6 things to know about a woman's $48K allergy test

A California woman who underwent extensive allergy skin-patch testing had a total bill of  $48,329, according to a Kaiser Health News report.

Six things to know:

1. Janet Winston, 56, of Eureka, Calif., an English professor at Arcata, Calif.-based Humboldt State University, underwent extensive allergy skin-patch testing. Her Stanford (Calif.) Health Care-affiliated physician, who works at Stanford's outpatient dermatology clinic in Redwood City, Calif., was in network for the health plan she has as a state employee, the report states.

2. Ms. Winston's bill shows total charges of $48,329. Her insurer, Anthem Blue Cross, paid $11,376.47, the rate negotiated between the insurer and Stanford. Ms. Winston's out-of-pocket costs — 20 percent of the negotiated rate — came to $3,103.73.

3. Ms. Winston told Kaiser Health News the testing involved nearly 120 tiny plastic containers of allergens that were taped to her back to identify the cause of her skin rashes. Stanford's list price for each allergen is $399. That compares to the average charge of $16 per allergen that physicians submitted to Medicare in 2016, according to the report, which cites Medicare payment data.

4. An Anthem spokesperson told Kaiser Health News the insurer reviewed Ms. Winston's bill but did not say whether the cost affected the review process.

"We try to strike a balance between protecting affordability and providing a broad network of providers to create choices," the spokesperson told Kaiser Health News.

5. Stanford — a healthcare giant in the region with numerous hospitals, clinics and physician practices in the San Francisco Bay area and in Palo Alto, Calif. — pointed to the treatment involved in this case. A Stanford spokesperson told Kaiser Health News Ms. Winston's physician used customized treatment and that the university health system operates a large allergen bank.

"In this case, we conducted a comprehensive evaluation of the patient and her environmental exposures and meticulously selected appropriate allergens, which required obtaining and preparing putative allergens on an individual basis," the spokesperson said.

6. Ms. Winston, per the advice of her physician, contested the charges with Stanford's billing department. According to Kaiser Health News, Ms. Winston argued her physician told her the per allergen cost would be about $100, and she was ultimately able to negotiate her out-of-pocket responsibility down to $1,561.86.

Access the full Kaiser Health News report here.

 

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