UIHC part of a disturbing national "wave"

In her recent opinion essay in the New York Times (June 17), Dr. Danielle Ofri points out a “lucrative corner of the health care market” that operates like a “trap” for American consumers.

Not only is she right, but the University of Iowa Hospitals and Clinics, which is now a functional monopoly in Iowa City, is maximizing this ridiculous loophole. Let me explain, by way of telling a story.

In the spring, my son had a sore throat for several days that seemed to be getting worse instead of better. Rather than clogging up the emergency room or running to urgent care, we called his primary care physician and made an appointment.

The doctor administered flu and strep tests right there in his office.

A month later, I got sick, too. My symptoms were significantly worse, and it was a Saturday, so I went to Urgent Care. I, too, got tested for flu and strep.

When our bills arrived several weeks later, my son’s strep and flu tests were billed at $846, and we owed $165.76 out of pocket. My tests were billed at $688, and we owed $0, as office medical tests are covered by our insurance.

There was absolutely no discernible difference between our care. In fact, I think the rooms in which we were treated had the same layout and wall stickers.

I assumed it was an insurance problem, so I called our insurer. They quickly explained that my son’s strep and flu tests had been done at a “hospital outpatient department” (HOPD) and so were billed as “hospital labs,” while my strep and flu tests had been done in an “office” and billed as “office medical.” Our explanation of benefits documents supported this explanation.

Next, I called UIHC. When I pointed out that they are a primary care center for family medicine and pediatrics in our community — they retorted they are a hospital, even as an “outpatient facility.” Next, I asked them to provide a list of all of the facilities that bill as clinics vs. those that bill as “outpatient hospital,” they told me they didn’t have such a list.

My husband contacted the patient experience team with these concerns. They sent us back a flyer that contained the same information I had been given over the phone, again, with no clarity about which UIHC facilities are “office medical” billing and which are “hospital” billing.

Any parent knows that strep tests are a mandatory part of parenting, as are the X-rays for a sprained ankle in Dr. Ofri’s story. They’re mandatory because these tests determine the course of treatment. As a result, even small price increases add up to big benefits for hospitals. But something is wrong when the average American family must foot the bill of big medicine’s profit margin. How much more devastating such a price differential would be to an underinsured/uninsured family!

It’s more than a little unnerving to imagine a doctor saying — as veterinarians often do — "Your son needs a strep and flu test before I can prescribe antibiotics. Those tests will cost $846, do you want to proceed?” Instead, Dr. Ofri calls for “transparency” in pricing or “site neutral” pricing, a common-sense measure that has unfortunately been defeated once already by “ferocious lobbying.”

I support her proposals.

But locally, UIHC should at least publish and provide on request a list of which clinics bill as hospital outpatient departments so that my family and families like mine can make informed decisions about which facilities to visit.

Alina Borger Germann has been writing and teaching in Iowa City for over 20 years. She and her family are not alone in facing unexpected billing from health care providers.