Times Insider explains who we are and what we do, and gives a behind-the-scenes look at how our journalism works.
For the past few months, I’ve started my morning with the same routine: reviewing the medical bills from readers of The New York Times over coffee.
The documents are part of a project I started in August, asking readers to send in the charges they faced for coronavirus testing and treatment. Invoices can reveal important information that hospitals and doctors often keep secret, such as the actual cost of a hospital stay or the amount of the charge varying from patient to patient. A few drops each day, and I watch each one.
If you read enough – I’m 400 and counting right now – they can also show patterns in how providers bill patients. This is how I got to my last story, which is about a doctor from Greenwich, Connecticut named Steven Murphy. Patients say he used public testing sites to perform unnecessary and expensive tests. Dr Murphy has defended his billing practices and said he is providing a vital service to the community.
The story only caught my attention because of the high number of patients sending invoices from its testing sites in suburban New York. Without this wave of reader submissions, I would never have known something was wrong.
The first invoice with this supplier was sent to me on August 3, the same day I started the collection project. A woman from out of New York City said she was “shocked” to see a coronavirus testing site bill her insurance for $ 1,944. “How can this vendor charge $ 480 for a 3 minute phone call giving test results?” she asked in her submission.
The next day another submission from a patient of Dr. Murphy’s arrived. “I can pay my bill, but I’m amazed at the cost the provider charges for the test,” the patient wrote. Four days later, another patient reported the “sky-high rates” she was facing, also from Dr Murphy.
When the first bill came in I thought it was interesting, but I didn’t quite see a full story. The high patient charges could be an anomaly. By the end of the summer, I had six separate bills and a suspicion that something was wrong. I had slowly accumulated a set of data that showed that a doctor who looked after public testing sites repeatedly billed insurers over $ 1,000 for coronavirus testing.
This is information that powerful health lobbies usually try to keep secret. The American Hospital Association recently sued the Trump administration over new rules that would make healthcare prices public (they lost that challenge but said they plan to appeal to a higher court). It makes it frustrating for journalists and patients to answer seemingly basic questions, like the cost of a coronavirus test in the United States.
Patients who showed up for one of these drive-thru tests had no chance of knowing in advance what loads they would be facing. Their bills, however, can help shed light on the matter. They display secret prices for all to see.
They also contain five-digit billing codes, which I must have become more adept at reading as I covered the healthcare system. These codes indicate exactly what service the doctor provided. In this case, those codes let me know that Dr Murphy was not just billing for coronavirus tests, as his patients believed. He was also billing 20 other respiratory pathogens.
Invoices are important, but they never make up the whole story. After I racked up enough bills to start seeing a pattern, I started asking patients about their experiences. I spoke with Dr. Murphy about his billing practices. He said using a larger test was appropriate because it could detect a wider range of illnesses, especially those that were symptomatic.
I spoke to medical billing experts to get their ideas, and elected officials who had set up the test sites. I filed public record requests and upon their return went through thousands of pages of emails between Dr. Murphy and city officials.
In most cases, the patient bills I receive don’t turn into stories. Some do not reveal new information. Of those who do, we often don’t have enough submissions to show a model or the ability to review all of them.
In this case, however, we were lucky: a critical mass of readers decided to take a few minutes to send us a medical bill that they found strange. This decision allowed me to do my job better and tell a story that otherwise might have been unknown.