How A Urine Test After Back Surgery Triggered A $17,800 Bill

In her late 20s and attending college in Texas, Elizabeth Moreno suffered from debilitating back pain caused by a spinal abnormality. "I just could not live with the pain," she says. "I couldn't get dressed by myself, I couldn't walk across my house, let alone to class, and nothing, no drug that had been prescribed to me, even dulled the pain."

Moreno says she also tried chiropractic medicine and acupuncture, but they didn't make the pain go away. Finally, a doctor at the student health center referred her to an orthopedic specialist who performed tests and concluded a disc was blocking nerves down her legs and needed to be removed. Moreno's father, a retired Ohio doctor who had seen many failed back surgeries over his career, agreed it was the best course.

In late 2015, Moreno had the operation in Houston, which she described as "a complete success." She gave it little thought when the surgical office asked her to leave a urine sample for a drug test.

Medical treatment: Moreno had a disc removed from her back in December 2015. Her surgeon prescribed an opioid painkiller, hydrocodone. At a follow-up office visit in mid-January 2016, the staff asked her to leave a urine sample, which she figured was routine. In March 2017, the lab sent her a bill for $17,850 for testing her urine for a slew of drugs, including cocaine, methadone, anti-anxiety drugs and several other drugs she had never heard of.

What gives: Urine drug testing has exploded over the past decade amid alarm over rising opioid overdose deaths. Many doctors who prescribe the pills rely on the urine tests to help reduce drug abuse and keep patients with chronic pain safe. Yet the tests have become a cash cow for a burgeoning testing industry, and critics charge that unneeded and often expensive ones are sometimes ordered for profit rather than patient care. Doctors can decide whether to test patients who take opioids for short periods, such as after an operation. Moreno's surgeon would not discuss her urine test — why he ordered it and why the sample was tested for so many substances.

Three experts contacted by Kaiser Health News questioned the need for such extensive testing and were shocked to hear of the lab's prices. They said these tests rarely cost more than $200, and typically much less, depending on the complexity and the technology used. Some doctors' offices use a simple cup test, which can detect several classes of drugs on the spot and could be purchased for about $10. Bills can climb higher when labs run tests to detect the quantity of specific drugs and bill for each one, as the lab did here.

Source: Npr News