For a stiff neck, nearly $6,000 in physical therapy seemed too much

By Chris Core,

August 05, 2013

 

I’m not a health policy analyst or an expert on America’s health-care system. I’m simply an average consumer who put 2 and 2 together. When that added up to much more than 4, it got me thinking.
I woke up one morning in the middle of June with a stiff neck. It was painful to try to turn my head from side to side. When a couple of days of heat, rest and Advil didn’t make me better, I went to a doctor.
The doctor took X-rays, prescribed a muscle relaxant and suggested physical therapy. One of the therapy clinics was in his building, so I stopped by on my way out to make an appointment for later that afternoon. Before I left the therapy office, the folks at the front desk took my insurance information.
When I showed up for my appointment, the front-desk clan was positively giddy with the news that my insurance plan would cover up to 12 physical therapy visits per quarter. And because it was the middle of June, they urged me to book 11 more sessions right away to take full advantage of my coverage this quarter. My only cost would be a $10 co-pay each time.

I found it odd that the front-desk folks wanted me to book 11 more sessions before their therapist had even seen me. I said I would let them know.
I was assigned a therapist who was only a year out of physical therapy school. She put heat on my neck and began to go down a list of questions. “On a scale of 1 to 10, how much discomfort are you in?” was one of them. More questions followed. Then she asked what I hoped to accomplish with my physical therapy. Given that I couldn’t turn my neck, I thought the answer was obvious.
The therapist rubbed my neck and shoulders a bit, then gave me a printout of some exercises to do at home. I was in and out in less than 45 minutes.
The front desk was still eager for me to book another appointment, so I did, for two days later.
Appointment No. 2 lasted an hour. I got heat on my neck, a little massage and more exercises. I also was given some big rubber bands and an instruction sheet on how to exercise with them at home.
As I left the office, the front desk suggested I make more appointments, but because I was leaving town a couple of days later, I told them I’d call when I got back.

Be it the muscle relaxers or the exercises, my neck was much better at the end of my trip, so I never did call them back. They, however, continue to call me to remind me to make more appointments.
A few days later, I discovered why they want me to come back for more treatment. My insurance company sent me notification it was “seeking additional information about these charges,” which would mean a “delay in payment” for my PT treatments. My insurer had been billed $412 for my first appointment and $384 for the second. I can hardly blame the company for wanting to know the justification of such costs.
Now I understand why the front desk seemed so eager to have me use my maximum of 12 visits before the end of June: I was leaving nearly $5,000 worth of payments on the table.
I recognize that I am partly to blame for running up the tab. At no time did I ever ask how much each treatment cost. I never inquired about the breakdown in charges for the heating pad, the interview, the massage and the big rubber bands. I simply handed over my little $10 co-pay.
As I look at it now, the charges seem excessive. There is little justification in my mind for the $800 my insurance company was billed. Had I been told the costs upfront and been expected to pay for them, I would have said no. But nobody volunteered the information, and I didn’t ask.
I suspect my experience is a small example of why America’s health care costs so much. As long as consumers aren’t asked to pay and don’t even know the true costs of procedures, our health-care spending will continue to skyrocket.
Perhaps a place for health-care reform to start is with full disclosure of costs. If we customers are aware of what our insurance company is being billed for, we could do our part in holding our providers responsible for excessive costs and unnecessary treatment.


Core is a commentator for WTOP Radio.