Here is an example of what is wrong. My son got hurt and didn't have any money, so he called a hospital to find out what it would cost to xray his ankle to see if it was broken. Because he knew if it was just sprained, there was very little anyone could do other than tell him to 'stay off it'. They hospital refused to quote a price, because there was no way they knew how much it could cost because they didn't know what was wrong. In other words, if all he wanted to get was an xray and have a doctor tell him if the ankle was broken, they wouldn't do it.
There are several reasons this is the case:
- 1) Hospitals that are subject to EMTALA (a.k.a. all except the VA) are prevented from telling you the cost of possible services prior to a medical screening exam (MSE) by a physician or a mid-level like an NP or PA. This is to ensure that hospitals don't use cost to dissuade people from seeking care. If a hospital answers that question they can be subject to a fuckton of fines. I am surprised they called back.
- 2) The real reason that a MSE is important (other than to avoid fines for violating EMTALA) is that not every sprain needs an X-Ray. The Ottowa Ankle Rules are very useful to eliminate the need for XRay in about 30% of people presenting with acute traumatic ankle pain.
- 3) The FDA and states regulate medical treatments and tests for a good reason. If you made medical test/treatments like a vending machine, you would harm way more people than you help. Full body CTs are a good example (though these still required a physician's order, they were essentially provided to anyone with the $ to pay for it.) The brochures showed you the father of 4 who had a stage 1 kidney cancer diagnosed and treated, but not the ten other people who had incidental findings that once discovered had to be followed up... landing people in the hospital, with invasive procedures, and sometimes disabling complications from these unnecessary investigations. If you look at the cost-benefit for tests like this, the cost weigh outweighs the benefit, but that doesn't stop people who have no concept of basic math, much less Bayes Theorem, from getting the test. That's the reason that lotteries are so so popular: tax on those who can't do math.
- 4) Without an exam the diagnostic value of an ankle Xray is diminished (also a Bayesian deal). The pre-test probability of disease effects the performance of the test. As an example, think of a test for HIV that has a 1% false positive rate (but for simplicity assume no false negatives). If you do that test in an individual in a population with 0.1% incidence of HIV, and it is positive, 90% of the time the person with the positive result doesn't have HIV. In a population with a 20% incidence, 95% of the time they really do have HIV. So there is an additional negative of testing not directed by history/exam in that its less accurate. (Which is why I am surprised that the Radiologist who volunteered to read it did... the malpractice vulnerability increases with decreased accuracy.)
Finally, if your son wants a cheaper option next time, try a NP staffed clinic. In some states you even will find them in big box stores or pharmacies. They are a better value especially if you have something simple like an ankle injury.