A Portland family argues that their $430 walking boot illustrates the problem of inflated costs in health care, where prices are obscure and detached from reality.
PORTLAND, Ore. — When Jennifer and Bryan Alger’s son got hurt playing soccer, the Portland couple did what most parents would — they took him to the doctor.
“We went straight from the soccer field to urgent care,” said Jennifer Alger.
The treatment was straightforward. The 13-year-old broke his foot and was given a walking boot. “We didn’t think it was going to be a large ticket item,” explained Jennifer.
Then came the bill. A Eugene-based company called Synergy Medical Systems demanded a payment of $129 for the walking boot.
At first, Jennifer and Bryan Alger thought maybe the invoice was for insurance to pay, not them. So, they asked for an itemized bill. It showed insurance had already agreed to pay $300, and their co-insurance, the amount insurance didn’t cover, was $129. Which meant that walking boot cost a total of $430.
“This is a company that is taking advantage of families at their most vulnerable times,” said Jennifer.
Keep in mind, this is not a particularly complicated device. The exact same walking boot, an Ossur Formfit Walker Air Boot, is available online for about $50. Amazon sells it for $64.99.
“My expectation is that I’m going to be charged a reasonable market rate. I don’t expect that I’m going to be taken advantage of when I go to the ER or urgent care,” Jennifer said.
The Algers contacted Synergy and asked the company to withdraw the $129 bill — not because they couldn’t pay, but because they felt Synergy had already collected enough from insurance.
“Is this the company that you’re trying to be?” asked Bryan Alger. “Take advantage of people when they really don’t have options or choices?”
So far, Synergy isn’t budging on the bill. It claims the family signed a waiver at urgent care, agreeing to pay whatever insurance didn’t cover.
“Whenever we go to get our care, we are forced to sign a blank check,” explained Cynthia Fisher, founder of the nonprofit PatientRightsAdvocate.org.
Fisher said health care is one of the few industries that tells you what things cost after the fact.
“As long as hospitals and insurance companies hide their prices, they can charge whatever they want,” Fisher said.
When asked to explain, Synergy referred KGW to its partner company, AMC Billing Services.
“We bill at the Medicare standard rate,” wrote Brittany Fonesca, billing manager for AMC Billing Services in an email to KGW. Fonesca explained insurance has the final say on the cost of durable medical equipment.
Insurers often contract with certain medical supply companies to provide equipment, just as they negotiate rates for other services.
The Algers’ insurance company, PacificSource, declined to comment.
The urgent care in Cedar Hills, Legacy-GoHealth Urgent Care, explained it publishes rates for common procedures when paid in full at the time of service and customers can reach out for an estimate of actual pricing.
“For those with health insurance seeking non-emergency care, patient responsibility — or out-of-pocket cost — is based on your specific insurance coverage and plan,” said Scotty Sonntag, vice president of operations for Legacy-GoHealth Urgent Care. “We strongly recommend that customers contact their insurance carrier for details about plans and coverage, including copays, before visiting to understand financial responsibility.”
“If I were to do it again, I would have declined taking it and just ordered it and had it the next day,” said Jennifer.
Patient advocates suggest, if possible, that consumers ask about pricing. Find out who is supplying the equipment, if they’re in your insurance network and how much you’ll owe out-of-pocket.
If you can wait, pull out your phone and compare prices.
“You can say, ‘I refuse,’” said Fisher of PatientRightsAdvocate.org. “I’ll have it delivered to my door in a couple of hours. We are empowered to do that. We can do that.”
Alternatively, consumers can avoid buying new equipment by asking family or friends if they have a wheelchair, crutches or knee brace at home that can be borrowed.
Several nonprofits in the Portland area, including A Caring Closet, provide used durable medical equipment for free to those in need. Thrift stores also sell certain used medical equipment such as walkers, canes and crutches.
Jennifer and Bryan Alger feel this $430 walking boot helps illustrate a broken health care system — one where profits come before patients.
