A patient has just learned that she needs a semiannual cardiac ultrasound. The question is, how much will it cost?
These exams are done in both the clinic and hospital settings, so our patient picks up the phone to do a little price shopping:
Call #1: “What is your last name and birth date? Sorry, we don’t have that information. Call our billing office at ...”
Call #2: “What is your last name and birth date? We don’t provide that information from this office. Try talking to someone at the corporate office. Let me help you with the phone number ...”
Call #3: “What is your last name and birth date? We do have a special department that does just that for our patients. Call this number ...”
Call #4: “Yes, I can help you with that. What is your last name and birth date? First, a couple of questions:
Q: “Do you have insurance?”
A: “I will be paying out of pocket for 100 percent of the cost of this exam.”
Q: “Where would you like to do the exam?”
A: “Wherever it is least expensive.”
Q: “We will provide a formal estimate of expected charges in three to five business days. Would you like them e-mailed to you?”
This experience is the norm, not the exception. Pricing for health care services is simply not transparent. This call could have gone to any of the major networks in Minnesota — including Fairview, Allina, Essentia, Children’s, HealthEast, Mayo or CentraCare — and the resulting runaround would have been the same.
This lack of transparency has evolved because of consumer complacency. For the system to change, consumers must open their windows, lean out and shout: “I am not going to take this anymore!”
Patients should be able to enter a clinic or a hospital for a scheduled visit and have a pretty clear understanding of what a service will cost. Why is it different from taking your car to a mechanic? They have figured out how to provide an accurate estimate. Their written proposals even include all subcontracted services, such as parts, diagnostics and the mechanic’s labor.
Unfortunately, the estimates provided by health care providers may or may not be comprehensive. Surprise billings by the anesthesiologist, ER doctors, pharmacy and radiologist may come in separate envelopes.
There are steps a consumer can take to guard against a big surprise:
1) Visit a website that aggregates estimates for common procedures and pharmacy prices:
2) Contact your insurance provider; it may have a pricing tool.
3) Contact the provider networks and drill them for accurate estimates. Make sure they know you are shopping price. Document what you learn.
4) Fight bills that you feel are not accurate or do not match the estimate. Hold their feet to the fire.
Market forces are the only real way for health care costs to reverse course and start easing. In the 1980s and 1990s, most employees had great insurance coverage through their jobs, with relatively small copays and full coverage for most services. Patients didn’t worry about the cost of services because they never saw the bill.
Those days are behind us. With high deductibles, health savings accounts, flexible spending account contributions and co-payments on just about everything, the consumer is back in the game.
The conversation about cost will change when providers feel compelled to compete on price. Currently, they do not have much empathy for the patient on the financial side of the relationship. They worry about private insurance and government payers because that is where the money is.
The consumer will soon be a major source of funding. The earlier consumers start bringing price pressure to bear, the quicker costs will stabilize.
John Folsom, of Apple Valley, is an independent sales representative in the medical device industry.