Atrium Health's response: Health care is very complex, and so is its billing

To ensure that we fully understood the issues described in the Ledger article “The case of the $10,000 colonoscopy,” we sent a series of questions about billing practices to Atrium Health.

Here is the complete statement from Atrium Health spokeswoman Kate Gaier:

Due to federal privacy laws, I’m unable to address the specifics of this case. However, I can address, in general, the root of what you are asking.

Health care is very complex and, as a result, so is its billing. Earlier this year, Atrium Health launched a new, online cost estimator tool which allows patients to input their anticipated procedure and insurance information and get an approximate cost. Even with that, however, there can be variables. For example, if an outpatient surgery takes longer than is typical or there is a complication discovered that has to be addressed, that can result in assessed costs being higher. The estimator may not include some costs, including physician fees and costs from third-party providers (e.g., independent physician groups, anesthesiology, radiology, lab work, etc.) who may be part of the service delivery.

Insurance coverage is another variable. The actual patient out-of-pocket costs are dependent on a number of factors, including co-pays and deductibles that are part of a patient’s personal health insurance policy. We strongly encourage patients to work with their insurance company before a scheduled procedure to understand how much of the total cost their insurance will pay. 

You also asked about facility fees. Where you receive care matters and directly relates to the level of care that is available to be provided at that location. Receiving care in a trauma center is more expensive than in many other parts of a hospital. Care in a hospital is more expensive than in a physician’s office or an outpatient facility. This is largely due to the governmental requirements of each type of facility, in terms of staffing and equipment that has to be available at all times.

As part of our efforts to be transparent about pricing, we also offer a dedicated phone line for patients who have questions to get more detailed information. Here, it is important that the patient be as specific as possible, including the applicable codes provided by their provider, to get a detailed summary of expected costs. In addition, we need any insurance coverage so we can provide the best possible estimate. (In your case, when you called, you were not a patient — the phone operators would not be able to reach out to a doctor about a scheduled procedure to arrive at an estimate for you, specifically, since there was nothing scheduled for you. With a patient, they would be expected to do so. That’s why the CPT codes were so important, as there are many variables.)

We recognize health care expenses are often unplanned events for our patients, and we work diligently to ensure our costs are consistent with the level of care we provide. Atrium Health is committed to empowering patients to make informed decisions about their health care and provide financial counseling and assistance for eligible patients to help with their health care expenses. 

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Executive editor: Tony Mecia; Managing editor: Cristina Bolling; Contributing editor: Tim Whitmire, CXN Advisory; Contributing photographer/videographer: Kevin Young, The 5 and 2 Project