Kevin Hunt: Pelvic Ultrasound Fails, Woman Refuses To Pay




It's hard to tell sometimes who's more challenged by health care, the consumer or the health-care provider.

"The system needs greater transparency," says Dr. Ethan Foxman, president and chief executive officer of Jefferson Radiology, "with easy access to information, whether it's a basic [medical] chart or payment information."

Mary Jane, a Greater Hartford psychotherapist whose real name is being withheld for reasons that will become apparent, knows both ends of the system.

"I work with a number of chronic medical patients," she says, "and I agree that navigating the system is more complicated than it needs to be."

But earlier this year, she objected to what she considered a lack of transparency when she visited Jefferson Radiology as a patient after her doctor ordered an ultrasound scan of her ovaries.

Mary Jane had two options: return to the doctor's office for an internal ultrasound or choose Jefferson Radiology, which would attempt an external pelvic scan before the internal scan.

"Despite the hassle of the external scan, I decided to go to Jefferson," she says, because it was closer to her home.

Mary Jane says the technician told her she would only perform the internal scan if she could not "visualize" the ovaries with an external scan. As part of the test, Mary Jane was instructed to drink a substantial amount of water, straining her comfort level, before the scan. Within seconds, she says, the technician judged the external scan fruitless and proceeded to the internal scan.

When Mary Jane received the bill, however, Jefferson Radiology had charged her for two procedures, $300 each, even though the first was abandoned almost immediately.

"I assumed it was a mistake," says Mary Jane.

She called the Jefferson Radiology billing department. No, it was not a mistake. That's the policy.

"At no time was I informed that I could be charged for both procedures," says Mary Jane, "as I would have simply gone to my doctor's office instead."

Mary Jane's insurance, a high-deductible policy, does not pay for either procedure. The $600 payment would come out of her pocket. Except Mary Jane sent in a check for $300, refusing to pay for the first test.

Mary Jane called Jefferson Radiology. She wrote a letter of complaint to Jefferson Radiology's corporate office. She also contacted the state's Healthcare Advocate office, which told her the policy was not illegal.

"I don't remember ever being charged for a blurry X-ray," says Mary Jane. "They just retake the picture."

So why the charge for a failed scan?

When Mary Jane contacted The Bottom Line in June, insistent that Jefferson Radiology's pelvic-scan policy was misleading and unfair to female patients, she was still getting invoices for the remaining $300 charge.

"I believe Jefferson should modify their policy to either tell women that they will be charged for two scans," she says, "and/or offer women the option of foregoing the less reliable scan."

After TBL contacted Jefferson Radiology, a supervisor called Mary Jane and promised to research her complaint. Two days later, Chief Financial Officer Paul Desantis called and said the outstanding charge would be waived and someone from clinical management would call to explain the policy.

And Foxman, Jefferson Radiology's CEO, visited TBL headquarters where he said administering two scans was proper.

"She left her OB/GYN thinking she needed one test, or just half the test," he says. "On medical grounds, I know that's not the right information."

Theresa Szymanski, Jefferson Radiology's corporate compliance officer, says the technicians and radiologists cannot give patients a choice of exams because they are only following the orders of the prescribing physician.

"Theoretically," she says, "the woman can, at any step along the way, choose to not undergo what her doctor has ordered, but typically that conversation occurs between the patient and her treating physician. . . . . It seemed clear that her physician had advised her before she came to Jefferson that there were two procedures involved in the exam."

Yes, says Mary Jane, because it was implied that was Jefferson's policy. Foxman is right about easy access to payment information. Neither the patient or the health-care provider seem to have it.

"In our daily clinical practice," he says, "we do the tests and the bill goes out the door later. . . . We just don't know what the impact will be on a patient's deductible. That should be really clear up front with people."

How could Mary Jane have known Jefferson would charge for both procedures, even if the first failed? She could have called Jefferson Radiology before the scans and asked about its policy. Maybe she should have asked her physician to prescribe only the second procedure. She also could have asked her insurance company for coverage specifics.

"I expect that some women would prefer the less invasive scan," she says. "For a post-childbirth female, filling up on water and having someone push on my stomach is worse. It's bearable, but not for $300 plus a subsequent internal scan."

But is all of that research a reasonable expectation for every a scan, X-ray or medical procedure? No, which even Jefferson Radiology acknowledges.

"We have to move toward the empowerment of individuals," says Foxman.

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