Reesha Ahmed was on cloud nine.<\/p>\n

It was January and Ahmed was at an OB-GYN\u2019s office near her home in Venus, Texas, for her first prenatal checkup. After an ultrasound, getting anti-nausea medication, and discussing her pregnancy care plan, she said, a nurse made a convenient suggestion: Head to the lab just down the hall for a standard panel of tests.<\/p>\n

The lab was inside Texas Health Hospital Mansfield, which opened in December 2020<\/a> in a Dallas-Fort Worth suburb. Ahmed, just eight weeks pregnant, said the doctor told her everything about the visit was routine. \u201cNothing really stood out,\u201d Ahmed said. \u201cAnd, of course, there\u2019s just a lot of excitement, and so I really didn\u2019t think twice about anything.\u201d<\/p>\n

Her blood tests checked for multiple sexually transmitted infections, her blood type, and various hormones. Within days, Ahmed began bleeding and her excitement turned to fear. A repeat ultrasound in early February showed no fetus.<\/p>\n

\u201cMy heart kind of fell apart at that moment because I knew exactly what that meant,\u201d she said. She would have a miscarriage.<\/p>\n

Then the bills came.<\/p>\n

The Patient:<\/strong> Reesha Ahmed, 32, has an Anthem Blue Cross and Blue Shield policy through her employer.<\/p>\n

Medical Services:<\/strong> An analysis of Pap smear results and several blood tests in tandem with Ahmed\u2019s initial prenatal visit, including complete blood count, blood type, and testing for STIs such as hepatitis B, syphilis, and HIV.<\/p>\n

Service Provider:<\/strong> Ahmed got her tests at Texas Health Mansfield, a tax-exempt hospital jointly operated by Texas Health Resources, a faith-based nonprofit health system, and AdventHealth, another religious nonprofit.<\/p>\n

Total Bill:<\/strong> The hospital charged $9,520.02 for the blood tests and pathology services. The insurer negotiated that down to $6,700.50 and then paid $4,310.38, leaving Ahmed with a lab bill of $2,390.12.<\/p>\n

What Gives:<\/strong> Ahmed\u2019s situation reveals how hospital-based labs often charge high prices for tests. Even when providers are in network, a patient can be on the hook for thousands of dollars for common blood tests that are far cheaper in other settings. Research shows<\/a> hospitals typically charge much more<\/a> than physicians\u2019 offices or independent commercial labs for the same tests.<\/p>\n

The situation was particularly difficult for Ahmed because she had lost the pregnancy.<\/p>\n

\u201cTo come to terms with it mentally, emotionally, physically \u2014 dealing with the ramifications of the miscarriage \u2014 and then having to muster up the fighting strength to then start calling your insurance, and the billing department, the provider\u2019s office, trying to fight back a bill that you don\u2019t feel like you were correctly sent? It\u2019s just, it\u2019s a lot,\u201d she said.<\/p>\n

In Texas, the same lab tests were at least six times as expensive<\/a> in a hospital as in a doctor\u2019s office, according to research from the Health Care Cost Institute, a nonprofit that examines health spending.<\/p>\n

The markup can be even higher depending on the test. HCCI data, based on 2019 prices, shows the median price for a complete blood count in Texas was $6.34 at an independent lab and $58.22 at a hospital. Texas Health charged Ahmed $206.69 for that test alone.<\/p>\n

