn, who reached out and offered to look at Ryan’s bill after the story first aired on WINK News.
The real culprit leading to the high charge for the shot: Ryan’s high deductible insurance plan.
Ryan’s health insurance changed when she moved from Illinois to a plan that required thousands of dollars spent upfront before the insurance carrier covers any costs.
Horn also said patients who need this type of injection can save money by having it administered at a standalone physician’s office, and not a hospital-based facility. She looked up the price using Ryan’s insurance plan information and found that it would have cost her $1,200 instead of $2,500.
Once Ryan met her deductible, there would not be a charge for the shot the rest of the year.
According to Amgen, which makes Prolia, about 40% of people on commercial insurance will pay higher out of pocket costs to receive the drug. Amgen offers a drug discount program that can lower costs to around $25 a shot for people in those situations.
Ryan said she wished Lee Health would have alerted her about the high upfront cost before she had the shot. After disputing the charge, Lee Health agreed to lower Ryan’s bill to just $250. Briggs said courtesy adjustments are offered on a case-by-case basis.
“We understand that physician and hospital bills can be difficult to understand, so Lee Health offers personalized assistance for patients who have questions about their bills. You can call our financial representatives or come in and meet one-on-one to walk you through your bill or help you reconcile your bill with your insurance coverage,” said Briggs.
Horn said that it’s actually more important to look at the explanation of benefits statement from your insurance company before paying any bill you receive from a physician or a hospital. An explanation of benefits will break down the contracted rate the provider is allowed to charge you and show you how much of it you owe based on your out of pocket copays, coinsurance, and deductibles.
WINK News is taking an in-depth look at health care in our Cost of Care series. If you have a story you want to be heard, whether it’s a high medical bill, an insurance dispute or a medical procedure gone wrong, send us an email to firstname.lastname@example.org.