When Andrew Westphal's Costa Rica honeymoon was over last May, you could say the honeymoon was really over.
"Traveler's trots. Let's just say again, gastrointestinal distress," Westphal said.
He and his new bride were experiencing the same stomach symptoms and decided to go to an urgent care near them.
"And it ended up being a $4 antibiotic that solved the issue completely in a day," Westphal recalled.
But then, Westphal said, the real pain began when he received his first bill: $1,888. What really stood out, though, was the difference between what his insurance covered compared to his wife's insurance for the medical testing.
"So mine ended up being just about $1,700 to $1,800, and she paid $21 for those labs," Westphal said. "I'm trying to just wrap my head around how I could get such a large bill for such a simple service."
His insurance carrier is Anthem while hers is Cigna. They both have high-deductible plans, and neither has met their deductibles.
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"I, unfortunately, am not surprised," said Adam Fox, the deputy director of the Colorado Consumer Health Initiative.
Fox said Westphal's story underscores the idea that insurance plans are not negotiating better costs for the people they are serving, putting consumers at risk of unpredictably high bills.
Additionally, Fox said, there is a larger issue with the rates being charged at so-called "Hospital Outpatient Departments."
In a letter to Westphal regarding his urgent care bill, UC Health stated that he had "received these services within a Hospital Outpatient Department."
Fox said Medicare charges about $440 for the same tests Westphal was billed $1,840.
"They're basically charging four times what Medicare does," said Fox. "I think those services can be provided at a much lower cost. And I think what we are seeing is as hospitals acquire more facilities and doctors offices, they are charging higher costs for the same level of service to patients. And that puts Coloradans at financial risk."
A UCHealth spokesperson clarified that its urgent care centers are not Hospital Outpatient Departments, but the labs in certain cases are at the hospital.
UCHealth and Anthem declined our requests for interviews, but in an email, a UCHealth spokesman pointed to high-deductible health insurance plans, stating, "This shifts more of the burden of paying medical bills onto patients." UCHealth said it offers billing estimates for anyone who wants to know individual responsibility for a service.
An Anthem statement also references high-deductible plans, stating that Westphal's "claim was therefore processed correctly." Anthem said, "We are transparent with Anthem members about the price of health care services."
Westphal said he had no idea that what he thought was a simple doctor's visit for antibiotics could cost so much. After his appeals were denied, he said he is learning a frustrating lesson.
"You need to find out how much your services are going to cost, even if you think it's something that should be very simple, cost so little," Westphal said. "And yet this insurance company or this provider can really do whatever they want."
Full statement from Anthem:
"We can confirm this member receives employer-sponsored coverage and selected a high-deductible plan option with a $6,000 deductible. Our reviews affirmed that the member’s annual deductible had not been met at the time of service, and his claim was therefore processed correctly according to his benefit plan. While Anthem’s specific negotiated rates with health systems are confidential, we are transparent with Anthem members about the price of health care services. Before selecting a care provider, members can quickly and easily compare prices for health care services from various care providers through the Sydney Health app."
This story was originally published by Jaclyn Allen at Scripps News Denver.
