The Portland family claims that the $430 walking boots show the problem of inflation in healthcare costs, where prices are vague and detached from reality.
PORTLAND, Oregon – When Jennifer and Brian Alger's son got injured playing football, the Portland couple did what most parents did – they took him to the doctor.
“We went straight from the football field to emergency care,” Jennifer Alger said.
The treatment was easy. The 13-year-old suffered a broken leg and was given walking boots. “We didn't think it would be a big ticket item,” Jennifer explained.
Then came the bill. A Eugene-based company called Synergy Medical Systems requested a $129 payment for walking boots.
Initially, Jennifer and Brian Alger thought that the bill could be something they should pay, not insurance. So they asked for an itemized invoice. The insurance already indicated they agreed to pay $300, and their coinsurance, the uncovered amount was $129. That is, the walking boots cost a total of $430.
“This is a company that uses families during the most vulnerable period,” Jennifer said.
Keep in mind that this is not a particularly complicated device. The exact same walking boots, the Ossur Formfit Walker Air Boot, is available online for around $50. Amazon sells it for $64.99.
“My expectation is to be charged a reasonable market rate, Jennifer said. Jennifer said.
Algers contacted the synergy and asked the company to withdraw its $129 bill. Not because they couldn't pay, but because they felt they were already well collected from their insurance.
“Is this the company you're trying to do?” asked Brian Alger. “Do you want people to use when people really don't have options or options?”
So far, no synergy has been enacted in the bill. It claims that the family has signed the exemption in emergency care and agrees to pay anything that the insurance doesn't cover.
“Every time we go to get care, we are forced to sign a blank check,” explained Cynthia Fisher, founder of non-profit PatientRightSadvocate.org.
Fisher said healthcare is one of the few industries that tell you what costs will be after the fact.
“As long as the hospital or insurance company hides the price, they can charge whatever they want,” Fisher said.
When asked to explain, Synergy introduced KGW to its partner company AMC Billing Services.
“We charge at standard Medicare rates,” wrote Brittany Fonesca, billing manager for the AMC billing service, in an email to KGW. Fonesca explained that insurance has final say on the costs of durable medical devices.
Insurers contract to provide equipment to contract with a particular healthcare provider, just like they negotiate fees for other services.
PacificSource, the Algers insurance company, declined to comment.
Legacy-Gohealth Urgent Care, Cedar Hills' emergency care, has published a general procedure fee if paid in full at the time of service, explaining that customers can reach out to their actual pricing estimates.
“For those with health insurance seeking non-emergency care, the patient's liability, or out-of-pocket costs, is based on the coverage and planning of a particular insurance,” said Scotty Sonntag, vice president of operations at Legacy-Gohealth Urgent Care. “We strongly recommend that customers contact their insurance company for more details on plans and coverage before visiting to understand their financial liability.”
“If I did it again, I would have taken it and refused, ordered it and had it the next day,” Jennifer said.
Patient advocates suggest that consumers will ask about pricing if possible. Find out if your equipment is in your insurance network and how much you are at your own expense.
If you can wait, pull out your phone and compare prices.
“You can say, 'I refuse,'” said Fisher of PatientSadvocate.org. “We'll have it delivered to the door in a few hours. We're given the authority to do that. We can do that.”
Alternatively, consumers can avoid purchasing new equipment by asking family and friends if they have wheelchairs, crutches, or knee braces at homes that they can rent.
Several nonprofits in the Portland area, including caring closets, offer free durable medical devices for use by people in need. The thrift stores also sell certain second-hand medical devices such as pedestrians, canes and crutches.
Jennifer and Brian Alger find this $430 walking boot to help explain the broken health care system.
