When surprise bills meet clinical studies
Interested in participating in a clinical study? Make sure your medical providers don’t bill you for simply learning what’s involved.
The big picture: Clinical trials aren't free for patients, but experts interviewed for this story agreed that a hospital shouldn't charge people just for getting information about them.
Zoom in: John Mathna, 58, of Chattanooga, Tennessee, suffers from a brachial plexus avulsion injury, which creates pain due to damaged nerves near his spinal cord.
- Last June, he says he got in touch with a Mayo Clinic doctor conducting a study to see if electrical stimulation could help ease the pain in these types of injuries.
- After a video call with the doctor that lasted 20–30 minutes, Mathna weighed his options with his wife. He ultimately decided not to participate.
The bill: $476 from Mayo Clinic.
- On top of that, he says Cigna, his insurer, told him the consult was out-of-network and therefore not covered at all.
Between the lines: Mathna had to submit personal and insurance information online before the video call, but he said nobody at Mayo Clinic told him he would be getting billed for anything — and he didn't receive any actual care.
- "Had I been notified of the possible charges, I would've notified my insurance company to say, 'Hey, can we get this paid for?'" Mathna said.
What they're saying: Health care finance and clinical trial experts say out-of-pocket costs have hindered clinical study participation. But no one contacted by Axios had heard of hospitals billing patients who are only learning what's involved — and they hoped Mathna's situation was a mistake and an anomaly.
- "What you don't want to do is create barriers for people who are interested in participating in a study," said Erin Fuse Brown, a health care law and policy professor at Georgia State University.
- "This would be a huge disincentive if there was a possibility you could get a bill prior to giving your consent."
The other side: Mayo Clinic declined multiple interview requests and instead submitted a statement that said, "We will not comment on a specific patient's circumstances, but we can say that participation in studies are handled separately from clinical appointments or consultations."
- Cigna did not respond to interview requests.
The resolution: Mayo Clinic waived Mathna's entire $476 balance after Axios asked about his case. Mayo also notified the collections agency that had been pursuing Mathna to "cease all contact" with him, according to an email shared by Mathna.
- Mathna was happy the bill was cleared, but he said the experience "made me feel very uneasy about the supposedly respected medical treatment facilities out there."
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