Case 16.3: Diagnosing Chest Pains
One evening during the summer of 2012, a Con- necticut woman experienced chest pain (Brill
2013). She took an ambulance to a local not-for-profit hospital. After several hours in the emergency room, she was sent home with a diag- nosis of indigestion.
Shortly thereafter, she received a bill of $995 for the ambulance,
$3,000 for physicians’ services, and $17,000 for the hospital. A major part of the hospital bill was a $7,998 charge for a CT scan with con- trast. (The Medicare rate is $554.) The alternative to the CT scan would have been a stress test using an electrocardiograph. Its list price was
$1,200 and the Medicare rate was $96. Unfortunately for the patient, she was not offered this option, was uninsured, and was a year too young to be eligible for Medicare.
When questioned about the bill, a hospital representative said,
“I’ve told you I don’t think a bill like this is relevant. Very few people actually pay those rates.” Nonetheless, the patient was asked to pay it. A medical billing advocate was able to negotiate a $10,000 discount but made it clear that she thought even this amount was excessive.

Discussion questions:
• After reading this case, would you be more or less willing to have a CT scan done if an emergency room physician recommended it?
If I am going to the emergency room (ER) then for me it will be a true emergency and I will more than likely do whatever the doctor recommends no questions asked just like we discussed in our intensive session with the gentleman who was having the heart-attach.
How confident would you be that your choice was a good one? I wouldn’t question my choice in the case of an emergency. However if like the women in this case study and I had these expensive procedures for only indigestion I would be pretty upset and question why this happened. I