Variations in the cost of C.T. Scans; unconscionable CAT Scan contracts

When a family member requires a C.T. scan, it makes sense to assume the doctor has weighed this decision carefully. After all, the patient is vulnerable, those who love the patient are vulnerable. The doctor has the medically ignorant up a creek; a high degree of trust is essential.

In 2009, patients succumbed to the adverse effects of poorly manufactured CT scanners that resulted in elevated C.T. scan PCB levels. These scans should not be administered lightly. There must be a compelling reason for sending a patient into harm's way. The physician is prescribing radiation. There is a chance that the patient may have an allergic reaction to the iodine. Last, but not least, there is the cost of the procedure.

I have been taken by unscrupulous auto mechanics who authorize expensive fixes when nothing is broken. The general public- and particularly women- are vulnerable to such thieves.

When told my daughter needed a C.T. scan, I was in no position to argue. I am not a doctor. I was not there. I could not assess the degree of pain my daughter was experiencing. I expected it would cost a lot... possibly even $1000. My husband would not be happy; one of our monthly unemployment checks went directly to Golden Rule to cover our H.S.A.

I trusted the doctor to administer what was necessary and nothing more.

I was wrong on two counts: the C.T. scan was 2.5 times the highest number I had imagined. And the procedure proved unnecessary. My daughter was released with a prescription for a pain killer and was fine the next morning.

At minimum, one would expect the cost of such a procedure to be consistent. Or at least within a reasonable range of costs. This expectation, however, is far, far from the truth. The cost of a C.T. scan can vary $1500 at hospitals within the same city for the exact same procedure!

Finally, large insurance companies are rebelling against this inequity. In a New Jersey court, Aetna versus Hannallah claims doctors are charging unconscionable costs. What for a multi-billion dollar industry is unconscionable is thousands beyond similar claims for an average housewife.

At minimum, one would expect the cost of such a procedure to be consistent: an iPhone is the same price no matter which Verizon store consumers visit. Technology is technology, right?

Wrong! This expectation is far from the truth. The cost of a C.T. scan can vary within thousands of dollars at hospitals within the same city for the exact same procedure! (See link to the right.)

Even large insurance companies are rebelling against this inequity. In a New Jersey court, Aetna versus Hannallah claims out of network doctors are charging unconscionable costs. What is unconscionable for a multi-billion dollar industry is thousands beyond what is unconscionable for the average housewife, yet the claim is the same.

The cost of a C.T. scan varies according to the body part scanned, the location of the facility and the type of insurance a patient has. How can this possibly be defensible?

For example, in 2009, my 17 year old daughter was sent to the Emergency Room at Yampa Medical Center in Steamboat Springs, because she was experiencing abdominal pain. I was four hours away, in Denver, when I received a call saying she was in the hospital. Of course, I immediately went into stress mode; my brain went on overdrive and I became completely dependent on the doctor to make decisions in my daughter's best interest. I am not a doctor.

My husband had just become unemployed and for some reason, my daughter had our old group insurance policy in her purse. Therefore, the Emergency Room personnel initially thought she had good coverage through Anthem when the doctor prescribed a C.T. scan for her abdomen. In fact, we had an H.S.A. for which we paid $800 a month. We were personally responsible for all expenses up to $5800.

When the bill arrived, we owed $4053.63. Yet, the C.T. scan revealed nothing. My daughter was sent home with a prescription for pain killer and was fine the next morning.

The cost of the CAT SCAN BODY PORTION was $2191.00. The radiologist's fee was $466.00. The rest was the cost of the Emergency Room services, Lab tests, pharmacy and general supplies. I had expected a bill in the range of $1500.

The cost of the C.T. scan raised three questions:

1. Would the C.T. scan have been prescribed, had they immediately known we were unemployed and had a personal H.S.A. plan (that cost us $10,000 a year and yet paid nothing until we reached $5800)? Did they administer it because they thought we had a comprehensive Insurance plan in place?

2. Was the C.T. scan warranted? Or was it administered because this hospital was still paying off the CT scan machine purchased in January of 2007? To pay off these $1 million scanners, doctors need to administer 3000 tests, according to the New York Times article linked to the right, published in June of 2008. By 2007, 1 in 7 Emergency Visitors were given CT scans, says Keith Kocher, M.D., M.P.H., a clinical lecturer in University of Michigan's Department of Emergency Medicine. Yampa Valley Medical Center serves less than 8000 Emergency patients annually, if 2010 is any indication. (See link to the right.)

3. Reading all of these statistics and noting that a diagnosis in my daughter's situation was never made leaves me wondering, was I duped into authorizing this procedure under duress? Did these doctors convince me that my daughter needed a C.T. scan, when all she had were stomach cramps? Was I deceived due to my emotional state? What happened to the Hippocratic Oath? Has it been replaced by the Oath of the Almighty Dollar?

No explanation was ever given as to why this procedure was considered necessary. In follow up conversations, as I repeatedly posed this question in phone conversations and with the collections agency, my concern was never considered worthy of even a mention. It seems that what concerned the hospital was their expected payment of $4053.63. They had no reason to bother giving me the courtesy of an explanation as to why I should pay them one penny of this $4053.63; no one watch dogged the proceedings but... me!

In fact, they had no reason to give me the courtesy of laying out these expenses when they asked whether or not I wished to have a C.T. scan administered to my daughter. They gave me some specific medical jargon that terrified me. At that point, I would have consented to a lobotomy, had they told me this was what my daughter required to make a 100% recovery.

In contract law, the courts consider unconscionable any contract which allows one side superior bargaining power. Balancing a scale between an Emergency Room doctor and a parent financially responsible for a minor patient, the Emergency doctor's pan contains these items:

1. medical training (A plus)
2. unemotional state of mind (a plus)
3. possession of minor (a plus)
4. argument that treatment outweighs cost (a plus)
5. urgency (a negative)

The pan of a parent financially responsible for the minor, though not present in the Emergency Room contains:

1. instinct to protect child (a negative)
2. fear (a negative)
3. the doctor's word (a negative)
4. unwillingness of ER to discuss cost expectations AND industry wide inequity in fees (a negative)
5. urgency (a negative)

On such a scale, the Emergency Physician holds superior bargaining power; the scale hits the table on the side of the physician, rendering the parent victim of duress, undue influence and unconciounable dealings.