Friday, August 16, 2013

How can patients be responsible consumers without knowing costs?

Earlier this week, I posted a reference to the Kaiser Health News article on the proliferation of high deductible health insurance plans and how hospitals have noticed an increase in the number of unpaid accounts as a result.

Reader William Ertel, a Charlotte financial planner, wrote to suggest the problem should be viewed differently.

People should be expected to pay their bills, he said. But how are patients supposed to be responsible consumers if they can’t find out the cost of the services they are buying? 

Ertel said he’s had a high-deductible policy for years, and a health savings account to build up a pot of money to use for medical expenses. But "the novelty of this has disappeared for me," he said.

That's because: “No one at a doctor’s office can tell you what anything costs... In my business (or just about any other) we would say that is crazy!”

When a doctor recommends a test, Ertel said he asks for the cost, and the answer is often, “It depends on your insurance.”

“This is, of course, factually incorrect. My insurance might dictate how much I will pay (which is important) but it certainly should have no bearing on what it costs. Should a (procedure) cost more if I have a (Blue Cross Blue Shield of North Carolina) high-deductible plan or if I am uninsured?

"So the original story about hospitals complaining about high deductible delinquency could easily have been -- Hospitals Are Unable to Tell Patients the Costs."

One of Ertel's relatives recently went to the emergency room, and was released after about an hour. The bill from the hospital said "ER services" for $1,200, which was discounted to $900 based on the insurance contract. It was due within 15 days. And there was no more explanation.

Ertel called the billing office for details. Five days later, he got a list of insurance codes and cryptic descriptions – “none of which could interpreted or understood by an average person,” he said. 

Instead of focusing on patients not paying their bills, Ertel said: “You ought to let people know how poorly medical service providers communicate their fees and provide billing information....Again, I think people should pay what they owe, but hospitals are failing at providing timely information on amounts and explanations. I think this may contribute to the hospital being paid slowly."


Shamash said...

Our medical system is still based on a medieval guild model of a monopoly.

Which works great for the providers.

Until we disassemble that, we will NEVER be able to control rising medical costs.

Anonymous said...

My wife entered the Presbyterian Pain Rehabilitation Program. It was an intensive 4 week, 4 days a week, 4 hours a day program. She asked the director about the cost. The director said that she or nobody else could answer that question. "There used to be someone who could tell costs, but they eliminated that position." It ended up costing $10-20,000 retail (before insurance). My wife asked how a 45 minute Physical Therapy session was billed. They said it was based on "units" and it was hard to explain or understand. It is done like this for a reason; if you don't know the price, you can't comparison shop!

Archiguy said...

The system is a mess. This is "Exhibit A" why we need to implement a single-payer, government run health insurance model in this country. Basically, Medicare for all. It's what every other civilized country in the world has done, and it's the only way to control the out-of-control spiral of ever-increasing medical costs.

Basically, the government sets a price schedule, what it will pay for a given service. Then the market competes on price based on that schedule. It's the ONLY way to control costs.

The other advantage of a single-payer plan is it takes the burden of providing health care off the backs of American business, better helping them compete in a global marketplace.

It's what we should have had instead of Obamacare which, while flawed, at least attempts to bring most of the population under some kind of insurance umbrella and eliminates some of the more grievous wrongs inherent in the current system such as refusal of insurance based on pre-existing conditions, etc.

But considering how much irrational and hyperbolic opposition the President has had to endure from the political right-wing on the ACA, you can just imagine how apoplectic they would have gotten if he had tried to establish a single-payer plan instead. It's what he and most Democrats really wanted. Someday, hopefully, we'll end up there. We really have no choice if we want to keep the system solvent. Obamacare is a start, but Medicare for All is the necessary finish line.

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Novak Jim said...

In this matter, patients need to make sure about the costs of services which he is going to avail. The professional should also show responsibility in this regards.
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