\n
\n<\/iframe>\n<\/p>\n<\/figure>\n\u201cIt is convenient to get your lab done right in the same building,\u201d said Jessica Chang, a senior researcher at HCCI, but \u201cmany patients are not thinking about how highly marked up these lab tests are.\u201d Chang said she suspects many hospitals tack on their overhead costs when they bill insurance.<\/p>\nAnthem also charged Ahmed for at least four tests that most insurance plans would consider preventive care and therefore covered at no cost to patients under the Affordable Care Act\u2019s requirements for covering preventive care, which includes aspects of prenatal care. Her EOBs, or \u201cexplanation of benefits\u201d notices, show she paid out-of-pocket for a test identifying her Rh factor \u2014 which detects a protein on the surface of red blood cells \u2014 as well as for tests for hepatitis B, hepatitis C, and syphilis.<\/p>\nAsked to review Ahmed\u2019s tests, Anthem spokesperson Emily Snooks wrote in an email to KFF Health News that the claims \u201cwere submitted as diagnostic \u2014 not preventive \u2014 and were paid according to the benefits in the member\u2019s health plan.\u201d<\/p>\n<div class=\"wp-block block--newsletter \" data-type=\"kaiser-health-news\/newsletter\" data-align=\"center\" style=\"\">\n<h4 class=\"newsletter__title\">\n\t\t<a href=\"https:\/\/kffhealthnews.org\/email\/\"> \n\t\t\tEmail Sign-Up\t\t<\/a> \n\t<\/h4>\n\n\t\tSubscribe to KFF Health News’ free Morning Briefing.\t<\/p>\n<\/div>\nThere \u201cdefinitely shouldn\u2019t be\u201d out-of-pocket costs for those screenings, said Sabrina Corlette, co-director of Georgetown University\u2019s Center on Health Insurance Reforms.<\/p>\nThe Centers for Disease Control and Prevention <a href=\"https:\/\/www.cdc.gov\/nchhstp\/pregnancy\/default.htm\">recommends screening pregnant patients<\/a> for several infectious diseases that pose major risks during pregnancy. Ina Park, a professor of family community medicine at the University of California-San Francisco and an expert on STIs, said the tests Ahmed received didn\u2019t raise red flags from a clinical perspective. \u201cIt\u2019s really more what the actual lab charged based on what the tests actually cost,\u201d Park said. \u201cThis is a really exorbitant price.\u201d<\/p>\nFor example, Ahmed paid $71.86 in coinsurance for a hepatitis B test for which the hospital charged $418.55. The hospital charged $295.52 to screen for syphilis; her out-of-pocket cost was $50.74.<\/p>\n\u201cYou just wonder, is the insurance company really negotiating with this provider as aggressively as they should to keep the reimbursement to a reasonable amount?\u201d Corlette said.<\/p>\n<figure class=\"wp-block-image alignfull size-full\"><figcaption class=\"wp-element-caption\">\u201cHow can something be so expensive?\u201d wondered Ahmed after receiving a bill for nearly $2,400 for standard prenatal blood tests. (Nitashia Johnson for KFF Health News)<\/span><\/figcaption><\/figure>\nThe Resolution:<\/strong> Ahmed refused to pay the bills and Texas Health sent the debt to collections. When she tried to get answers about the costs, she said she was bounced between the doctor\u2019s office and the hospital billing department. Ahmed submitted a complaint to the Texas attorney general\u2019s office, which passed it to the Texas Health and Human Services Commission. She never heard back.<\/p>\nAccording to Ahmed, a hospital representative suggested her bloodwork might have been coded incorrectly and agreed the charges \u201cwere really unusually high,\u201d Ahmed said, but she was told there was nothing the hospital could do to change it. The hospital did not comment on the reason behind the high charge. And in a March 7 email, an AdventHealth employee told Ahmed the doctor\u2019s office had \u201cno control\u201d over the hospital\u2019s billing.<\/p>\nAhmed filed an appeal with Anthem, but it was denied. The insurance company stated the claims were processed correctly under her benefits, which cover 80% of what the insurer agrees to pay for in-network lab services after she meets her deductible. Ahmed has a $1,400 deductible and a $4,600 out-of-pocket maximum for in-network providers.<\/p>\n\u201cWe depend on health care providers to submit accurate billing information regarding what medical care was needed and delivered,\u201d Snooks said. Asked about reimbursements to the Texas Health lab, she added, \u201cThe claim was reimbursed based on the laboratory\u2019s contract with the health plan.\u201d<\/p>\nAfter a KFF Health News reporter contacted Texas Health on Oct. 9, the hospital called Ahmed on Oct. 10 and said it would zero out her bills and remove the charges from collections. Ahmed was relieved, \u201clike a giant burden\u2019s just been lifted off my shoulders.\u201d<\/p>\n\u201cIt\u2019s just been fighting this for 10 months now, and it\u2019s finally gone,\u201d she said.<\/p>\nTexas Health Resources and AdventHealth declined to respond to detailed questions about Ahmed\u2019s charges and the tests she was directed to obtain.<\/p>\n\u201cWe are sorry Ms. Ahmed did not get clarity on her care with us. Our top priority is to provide our patients with safe, effective and medically appropriate care,\u201d Laura Shea, a spokesperson for the hospital, said in an emailed statement.<\/p>\nThe Takeaway:<\/strong> Ahmed\u2019s problem demonstrates the pitfalls of using a hospital lab for routine testing.