To Be an Informed Healthcare Consumer

 

shutterstock_93062659I 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.

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  1. Vicryl Contessa Thatcher
    Vicryl Contessa
    @VicrylContessa

    Just FYI, most visits are not billed by time. Some are, but most aren’t, so it doesn’t matter if the visit is 5 minutes or 30.

    • #1
  2. The King Prawn Inactive
    The King Prawn
    @TheKingPrawn

    Vicryl Contessa:Just FYI, most visits are not billed by time. Some are, but most aren’t, so it doesn’t matter if the visit is 5 minutes or 30.

    I know, but seriously, almost $1200/hr if it was billed by time?

    • #2
  3. Vicryl Contessa Thatcher
    Vicryl Contessa
    @VicrylContessa

    But it’s not billed by time, so you can’t really extrapolate out based on what you were billed.

    • #3
  4. The King Prawn Inactive
    The King Prawn
    @TheKingPrawn

    But billing almost $600 to ask questions he could have read the answers to on the piece of paper he was holding in his hands and see something previously documented by two other physicians? I get that everyone has to make a living, but come on!

    • #4
  5. Vicryl Contessa Thatcher
    Vicryl Contessa
    @VicrylContessa

    Of the $600 billed, how much did insurance actually pay?

    • #5
  6. Bryan G. Stephens Thatcher
    Bryan G. Stephens
    @BryanGStephens

    TKP: It is all out of wack.

    My wife had surgery, and the cost of the surgery was $23,000. Insurance had negotiated to pay $2600.

    If there is a law, it should be that all medical prices are posted at all times, including what all insurance companies have negotiated to pay.

    That would drive down prices.

    Also, getting government totally out of insurance would help. If we need to use tax dollars, we should do vouchers.

    • #6
  7. The King Prawn Inactive
    The King Prawn
    @TheKingPrawn

    Bryan G. Stephens: If there is a law, it should be that all medical prices are posted at all times, including what all insurance companies have negotiated to pay.

    I can understand some secrecy for trade practices, etc., but I specifically called both the insurance and the hospital to get the information, even the billed amount, and couldn’t get it out of either of them.

    • #7
  8. The King Prawn Inactive
    The King Prawn
    @TheKingPrawn

    Vicryl Contessa:Of the $600 billed, how much did insurance actually pay?

    $225, and I pay $30 copay for a total of $255, so less than half of the billed amount is the actual cost of the service. This is the sort of things consumers need to know when decided what to purchase.

    • #8
  9. RushBabe49 Thatcher
    RushBabe49
    @RushBabe49

    Our friend EThompson said that she has a high-deductible plan.  Since she has to pay the first x thousand dollars out of pocket, she negotiates “cash” pricing with her various providers, and can often get much lower prices than the usual private-pay customer.  You ask, you get…you don’t ask, you don’t get.

    • #9
  10. The King Prawn Inactive
    The King Prawn
    @TheKingPrawn

    RushBabe49:Our friend EThompson said that she has a high-deductible plan. Since she has to pay the first x thousand dollars out of pocket, she negotiates “cash” pricing with her various providers, and can often get much lower prices than the usual private-pay customer. You ask, you get…you don’t ask, you don’t get.

    She also has plenty of disposable income, some of us have children instead.

    • #10
  11. Bryan G. Stephens Thatcher
    Bryan G. Stephens
    @BryanGStephens

    The King Prawn:

    Bryan G. Stephens: If there is a law, it should be that all medical prices are posted at all times, including what all insurance companies have negotiated to pay.

    I can understand some secrecy for trade practices, etc., but I specifically called both the insurance and the hospital to get the information, even the billed amount, and couldn’t get it out of either of them.

    But they would charge someone without insurance almost 10X what the insurance  company paid for. That has to be immoral.

    • #11
  12. The King Prawn Inactive
    The King Prawn
    @TheKingPrawn

    Bryan G. Stephens:

    The King Prawn:

    Bryan G. Stephens: If there is a law, it should be that all medical prices are posted at all times, including what all insurance companies have negotiated to pay.

    I can understand some secrecy for trade practices, etc., but I specifically called both the insurance and the hospital to get the information, even the billed amount, and couldn’t get it out of either of them.

