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Patient Questions Same Procedures’ Cost Difference

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CBS Minnesota (con't)

Affordable Care Act Updates: CBSMinnesota.com/ACA

Health News & Information: CBSMinnesota.com/Health

MINNEAPOLIS (WCCO) — Thousands of dollars difference in price for the exact same thing? That’s what one Minnesota woman experienced when she had a common medical procedure done twice.

She’s worried stories like hers are why the average worker’s health care costs have more than tripled in the last decade.

School teacher Ruth Clifford got a lesson herself over the past year on medical costs. Clifford had successful bunion surgery on each of her feet. A little screw was left in to stabilize the bone while it healed. Two months after each operation there was a quick outpatient procedure.

“They cut it open, take the screw out and put two stitches in,” said Clifford. “This screw is $1,500 and this one is about $1,100. And they’re identical screws, identical procedures.”

The procedures were performed by the exact same surgeon. So, how could this be? What was the difference?

The bills show Dr. Kim Fjelstad removed the screw each time and was paid $525 each time.

“I called the surgeon to confirm, ‘Was it exactly the same?’ He said, yes it was.”

First, Centennial Lakes Surgery Center in Minneapolis charged $1,556 dollars for the use of its facility under billing code 20680.

For scheduling convenience Clifford had the second screw removed at Minnesota Valley Surgery Center in Burnsville, which was under the billing code 20680 and the charge was $10,767.27.

Minnesota Valley Surgery Center declined to speak on camera, saying it was unable to discuss Clifford’s case because of HIPPA and federal law protecting patient privacy.

The Center’s Administrator told WCCO-TV reporter Dennis Douda, “This is not an apples to apples comparison. There are many extenuating circumstances.”

According to a company statement, “Facility charges are based upon average charges in a particular for the market as determined by a third-party provider of that information.”

The Minnesota Valley Center’s website identifies it as part of Nueterra Healthcare, a Kansas-based company with over 90 surgical and outpatient medical facilities across the country.

Clifford’s insurance company, Health Partners, said the charges exceeded its fee limits, but it still paid out over $6,700 on the claim.

Health Partners declined to speak on camera, but did say it always encourages its members to shop around for services and even provides online tools to make it easier to compare costs for over a hundred medical procedures.

Clifford pursued her concerns with the Minnesota Attorney General’s office, which offered to mediate the differences, but ultimately conceded: “Under Minnesota law, the Attorney General’s Office has limited authority.”

Meanwhile, Minnesota Valley Surgical Center sent a letter of collection to Clifford, who says one phone conversation with an administrator at the center still frustrates her.

“One thing that she said was that it really shouldn’t concern me because my insurance was covering most of it,” she said. “But I remember thinking, that money comes from somewhere. I’m paying for insurance. Other people are paying for insurance. So, it’s not that it’s just free.”

By Dennis Douda, WCCO-TV

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