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

    David Sussman:

    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.

    Im having a procedure next week. I also have a high deductible (after losing my original insurance and Dr.).

    But…but…Obama said if you liked your plan and your doctor you could keep them…

    • #61
  2. EThompson Inactive
    EThompson
    @EThompson

    Vicryl Contessa:

    David Sussman:

    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.

    Im having a procedure next week. I also have a high deductible (after losing my original insurance and Dr.).

    But…but…Obama said if you liked your plan and your doctor you could keep them…

    I think BHO meant to say if he likes your plan, you can keep it.

    • #62
  3. Vicryl Contessa Thatcher
    Vicryl Contessa
    @VicrylContessa

    EThompson:

    Vicryl Contessa:

    David Sussman:

    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.

    Im having a procedure next week. I also have a high deductible (after losing my original insurance and Dr.).

    But…but…Obama said if you liked your plan and your doctor you could keep them…

    I think BHO meant to say if he likes your plan, you can keep it.

    For true! Thus far I’ve avoided having my plan cancelled, but the premium sure has gone up in cost since AHA went into effect.

    • #63
  4. Dean Murphy Member
    Dean Murphy
    @DeanMurphy

    The King Prawn:

    Mike H:KP, it might be worth getting your Vitamin D and B12 levels tested. It seems like getting these blood levels up helps get rid of sleep apnea for some people. I use to stop breathing for short periods of time often. Now, my wife hasn’t told me she noticed it for a year or more.

    There’s no evidence that I stop breathing in my sleep. My wife assures me it is not happening, but government regulation demands I be tested in spite of contrary evidence.

    You can get an o2 monitor that clips on your finger on Amazon for a bout $30 or so.  I got one that records for up to 30 hours and can download the data to my laptop.  I used it to show my PCP that I didn’t need the oxygen concentrator that a pulmonologist said I needed for my CNS apnea.  I still use the CPAP because I sleep more comfortably and don’t snore anymore with it on; but I saved a lot of money not having to rent the concentrator.

    • #64
  5. Dean Murphy Member
    Dean Murphy
    @DeanMurphy

    MarciN:It’s getting to be like the IRS these days and those stories we hear all the time–five people call the IRS to get an answer to a simple question and those people get five different answers. That’s because the IRS code is five inches thick.

    That’s what’s happening with health insurance. The regulations are so contradictory, confusing, inaccurate, and vague that it is total chaos for doctors and patients.

    The confusion is intentional on the part of the insurance companies. Without clear language, they always have an out. And they are bigger and stronger than any individual doctor or patient.

    Somehow the answer ends up always being the same: the insurance company is right, the patient is wrong.

    It’s all operating as designed.  The ACA is supposed to  be so painful that after enough time, Americans will clamor for a single payer system to relieve the pain.

    • #65
  6. Dean Murphy Member
    Dean Murphy
    @DeanMurphy

    The King Prawn:So the latest bit of the adventure was “the doctor ordered you a machine.” Really? He knows what fits both medical necessity and my budget? Of course, this is yet another thing I’ll just get a bill for and have no say in. Apparently I’ll need to be trained in its use which will incur more costs because obviously a person trained to use procedures to work on our nation’s most sensitive weapons can’t read the manual and figure it out. I don’t plan on being unbearable, but stumbling around in the dark like this really gets me going. Even if the machine is super quiet I may still end up sleeping on the couch because I’ll be insufferable.

    rant

    I have a 3 year old machine, and you can’t tell its on except when the mask isn’t sealed to my nose.

    • #66
  7. James Gawron Inactive
    James Gawron
    @JamesGawron

    KP,

    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.

    Yes exactly. This is the medical through the looking glass madness that most in the medical profession refuse to even acknowledge as a problem. In any other transaction if one of the parties claims they can charge whatever they want to and refuses to set a price even if this is for a fixed known service there really is no contract. There is no meeting of the minds because of the bad faith of one of the parties. In this case it is the health provider who refuses to set a fixed cost for a known service. There is collaborative effort that goes on between the insurance company and the physician. This is really a conspiracy to defraud or would be seen so in almost any other setting.

    I had an experience that went even beyond this level of insanity. I was told that different departments had performed services on me at the hospital. When I requested a total bill so I could pay it, I was told that no one kept a total of charges on me and that each individual department would be billing me. I had my lawyer draw up an estoppel letter and sent it to the parent corporation that was responsible for the entire hospital. They simply ignored it. I paid some of the bills that came trailing in over the next few months. They were the most unclear bills I had ever received for anything. A few lines that looked like the one below.

    Procedure #1572                                                                         $276.00

    After I repeatedly tried to contact them to ask for a total bill so I that I could pay them I was simply ignored so I stopped paying anymore bills. After about a year the bills stopped. I felt like I was in the twilight zone. My lawyer had a copy of everything so I was prepared in case there were any repercussions. None ever happened.

