$28,000 for a 10-Minute Neck Injection

Jamie Estrada of Albuquerque got 2 lidocaine injections in his upper spine. 10 minutes each. The shots were a test: if the pain vanished, a permanent nerve ablation might help his chronic neck pain.

The pain vanished. For about 6 hours. Then it came back.

The real zinger was the bill. His insurer was billed $28,000 for each injection.

Elisabeth Rosenthal told the story for KFF Health News. The contracted rate his plan agreed to pay was $23,237.50 per shot. Estrada's coinsurance was $5,166.20. On a high-deductible plan, that meant he owed more than $5,000 for a brief visit.

I am not shocked. Look at what the same procedure costs in the same market. At the hospital where those surgery-center doctors admit patients, the same insurer's contracted rate for the same injection is $2,058.67. Other insurers pay that surgery center about $700 for the same shot, according to Turquoise Health data cited in the piece.

$28,000. $23,237. $2,058. $700. Same medicine. Same needle. Same town.

The surgery center is part of United Surgical Partners International, which owns more than 535 surgical facilities and sits under Tenet Healthcare. That is negotiating power wearing a local name on the door.

When Estrada challenged the bill, he said an administrator told him the charges came from a "legacy contract" with the insurer that was "advantageous" and "favorable" to the center. Advantageous to whom is the question.

He walked away from the ablation. While he was being prepped, he recalled, the physician said he had "heard he might sue" and chastised him. Estrada said he never threatened a lawsuit. He got off the table and put his shirt back on.

I am not anti-insurance. Keep a policy for the wreck. But a 10-minute diagnostic shot should not cost more than a used car, and a patient's coinsurance should not be five figures because somebody negotiated a "favorable" legacy rate and passed the slice to the deductible.

In direct care, the number on the door is the number you pay. No chargemaster. No legacy carve-out. No $5,000 surprise for a test that lasts 6 hours.

$28,000 is not a price. It is what happens when the invoice writes the medicine.

Sources: Elisabeth Rosenthal, KFF Health News: kffhealthnews.org/health-care-costs/insurers-pay-high-prices-premiums-coinsurance-cost-control-inflation-patients/