    But they would charge someone without insurance almost 10X what the

    Some info on how the billed amount and the negotiated amount correlate to the medicare/medicaid allowables would be enlightening I think.

    • #12
  13. Midget Faded Rattlesnake Contributor
    Midget Faded Rattlesnake
    @Midge

    RushBabe49:You ask, you get…you don’t ask, you don’t get.

    True ’nuff. If you know who, how, and what to ask.

    We’ve experimented with higher-deductible plans (we get a limited choice of coverage through Mr R’s employer). Even with bargaining, we often meet the deductible. (And you are not in the best bargaining position when it’s obvious you’re likely to meet the deductible anyhow. For then the argument goes, why not just meet it and leave us alone?)

    I miss our old Guardian plan, where consumers got a booklet (OK, more like a telephone directory) which exhaustively cataloged what was covered, what wasn’t, how much, and by how much. That at least made it easier to do comparison-shopping for procedures within the plan benefits. Under our newest plan, this information is supposedly available online, but mostly after the fact, it seems. Some things can be looked up ahead of time, but the information available online for, say, prior authorization, appears to be about as clear as mud for the consumer.

    Our plan provider has changed like five times since 2008. I used to have “ins” and know what to do, but with this many changes, it’s hard to keep up.

    • #13
  14. The King Prawn Inactive
    The King Prawn
    @TheKingPrawn

    Midget Faded Rattlesnake: I miss our old Guardian plan, where consumers got a booklet (OK, more like a telephone directory) which exhaustively cataloged what was covered, what wasn’t, how much, and by how much. That at least made it easier to do comparison-shopping for procedures within the plan benefits. Under our newest plan, this information is supposedly available online, but mostly after the fact, it seems. Some things can be looked up ahead of time, but the information available online for, say, prior authorization, appears to be about as clear as mud for the consumer.

    My understanding from fighting with my insurance company to get a certain doctor paid properly is that the provider network is a third entity which enters the fray. We contract with the insurance carrier, they contract with the provider network(s), the provider network contracts with the providers. Is it any wonder we sometimes feel like Oliver Twist when we approach the receptionist.

    https://youtu.be/sZrgxHvNNUc

    • #14
  15. Midget Faded Rattlesnake Contributor
    Midget Faded Rattlesnake
    @Midge

    The King Prawn:

    My understanding from fighting with my insurance company to get a certain doctor paid properly is that the provider network is a third entity which enters the fray. We contract with the insurance carrier, they contract with the provider network(s), the provider network contracts with the providers. Is it any wonder we sometimes feel like Oliver Twist when we approach the receptionist.

    Could be. Three plans ago, I used to know.

    Now we have a plan where “pay your medical bills online!” is touted as a feature, but what they don’t tell you is you need to go through two months of snail-mail form shuffling before you’re even approved to pay online. It’s like they don’t really want your money!

    Would Amazon need two months of paperwork from you before it deigned to take your money? Does your Visa card make you wait days or weeks before you know whether a particular purchase is approved or declined?

    • #15
  16. The King Prawn Inactive
    The King Prawn
    @TheKingPrawn

    Midget Faded Rattlesnake: Now we have a plan where “pay your medical bills online!” is touted as a feature, but what they don’t tell you is you need to go through two months of snail-mail form shuffling before you’re even approved to pay online. It’s like they don’t really want your money! Would Amazon need two months of paperwork from you before it deigned to take your money? Does your Visa card make you wait days or weeks before you know whether a particular purchase is approved or declined?

    But HIPAA.

    • #16
  17. EThompson Inactive
    EThompson
    @EThompson

    The King Prawn:

    RushBabe49:Our friend EThompson said that she has a high-deductible plan. Since she has to pay the first x thousand dollars out of pocket, she negotiates “cash” pricing with her various providers, and can often get much lower prices than the usual private-pay customer. You ask, you get…you don’t ask, you don’t get.

    She also has plenty of disposable income, some of us have children instead.

    First of all, you and VC are wrong; doctors do bill by 15 minute increments based on what insurance companies and medicare reimburse. I speak quite frankly with all my doctors and this is what they tell me.

    Example: my dentist spent 45 minutes with me last week and charged me merely $75 dollars because I pay in cash. His insurance/medicare patients (my parents) would have paid $150 plus.

