Ricochet is the best place on the internet to discuss the issues of the day, either through commenting on posts or writing your own for our active and dynamic community in a fully moderated environment. In addition, the Ricochet Audio Network offers over 50 original podcasts with new episodes released every day.
I cannot imagine how it is even remotely possible to be an informed healthcare consumer under the current system. With some effort and a helpful provider, one can accumulate useful knowledge about diet and exercise, the effectiveness of various treatments, etc., all of which is well and good. But when it comes to being a consumer in a supposedly capitalist system, one cannot operate as an informed consumer. Throw in government regulation, and all bets are off.
My recent travails with obstructive sleep apnea provide a perfect example of this. I’ve had the study done because I must in order to remain employed but — were this merely a matter of personal health — I would be lost in a raging sea of costs on a night darkened by ignorance. Though I have tried to determine the out-of-pocket costs for this simple procedure, the data is simply not available. In short, I could not (and cannot) use cost as a determining factor. Allow me to explain.
As with pretty much any medical procedure these days, I needed a specialist — in this case, a pulmonologist — to conduct the test and interpret the results. I met with him a few weeks ago for about half an hour. He asked all the same questions I’d already answered in a questionnaire and took a peak in my throat to see exactly what two other doctors had already seen and documented. This short chat was billed for $558. Of course, this is not what the interaction costs or what the doctor expects to be paid for services rendered. No, the actual price of this consultation is $255.51; at least this is the price negotiated between the insurance network and the provider. The baffling part is that I can only discover this actual cost when I receive the explanation of benefits from my insurance carrier.
Where the real challenge comes in is with the actual test. I’ve seen what the clinic billed my insurance, and I know that I’m on the hook for 15 percent. But, until it was billed, I could not get anyone — not from the doctor’s office, nor the hospital — to tell me how much the billed amount would be. Moreover, I am not allowed to know what the negotiated price actually is, which will surely differ from the billed amount, until the insurance company settles accounts and sends me an explanation of benefits form.
If I had to decide whether or not this non-life saving test — which is being performed solely at the behest of the Departments of the Navy and Transportation — was worth the actual out-of-pocket cost to me, I would have no data on which to base my decision, nor any way of acquiring it. There is no way for me, or anyone else, to be an informed consumer of healthcare if we can only know the real dollar amount until after the fact.
Oh, and the five minutes where a technician showed me how to hook up the contraption so as to perform the test on myself at home? That was billed at $166.