An $18,000 breast biopsy: Hospital makes woman pay more because she has insurance

September 14, 2022

Here’s a case that may make you angry. Kaiser Health News shares the story about Dani Yuengling, who at 35 felt a lump in her right breast.

At the time, Yuengling was the same age her mother had been when she first received a breast cancer diagnosis in 1997. The disease took Yuengling’s mom in 2017.

Yuengling tried to ignore her lump but eventually had a mammogram, which confirmed that the lump needed to be biopsied. She scheduled the procedure at her local hospital in North Carolina because that is where her doctor referred her to go.

Yuengling was of course concerned about having the procedure and what it would find. But she was also worried about the cost. The health insurance plan she had through her employer had a $6,000 annual deductible. She worried that whatever the procedure cost, she’d face a big bill.

Her worries continued after the hospital refused to give her a cost estimate for the procedure. She was told that there was no way of knowing what type of biopsy needle would be needed until the procedure was underway and that would affect the price. Yuengling then checked the hospital’s online “Patient Payment Estimator,” which showed that an uninsured patient would owe about $1,400 for the procedure. While she thought it would be cheaper than that, since she did have insurance, a Google search indicated that Yuengling might expect to pay about $3,000.

She decided to go ahead with the biopsy and learned that her lump was not cancer.

Then the bill arrived. The hospital charged a total of $17,979 for the procedure, including lab work, pharmacy charges and sterile supplies. The hospital’s negotiated in-network rate with Yuengling’s health plan was $8,424.14. Accounting for the deductible, the insurance covered $3,254.47, leaving Yuengling with a $5,169.67 bill.

Not only had the hospital charged an extraordinarily high price for the procedure, but they also boosted their profit because Yuengling had insurance. Interviewed by Kaiser Health News, the hospital blamed “a glitch” in its online calculator for providing inaccurate information and promised to fix it.

In the end, Yuengling called the hospital’s billing department and was offered a 36% discount, reducing the amount she would pay to $3,306.29.

Yuengling paid the bill in full because it was upsetting to her to have lingering debt.

Have you or someone you know been stuck with an excessive and unexpected medical bill? Share your story with Voices for Affordable Health.