A Pennsylvania man received two echocardiograms at Paoli (Pa.) Hospital: the first diagnosed a heart defect, and the second was to confirm a procedure was successful. The price was $339 for the first and $3,484 for the latter, according to the The Philadelphia Inquirer.
Here are five highlights from the report:
1. George Hahn's first heart scan was administered by Cardiology Consultants of Philadelphia in February 2017. The group has offices within Paoli Hospital, a part of Radnor, Pa.-based Main Line Health. The cardiology group also contracts with Mr. Hahn's health insurer, Independence Blue Cross, which negotiated a large discount for the test.
2. The group, which has its own ultrasound machines in the hospital-based office, billed Independence $1,335 for the echocardiogram. Independence negotiated the price down to $339. Since Mr. Hahn had met his deductible, the insurer paid half of his bill and Mr. Hahn owed $170, according to The Inquirer.
3. The echocardiogram revealed Mr. Hahn had a small hole in his heart. After he underwent surgery at another Main Line Health hospital, his cardiologist referred him to Paoli Hospital for a second echocardiogram to confirm the procedure was a success.
4. The test was performed in April by the hospital, which is in Independence's provider network, and not the cardiology group. Paoli Hospital billed Independence $3,484 for the test — more than double what the cardiology group in the hospital billed the insurer. Bonnie Graham, vice president of finance for Main Line Health, told The Inquirer the hospital's charge reflects the higher administrative and operating expenses it faces compared to provider groups.
5. Independence negotiated Paoli Hospital's charge to $3,101. Mr. Hahn was charged the full amount, as he has not met his deductible yet. Anthony Coletta, MD, president of Facilitated Health Networks at Independence, told the publication, "We want to give our members options by providing a broad network of participating providers, and the ability to go to different sites for services. At the same time, we try to make our members aware that it almost always costs more for non-complex, routine procedures to be done at a hospital."
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