    This level of insanity is hopeless and useless. The waste of effort and the manipulative inflationary overcharging is just evil. Part of the reform of health care that the Republican Presidential Candidates are proposing should be simple truth in billing for every medical procedure.

    Let the informed consumer with his own well funded HSA make his own choices. The price of health care will go down and I would bet dollars to donuts that the quality goes up.

    Regards,

    Jim

    • #67
  8. Midget Faded Rattlesnake Contributor
    Midget Faded Rattlesnake
    @Midge

    James Gawron: I had an experience that went even beyond this level of insanity. I was told that different departments had performed services on me at the hospital. When I requested a total bill so I could pay it, I was told that no one kept a total of charges on me and that each individual department would be billing me…

    I paid some of the bills that came trailing in over the next few months. They were the most unclear bills I had ever received for anything… After I repeatedly tried to contact them to ask for a total bill so I that I could pay them I was simply ignored so I stopped paying anymore bills. After about a year the bills stopped. I felt like I was in the twilight zone.

    Yeah, for one hospital stay, one of the multiple bills I should have been sent ended up getting sent to South Africa instead. Of course, having paid every hospital bill I received, and receiving no more, I thought I had paid everything….

    Little did I know there was another bill… sent to a continent I had never even visited… working its way onto my credit report… eating into my credit rating…

    Finally, the woman in South Africa receiving the bill contacted me. She was receiving legal threats over nonpayment by that point. I managed to get the debt canceled and my record expunged. But it was madness. How can a reasonable consumer anticipate that?

    • #68
  9. PsychLynne Inactive
    PsychLynne
    @PsychLynne

    Concierge medicine has been mentioned on the thread, but I go to a practice in Vienna, VA that isn’t concierge and bills by times.  It consists of a Family Practice doc and an internist or two, as well as a couple nurse practitioners.  Unlike concierge, I don’t pay a monthly fee.  They bill strictly by time-$400

    When you join the practice, you go for a 1/2 hour visit to establish yourself as a patient, after that, the vast majority of your ongoing care can be done by email or phone as needed.  Even better, they are fantastic at coordinating care.

    The office is calm, house calls are available, and same day appointments are always available.

    Here’s a link to their pricing page: http://www.doctalker.com/page.php?id=2

    I understand why this won’t work for every specialty, but it’s been a fantastic experience for our family–and it’s a different model of care than the usual or concierge.

    • #69
  10. MarciN Member
    MarciN
    @MarciN

    PsychLynne:Concierge medicine has been mentioned on the thread, but I go to a practice in Vienna, VA that isn’t concierge and bills by times. It consists of a Family Practice doc and an internist or two, as well as a couple nurse practitioners. Unlike concierge, I don’t pay a monthly fee. They bill strictly by time-$400

    When you join the practice, you go for a 1/2 hour visit to establish yourself as a patient, after that, the vast majority of your ongoing care can be done by email or phone as needed. Even better, they are fantastic at coordinating care.

    The office is calm, house calls are available, and same day appointments are always available.

    Here’s a link to their pricing page: http://www.doctalker.com/page.php?id=2

    I understand why this won’t work for every specialty, but it’s been a fantastic experience for our family–and it’s a different model of care than the usual or concierge.

    I like the five minutes for $33.00. I can talk fast.

    That is a very reasonable price.

    It makes me wonder why everyone else is charging so much.

    At $33 for a five-minute visit, more people would get health care they need. We’d be a healthier country.

    • #70
  11. The King Prawn Inactive
    The King Prawn
    @TheKingPrawn

    It should say something about our healthcare system that the least stressful and most satisfying encounters I’ve had recently were with the VA. Sure, late on a Friday afternoon the whole place had an air of oppression to it, but when a guy on his way home for the weekend took his own time to show me where the lab was just because I’m a veteran and didn’t deserve to be left wandering the labyrinth on my own it showed that I’m something other than a billing number. Or, as Arthur Brooks phrases it, I was treated like an asset to be developed rather than a liability to be managed.

    • #71
  12. PsychLynne Inactive
    PsychLynne
    @PsychLynne

    MarciN:

    PsychLynne:Concierge medicine has been mentioned on the thread, but I go to a practice in Vienna, VA that isn’t concierge and bills by times…

    I like the five minutes for $33.00. I can talk fast.

    That is a very reasonable price.

    It makes me wonder why everyone else is charging so much.

    At $33 for a five-minute visit, more people would get health care they need. We’d be a healthier country.

    My doctor has videoes on the web-site (I think his son works in editing) and says he wants to do a video with a typical doctor-patient visit and show everyone else who is “in the room” with an agenda…so the insurance company, EMR group, quality standards people, pharmacy benefits managers….

    And I said “and that’s why it’s tough to get patient-centered care.”

    • #72
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