    I do have plenty of disposable income but I surely don’t choose to spend it on overpriced insurance policies. I am self-employed and make it my business to know what things cost.

    • #17
  18. EThompson Inactive
    EThompson
    @EThompson

    P.S. My husband has sleep apnea and he solved it simply by avoiding sleeping on his back. What’s with the $558 bill to figure that out?

    • #18
  19. Vicryl Contessa Thatcher
    Vicryl Contessa
    @VicrylContessa

    EThompson:

    First of all, you and VC are wrong; doctors do bill by 15 minute increments based on what insurance companies and medicare reimburse. I speak quite frankly with all my doctors and this is what they tell me.

    Example: my dentist spent 45 minutes with me last week and charged me merely $75 dollars because I pay in cash. His insurance/medicare patients (my parents) would have paid $150 plus.

    I do have plenty of disposable income but I surely don’t choose to spend it on overpriced insurance policies. I am self-employed and make it my business to know what things cost.

    I do occasionally do timed visits, but when I fill out the charge sheet for each patient, it’s based on their diagnosis and the level of acuity they present with, and there’s no where in my notes that I detail how much time I actually spent with them. If the ladies at the front desk are keeping track, that’s news to me.

    I’ve also gotten discounts on dental work for paying in full at the time of service. It makes a lot of sense if you can swing it. However, there are a lot of people that feel very uncomfortable bargaining with their health care provider over cost. Maybe that’s a new business idea for you, Liz. Be a professional health care cash payment bargainer.

    • #19
  20. The King Prawn Inactive
    The King Prawn
    @TheKingPrawn

    EThompson:P.S. My husband has sleep apnea and he solved it simply by avoiding sleeping on his back. What’s with the $558 bill to figure that out?

    Doesn’t work for the DoT. I don’t even know that I have it, but I have risk factors, and that’s good enough for the government to demand I spend a bunch of money to ensure your safety.

    • #20
  21. EThompson Inactive
    EThompson
    @EThompson

    Vicryl Contessa:

    EThompson:

    First of all, you and VC are wrong; doctors do bill by 15 minute increments based on what insurance companies and medicare reimburse. I speak quite frankly with all my doctors and this is what they tell me.

    Example: my dentist spent 45 minutes with me last week and charged me merely $75 dollars because I pay in cash. His insurance/medicare patients (my parents) would have paid $150 plus.

    I do have plenty of disposable income but I surely don’t choose to spend it on overpriced insurance policies. I am self-employed and make it my business to know what things cost.

    However, there are a lot of people that feel very uncomfortable bargaining with their health care provider over cost. Maybe that’s a new business idea for you, Liz. Be a professional health care cash payment bargainer.

    Spare me the righteous remarks. It takes me two seconds to “bargain” with my doctors because as one mentioned to me, every patient like me eliminates one more annoying bureaucrat he has to pay to file insurance claims.

    • #21
  22. Midget Faded Rattlesnake Contributor
    Midget Faded Rattlesnake
    @Midge

    Vicryl Contessa: I’ve also gotten discounts on dental work for paying in full at the time of service. It makes a lot of sense if you can swing it.

    I get discounts on a lot by paying in full at the time of service – especially for something like dental care (which is not part of our group policy, anyhow).

    However, because we do have a policy from an employer, often what I’ve “paid in full” at a doctor’s office (or lab, or imaging center) is an estimate based on the office’s projection of what our particular policy will do. In the past, this used to work very well – I found offices that would even eat the cost of their underestimations as long as the up-front estimate was paid in full. Now this is working less well.

    Because we aren’t self-employed, but do have access to group benefits, it’s still unclear that ditching a plan altogether and going to pure out-of-pocket would be a better deal. It could come to that, though.

    • #22
  23. Vicryl Contessa Thatcher
    Vicryl Contessa
    @VicrylContessa

    EThompson:

    Vicryl Contessa:

    However, there are a lot of people that feel very uncomfortable bargaining with their health care provider over cost. Maybe that’s a new business idea for you, Liz. Be a professional health care cash payment bargainer.

