$1,206 to clip a toenail

Original post:  Apr 3, 2013

Healthcare costs in the United States are much higher than in any other country in the world. Sometimes that difference pays for advanced technology. At other times, there is no rational explanation. This real-life example from the Boston area seems to be one of those head-scratching moments. It was published on the Washington Post "Wonkblog" website yesterday.

In my opinion, there is a larger point to be made. Controlling the cost of medical devices may not completely impact the overall cost of care. In the example cited below, there is very little device cost (maybe some lab equipment?)!

The case of the $1,206 toenail clipping

One reader wrote in with a story that is perhaps more compelling than any of them:

Let me briefly share with you a rather amazing personal experience of overcharging by a Harvard-affiliated hospital here in the Boston area. It’s not a huge matter, but it is so outrageous and almost funny in a way that I thought you might have an interest in using it, maybe in something you are otherwise working on.

The hospital did a single toenail clipping. The bill is $1,206.

To avoid misunderstandings, this was not a surgical intervention. It was the same kind of clipping that you do yourself every week, except that only a small piece of only one nail was clipped.

The whole encounter, including the prior doctor consultation, took about 15 minutes.

Admittedly, the tiny piece of toenail was sent in for lab analysis, because the doctor thought there might be some infection. (There wasn’t.) But the lab charges, although extremely high, were only part of the issue.

Here is how the charges broke down in detail. (From Brigham and Women’s, the dermatology department, dating from March 5, 2013.)

Office Visit — $248.00

Biopsy — $182.00

Treatment Room — $328.00

AMB Clinic — $117.00

Pathology Lab — $165.00

Laboratory Services — $166.00

Total — $1206.

I called the billing department of course, and they say that everything seems correctly coded. The billing person agreed personally that the numbers are outrageous but says there is nothing they can do about it. I then called the department of dermatology and spoke to two separate people there, who both also agreed that the charges are ridiculous, but they emphasized that there is nothing they can do, either. I have a call in to the Patient Relations department, and they have promised to return my call within two working days, but frankly I’m not holding my breath for any redress or mitigation from them.

Link to the post:  http://www.washingtonpost.com/blogs/wonkblog/wp/2013/04/02/the-case-of-the-1206-toenail-clipping/