Vince Amalfitano isn't one to rush to the doctor's office every time his kid sniffles. But when 12-year-old Christopher's fever climbed past 102 and with nightly news horror stories of flu deaths swirling in his mind, the Montgomery County father decided it was time for a trip to the family pediatrician.
It turned out that Christopher did have the flu — the diagnosis was confirmed by a flu test ordered by the doctor. But the pharmacy was out of Tamiflu, the antiviral medication the doctor prescribed, so Christopher rode out the bug with lots of fluids and bed rest.
Christopher was back to school and running around outside when the virus hit the family again — this time, in the wallet. Quest Diagnostics had billed the family's insurance plan $887 for the flu test and the insurer had written down the charge to $400.
"If I would have known that test cost $887 or 400 bucks, I would have said, 'What does this test do and is there another option,' " said Amalfitano, 52, of Upper Pottsgrove. "The problem is there's no information out there."
The flu test Christopher received was called a respiratory viral panel, a newer product that tests for 12 to 20 flu-like illnesses. Doctors like it because it is often more accurate than the older rapid flu tests and more effective in finding out what's wrong with a patient, if not the flu. But testing for more than a dozen different illnesses makes these tests more expensive and, for many patients, may not make a significant difference in their treatment. After all, the recommendation for most flu patients who are not at risk of complications is extra rest and increased fluids.
High-deductible plans, which require members to pay thousands of dollars out of pocket before coverage kicks in, are making people more aware of — and sensitive to — the cost of health services, and forcing people to consider a new question when deciding on their care: Is the price worth it?
"It's awkward, especially when your child is involved," said Thomas Fekete, an infectious-disease specialist and chair of internal medicine at Temple University Hospital. "You don't want to be perceived as not caring. It becomes a lot of complicated social things weaving among the medical ones."
Too often, Fekete said, doctors don't know the cost of the test or procedure they're ordering.
Prices change and each patient's out-of-pocket cost will vary, depending on the insurance plan.
"Doctors forget that patients don't know until they have the test done what it's going to cost," he said. "It's a little more work for the patient, but obviously this sticker shock is no treat, either."
Most doctors are willing to talk about alternatives if patients broach the topic, he said.
Amalfitano said it didn't faze him when Christopher's doctor ordered a flu test because he couldn't imagine it costing more than $10 or $20.
He brought his $400 bill to Philly Health Costs, a price transparency project by the Philadelphia Inquirer and 6ABC Action News, because he didn't understand why the test would cost so much, and wished he'd known more about it beforehand.
The cost of flu tests varies significantly, in part because there are different types of tests a doctor can order to diagnose the flu.
CVS's MinuteClinic charges $70 for the rapid flu test, which tests for Influenza A and B, the two common strains of the flu, according to the pharmacy's website. The test returns results quickly and when it says you have the flu, you have the flu. But it is known for a high rate of false negatives — leaving patients who have the flu undiagnosed.
That's why newer, so-called panels that test for a range of illnesses with similar symptoms are becoming more popular, said Holly Batterman, a laboratory medical director for Quest Diagnostics.
"Basically, it provides additional information to the physician," Batterman said. "If you learn the person doesn't have the flu, but does have adenovirus, that might be helpful."
The sophistication of these tests is reflected in their cost.
Christopher's doctor sent a swab from his nose for testing at Quest Diagnostics, which billed the family's insurance plan $887 for the respiratory viral panel. The insurer, BlueCross BlueShield of North Carolina, wrote down the charge to $400.
The Amalfitanos have a high-deductible plan and paid the $400 out of pocket.
"This is definitely going to change my perspective going to the doctor's going forward," Amalfitano said. "I will know to ask the question."
But, he said, he's not sure he'll necessarily fare better, because knowing how much a health service costs is only half the battle. Deciding whether the test or service is truly necessary and whether it's worth the price can be difficult for both patients and doctors.
Sometimes doctors order tests out of precaution, while patients may sometimes seek out unnecessary tests because they want to feel that some action is being taken to improve their health or their child's health, said Tyree Winters, a pediatrician in Summit, N.J.
The flu is a perennial example, he said.
For most patients who come in with the flu, Winters recommends rest and fluids, and a close watch on symptoms.
He reserves the flu test and prescriptions of Tamiflu, the oral medication to treat flu symptoms, for high-risk patients, such as children with heart or lung conditions.
"It has its place; however, it can be overused," Winters said. "It can be overused not only based off the provider, but overused based off the desire or request of the families or the patient."
The antiviral needs to be taken within 48 hours of the first signs of infection to be most effective and reduces the duration of flu symptoms by about a day. That could be significant for a patient who is at risk of serious complications from the flu, but may not be worth the potential side effects of nausea and vomiting for an otherwise healthy patient.
Amalfitano said he didn't ask for the flu test.
Would he have agreed to the test had he known more about its usefulness and cost? Maybe not.
In hindsight, with his son now healthy, it's easy to say the test wasn't worth the price, Amalfitano said.
At the same time, what if Christopher had gotten sicker and the family was no closer to knowing what was wrong?
"It's sort of a Catch-22," he said. "I'm looking at it from the flip side — it was just the flu and it was nothing big — but it is sort of a conundrum."