The $300 Shot

When did the American healthcare system become a commodity?

2018-01-05

yellow fever vaccination certificate
This yellow piece of paper effectively cost me 300USD.

5 minutes sitting on an exam room table, one vaccination, and 300USD in fees later, I walked out of the doctor’s office livid. I felt wronged and I was on a fiery path to seek justice.

I hail from the righteous land of universal healthcare, a 3-hr drive due north from my Manhattan residence, in beautiful Canada. I count my lucky stars that I am a healthy, functional 20-something who averages 1.5 doctor’s appointments a year - for an annual checkup, and occasionally for a shot or a prescription of antibiotics. So as an unseasoned navigateur of the American healthcare system, I spent this week online shopping for “medical travel clinics near me”. It would be my second time at the doctor’s in America, for a very exciting purpose. I would be flying off to Maputo at the end of the month for a work trip and as part of the Mozambique visa application process, I needed to get the yellow fever vaccine, a shot that was not covered by my medical insurance.

My spree for a cheap, credible travel clinic was definitely not as therapeutic as retail shopping. I made a few calls to assess my clinic options, and ultimately settled on a doctor, “Dr. K”. Her Midtown clinic was walking distance from work, had a spot open during the week, and was steeper in pricing compared to surrounding clinics, but I thought it would be a solid choice if its professional sounding name was an indicator of anything: “Travel Clinics of America”.

So on Wednesday morning, I hurried down Madison Ave to make my 10:00AM appointment.

The 30 minutes in Dr. K’s office were spent accordingly:

  • 22 minutes waiting around in the lobby and then on the exam chair checking my e-mails (the appointment was during work hours).
  • 4 minutes 30 seconds with the nurse who measured my blood pressure, asked me to sign some more forms, and administered the Stamaril yellow fever vaccine.
  • 30 seconds with Dr. K who walked in, asked me 1-2 courtesy questions that were already covered in the pre-exam forms I had been e-mailed and had filled out meticulously the day before, and wished me well on my trip.
  • 3 minutes with the receptionist who I blanched at when she billed me the final amount - a total higher than she had quoted for me over the phone. Mind you, her original quote in itself had been steep.

All in all, 30 minutes of bullshit.

In my conversation with the receptionist after my appointment, I asked her incredulously to walk me through the three budget lines listed:
ridiculous vaccination bill

“What is the vaccine administration fee for?”
“It’s for the administration of the vaccine.”
“That isn’t covered in the non-consult fee?”
“No.”
“Then what is the non-consult fee? I explicitly told you I did not want a consultation.”
“That’s just how the practice usually works. Non-consult is $65 and if you want a consultation, it’s $105.”
“And what is a non-consult fee?”
“When you know exactly what vaccine you need. A consult is when you want the doctor’s recommendation.”

As I struggled to process her explanations of the line breakdowns, she shrugged. “That’s just how it is.”

I was shocked. Then confused. And then livid. It felt like I had been robbed and wronged in a big way. But by who? Was this an injustice by the doctor, of by the institution, or by both?

When I got back to the office, I made some calls. I was especially upset about two things: the hidden fees they had conveniently forgot to mention beforehand, and the “non-consult fee” as Dr. K had justified a $65 cost for spending a total of 30 seconds with me. The hidden fees I had already paid so there was little I could do, but there were two questions I wanted the answer to. Firstly, what a “non-consult fee” was. Secondly, if there were any rules regulating what New York State doctors were allowed to charge for.

On the non-consult fee, I looked online and couldn’t find anything. I did come across a site that listed a doctor’s visit for yellow fever vaccination to cost typically between $150 to $350 total (including consulting fee). I asked the same question to a friend who worked as a nurse in New York; she had never heard of such a fee. The nurse at my workplace, a pleasant, “fairy-like” lady as described by my workers, theorized Dr. K’s office probably billed “non-consultation” as the minimum pre-exam routine of asking me “Are you pregnant?”, “Are you allergic to any vaccines/food/other?” and the likes - questions that I filled out in forms before my visit. As the CDC states, “every provider who administers vaccines should screen every patient before giving a vaccine dose”. My nurse/fairy also noted that providers can charge however much they like, a point the New York Office of Professional Medical Conduct confirmed. “There is no governing body that regulates doctors’ fees,” the telephone operator recited to me monotonously before directing me to a mailing address where I could file a complaint.

According to the OECD, Americans’ health spending is more than any other OECD country. Yet, Americans are not getting better quality of care for our larger expense size as U.S. healthcare ranks last among the top eleven richest countries. The primary reason? Our healthcare costs more. We pay more per capita to our public health administration, hospitals, physicians, and pharmaceuticals with the pharma companies and doctors reaping in huge profits as they’re free to charge as they please. Take my visit this week: Sanofi charges a hefty$136.47 for the Stamaril yellow fever vaccine. A 2007 study of the 50 most top-selling prescription drugs showed that US pharmaceutical prices were at least 60% higher than those in five large European countries. So it is safe to assume that the $136.47 Dr. K pays is more than a doctor in France pays for a dose of Stamaril. Dr. K then pockets $80 per dose by charging me $210. And beyond the soaring prices that consumers incur, shopping for health services is the equivalent of shopping at Hollister - you’re left in the dark and effectively blind. Providers and insurers don’t share with us the critical info to make informed decisions like rate breakdowns, costs of procedures, and which hospitals and clinics provide the best outcomes. This is why we need government regulation in pricing.

Exasperated and having just spent an hour of my lunch hellbent for answers at a nonsensical doctor’s appointment, I dejectedly resigned to the fact that I had to get on with my work day. The general consensus seemed to be that yes, I was charged more than usual for my vaccine, but also, that what Dr. K did (or did not do) wasn’t illegal because there is no medical fee regulation in America. I wondered, is this what all 300 million Americans feel like after leaving the doctors’? Or just the 11% of the population - 30 million Americans - who don’t have health insurance.

Paying out an eye and a limb for healthcare is an injustice. But “that’s just how it is” in America.