<\/p>\nFor standard bloodwork \u201cit\u2019s really hard to argue that there\u2019s a quality difference\u201d between independent labs and hospitals that would warrant higher prices, Chang said. That holds true for other services, too, like imaging. \u201cThere\u2019s nothing special about the machines that hospitals use for a CT or MRI scan. It\u2019s the same machine.\u201d<\/p>\nBroadly, state and federal lawmakers are paying attention to this issue. Congress is considering legislation that would equalize payments for certain services regardless of whether they are provided in a hospital outpatient department or a doctor\u2019s office, although not lab services. Hospitals have tried to fend off such a policy, known as \u201csite-neutral payments.\u201d<\/p>\nFor example, the Lower Costs, More Transparency Act would require the same prices under Medicare for physician-administered drugs regardless of whether they\u2019re given in a doctor\u2019s office or an off-campus hospital outpatient department. That bill also would require labs to make public the prices they charge Medicare for tests. Another bill, the Bipartisan Primary Care and Health Workforce Act, would ban hospitals from charging commercial health plans some facility fees \u2014 which they use to cover operating or administrative expenses.<\/p>\nAccording to the National Conference of State Legislatures, Colorado, Connecticut, Ohio, New York, and Texas have <a href=\"https:\/\/www.ncsl.org\/health\/state-actions-to-control-commercial-health-care-costs\">limited providers\u2019 ability to charge<\/a> privately insured patients facility fees for certain services. Colorado, Connecticut, Maryland, and New York require health facilities to disclose facility fees to patients before providing care; Florida instituted similar requirements for free-standing emergency departments.<\/p>\nPatients should keep copies of itemized bills and insurance statements. While not the only evidence, those documents can help patients avoid out-of-pocket costs for recommended preventive screenings.<\/p>\nFor now, patients can proactively avoid such extreme bills: When your doctor says you need blood tests, ask that the requisition be sent to a commercial lab like Labcorp or Quest Diagnostics that is in your network and have the tests done there. If they can\u2019t do it electronically, ask for a paper requisition.<\/p>\n\u201cDon\u2019t always just go to the lab that your doctor recommends to you,\u201d Corlette said.<\/p>\n<a href=\"https:\/\/twitter.com\/ReporterSteph\">Stephanie O\u2019Neill<\/a>\u00a0reported the audio story.<\/em><\/p>\nBill of the Month is a crowdsourced investigation by <a href=\"https:\/\/kffhealthnews.org\/news\/tag\/bill-of-the-month\/\">KFF Health News<\/a> and <a href=\"https:\/\/www.npr.org\/sections\/health-shots\/2018\/02\/16\/585549568\/share-your-medical-bill-with-us\">NPR<\/a> that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? <a href=\"https:\/\/khn.org\/send-us-your-medical-bills\/\">Tell us about it<\/a>!<\/em><\/em><\/p>\n<aside class=\"meta-authors meta\">\n\n\t\t\t\t\t\t\t\t\t\t\tRachana Pradhan: <\/span> \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/kffhealthnews.org\/news\/article\/routine-bloodwork-lab-work-tests-surprise-bill\/mailto:rpradhan@kff.org\">rpradhan@kff.org<\/a>,\t\t\t\t\t\t\t\t\t\t\t<a href=\"http:\/\/twitter.com\/rachanadpradhan\" target=\"_blank\" rel=\"noopener\"> \n\t\t\t\t\t\t\t@rachanadpradhan<\/a>\n\t\t\t\t\t\t\t\t\t<\/p>\n<\/aside>\n<section class=\"block--category-tag-list \">\n<div class=\"category-tag-list__content-wrapper\">\n<h3 class=\"block--category-tag-list__title\">\n\t\t\t\tRelated Topics\t\t\t<\/h3>\n\t\t\t\t<a class=\"category-tag-list__contact-link\" href=\"https:\/\/kffhealthnews.org\/contact-us\/\"> \n\t\t\tContact Us\t\t<\/a> \n\t\t<a class=\"category-tag-list__tip-link\" href=\"https:\/\/kffhealthnews.org\/tips\/\"> \n\t\t\tSubmit a Story Tip\t\t<\/a>\n\t<\/div>\n<\/section><\/div>\n<script async src=\"\/\/platform.twitter.com\/widgets.js\" charset=\"utf-8\"><\/script><\/p>\n","protected":false},"excerpt":{"rendered":"Reesha Ahmed was on cloud nine. It was January and Ahmed was at an OB-GYN\u2019s office near her home in Venus, Texas, for her first prenatal checkup. After an ultrasound, getting anti-nausea medication, and discussing her pregnancy care plan, she said, a nurse made a convenient suggestion: Head to the lab just down the hall […]<\/p>\n","protected":false},"author":1,"featured_media":2025,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3],"tags":[],"class_list":["post-2024","post","type-post","status-publish","format-standard","has-post-thumbnail","category-health-industry"],"_links":{"self":[{"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=\/wp\/v2\/posts\/2024","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=2024"}],"version-history":[{"count":1,"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=\/wp\/v2\/posts\/2024\/revisions"}],"predecessor-version":[{"id":2026,"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=\/wp\/v2\/posts\/2024\/revisions\/2026"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=\/wp\/v2\/media\/2025"}],"wp:attachment":[{"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=2024"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=2024"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=2024"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}