    Spare me the righteous remarks. It takes me two seconds to “bargain” with my doctors because as one mentioned to me, every patient like me eliminates one more annoying bureaucrat he has to pay to file insurance claims.

    It wasn’t a righteous remark. It was mostly tongue in cheek. There are a lot of people that feel very uncomfortable about discussing payment and fees with their provider because they feel there’s an imbalance of power (I’m the lowly patient, and you’re the great and powerful doctor). Clearly, that’s not an issue for you or others that don’t experience that dynamic, but that dynamic does exists. You are in a much better position than the people that are scared of us providers. For those that are uncomfortable in that situation, I’m sure they would love to have someone as assertive and business minded as you to help them navigate the waters.

    • #23
  24. EThompson Inactive
    EThompson
    @EThompson

    @VC: I’m truly a respectful patient who simply isn’t satisfied with the “15 minutes.”  I tell my docs up front I may need more than a quarter hour and I’m willing to pay for it.

    I’m related to a bevy of doctors and my best friend practiced ER medicine at Columbia Presbyterian. I understand that MDs aren’t getting paid properly for all the hell they’ve gone through (internships and residency) not to mention two new friends who practice ob/gyn and are on call 24-7.

    I do wish DocJay was still commenting on this site so he could back me up on this one. He was smart to go concierge and this is exactly what many of us will have to decide to do in the near future if we want any consistent medical care at all.

    • #24
  25. Vicryl Contessa Thatcher
    Vicryl Contessa
    @VicrylContessa

    EThompson:@VC: I’m truly a respectful patient who simply isn’t satisfied with the “15 minutes.” I tell my docs up front I may need more than a quarter hour and I’m willing to pay for it.

    I’m related to a bevy of doctors and my best friend practiced ER medicine at Columbia Presbyterian. I understand that MDs aren’t getting paid properly for all the hell they’ve gone through (internships and residency) not to mention two new friends who practice ob/gyn and are on call 24-7.

    I do wish DocJay was still commenting on this site so he could back me up on this one. He was smart to go concierge and this is exactly what many of us will have to decide to do in the near future if we want any consistent medical care at all.

    OB/GYN is a grueling specialty, for sure!

    There are some practices that are only accepting cash payments that they work out directly with the patients. It seems to be working very well, and is starting to catch on. I’m sure, of course, that the insurance companies and especially the government would throw an absolute hissy fit if this became the norm. I think it sounds pretty exciting myself. It would be interesting to spend a day seeing patients in that kind of setting.

    • #25
  26. Z in MT Member
    Z in MT
    @ZinMT

    Sorry to harsh your buzz KP, but you will likely be diagnosed with sleep apnea. I don’t think any one does a sleep study and not get diagnosed with sleep apnea.

    • #26
  27. Z in MT Member
    Z in MT
    @ZinMT

    On your larger point, you are correct. Most hospitals and doctors have no way to determine price before a procedure. I am quickly coming to the conclusion that the only solution to the high cost of health care is to make direct payments from insurance to healthcare providers illegal. We have to force patients to become consumers.

    • #27
  28. Pony Convertible Inactive
    Pony Convertible
    @PonyConvertible

    My employer has given us access to a website that tracts costs for various procedures. For example if you need a colonoscopy, you could search the price charged by providers in the area with a few keystrokes and mouse clicks. You would find differences of several hundred percent.

    • #28
  29. The King Prawn Inactive
    The King Prawn
    @TheKingPrawn

    Z in MT:Sorry to harsh your buzz KP, but you will likely be diagnosed with sleep apnea. I don’t think any one does a sleep study and not get diagnosed with sleep apnea.

    I know person who had the study done and doesn’t have it, so there’s hope. The results are in, but the hospital’s electronic medical records are screwed up and won’t show it to me. On the plus side, there’s nothing new under the current conditions section.

    Pony Convertible:My employer has given us access to a website that tracts costs for various procedures.For example if you need a colonoscopy, you could search the price charged by providers in the area with a few keystrokes and mouse clicks.You would find differences of several hundred percent.

    When I tried finding data online the range was $600-$6000. Not very helpful.

    • #29
  30. iWe Coolidge
    iWe
    @iWe

    I am waiting for our family doctor to go concierge, so we can follow her. So far, she is resisting it.

    • #30

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