ATLANTA — It’s a story that has become more and more common: getting a medical bill that is much larger than expected.
Channel 2 consumer adviser Clark Howard talked to two Georgians who said they almost needed medical attention when they got an unwanted surprise in the mailbox.
Joyce Stone said she was astounded when she learned that a shot she has gotten for years that previously cost $45 suddenly ballooned to $1,900.
“The name of the shot is Prolia, and it’s supposed to strengthen the bones,” Stone said.
She told Howard that she gets the shot every six months and has been going to the same doctor for 30 years.
A few months ago, she got a letter from her doctor's office about the shot.
“Because of rising cost, they were no longer going to provide the shot or give the shot of Prolia to their patients,” Stone said.
The letter stated the office believed her “best option” was to go to a local hospital to get the shot.
“In January, I received a note from the hospital stating that my insurance had been billed for over $5,000 for the shot,” Stone said.
After insurance, her portion to pay was $1,900.
“I was in disbelief that I had gone to this location on the advice of my doctor to have what I thought was the normal shot. And it was,” Stone said.
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Howard said one key piece of advice to avoid something like this is to never have any procedure or service done in a hospital that you can receive somewhere else.
He said the hospital price will generally be much more expensive.
Medical billing advocate Cindy Holtzman said while Prolia is usually administered in a hospital, you can find it elsewhere.
“It took a while. I spent almost two hours searching where can I find a Prolia shot,” Holtzman said. “There is no place you can get it for an office visit copay within a 50-mile radius.”
Stone signed up for the Prolia copay, and the company is covering $1,500.
Tim Sayers found himself owing over $40,000 more than he was quoted after a recent surgery.
Sayers told Howard that he doesn’t have insurance but knows the questions to ask.
“I have to ask about the cost and everything, and I have to tell them that I'm self-pay, and normally they give you a discount for being self-pay, and if you pay up front, they give you an additional discount,” Sayers said.
He said before he had hernia surgery in March, he got a quote from St. Mary’s Hospital in Athens to know how much he would be charged.
“She had mentioned $20,000 based on the recent surgeries that this doctor had done. And she said since you're a self-pay, that knocks it down to, like, $14,500. She said if you pay up front, it would knock the price down to $11,696,” Sayers told Howard.
He paid the $14,500 up front, but a week later, he got a shock.
“She called me the following Thursday after the surgery and told me that she had some bad news for me. The hospital cost was $62,000,” Sayers said.
Channel 2 Action News called St. Mary's to ask about that bill. Hours later, the hospital told Sayers that he was off the hook for the extra money.
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