How Much Is This Going To Hurt? Let Me Look Into My Crystal Ball……

“Sorry, let’s check the crystal ball”

     If you’ve read this blog before, you’ve noticed my interest in our ever-changing healthcare system as it relates to the patient experience.  It’s time for an update!  In short, since passage of the Patient Protection and Affordable Care Act (ACA) in 2010, transparency of healthcare costs has been much vaunted.  I’d go so far as to say transparency was a core selling point.

     See this ironically-named page from the Centers for Medicare and Medicaid Services on the ACA and transparency for consumers:

https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/increasing-transparency02162012a.html

     As an also-ironic aside, the page boasts, that “consumers will have access to two key documents that will be written in plain language, in a standard format, to help you understand and evaluate your choices,” including “a uniform glossary of terms commonly used in health insurance coverage, such as ‘deductible’ and ‘co-payment.'”

     Unfortunately, the link to their Summary of Benefits and Coverage and the Uniform Glossary is…you guessed it: not functioning.

http://www.healthcare.gov/news/factsheets/2011/08/labels08172011a.html

     The icing on the cake is that if you somehow manage to follow the links to the Summary and Glossary page, you get this nonsensical eruption of legalese which is most definitely not transparent:

 https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/index.html#Summary of Benefits and Coverage and Uniform Glossary

      Back to the crystal ball.

     My family’s new health insurance plan is one of the high-deductible ‘catastrophic’ plans that are designed to cover very little unless and until you have the misfortune of serious illness or injury necessitating very expensive care.  I don’t want to bill the insurance company for my family’s routine minor care.  I am happy to pay, out of pocket, a reduced “direct pay” rate most clinics offer.  Seems like a win-win situation to me: the insurer pays nothing, I pay an uninflated, “actual” price, the clinic does not the expense of billing overhead and paperwork, and everyone is happy, right?

     But it appears that, unless they are not contracted with your provider at all, doctors must bill through your insurance even if

  • you do not want to use it
  • your service is not covered
  • your deductible has not been–and will likely never be– met
  • and critically: even if your payment will be HIGHER using insurance than if you were to pay directly!

I found this article on avoiding the problem: http://selfpaypatient.com/2014/01/03/insured-patients-can-save-money-by-pretending-to-be-uninsured/    Disclaimer: be careful if you try this because of the chance you actually could meet your deductible unexpectedly; your previous payments would not be ‘counted’ towards your deductible.

This is a long way of getting around to something that should not require a crystal ball: the price of your medical service.

I trotted into three different clinics with three different family members to ask the prices of three different medical services.  Before I agreed to pay the insurer’s contracted rate, I wanted to know the rate for ‘direct-pay’ patients, since I knew none of the services would be covered at all.

Not one of the three clinics could tell me the insurer’s contracted rate for the service.  They knew the direct-pay rate spot-on. So, intrigued, I got on the phone with our insurer (who I have to say, has been very professional and user-friendly aside from this issue).  I never did get a precise response. So, in short, I could not make an informed decision about my family’s care because critical information was unavailable.

This is unacceptable.  Imagine going to a store where you find a lovely pair of earrings.  The cashier says, “We’ll bill you. Could be $50.  Could be $500.”

What if they were goofy Christmas tree earrings, and you thought you could use them for the holidays?  Paying the lower price would be a reasonable judgment call, but you KNOW you don’t want them if they cost $500!  If you don’t know the price, you can’t decide whether they’re worth it.

What if you saw two shops, side by side, offering the same earrings, both unmarked?  Which ones would you buy, if you had no idea which were the better deal?

Just because healthcare is more precious and complex than a pair of earrings does not mean the costs should be any less transparent.  In fact, I’d argue the potential value, costs and benefits of healthcare make price transparency even more critical.  You should not have to look into a crystal ball to know exactly what you’re expected to pay, and exactly what you can expect to get in return.  That’s why at Neuropsychology, Inc., you are quoted a price and time frame upfront, with no hidden fees, denied payments or balance billing.  I trust you to make these decisions for yourself and your family.

One last tidbit….Here’s a clear and detailed article on surprise medical bills and how to avoid them:

https://consumerist.com/2015/09/24/a-loopholes-and-master-pricing-how-surprise-medical-bills-knock-consumers-down/