Doctors don’t know what healthcare costs

Heard on the golf course

I don’t want to reinforce the cliché that all doctors play golf, but my husband (not a doctor) plays with a lot of them.

Recently he shared with me a couple of conversations he’s had with his MD golf buddies about the cost of healthcare, specifically prescription medications.

A few weeks ago I posted about how much it costs to buy an EpiPen—over $700 for a pack of two, if you don’t have insurance. Even with insurance, it can cost well over $500.

My husband mentioned this to a friend, a urologist, during a golf game. The doctor responded, “No, that’s not right. It should cost about $40.”

When my husband pulled up the website GoodRx to prove he knew what he was talking about, his friend just shook his head and said, “That’s mixed up.”

Yes, it is!

During another golf game, a doctor complained to my husband about the cost of levothyroxine. His daughter had recently been diagnosed with low thyroid, and levothyroxine is the drug used to treat it.

My husband takes levothyroxine because he had his thyroid completely removed a few years ago due to a diagnosis of thyroid cancer. (Although that particular cancer is no longer called cancer and removing the whole thyroid is no longer recommended. That’s a story for another post!)

The cost of both the brand name (Synthroid) and generic levothyroxine has skyrocketed in the past 5 years. The increase has been partially due to temporary shortages, but I cynically believe the drug companies are raising prices on all drugs just because they can.

Anyway, we found it was cheapest to buy his levothyroxine through Walmart’s $4 prescription drug program. We get a 90-day supply for just $10. If we used our insurance, we would get a discount at a participating pharmacy, but it would still cost us between $15-25 for a 30-day supply. Some insurance companies charge a $10 or $25 co-pay for generic prescriptions. Walmart’s price is still much cheaper.

As I posted previously, sometimes it’s a better value NOT to use your insurance benefit for prescription drugs: 5 tips to save money on prescription drugs

Again, this doctor didn’t believe what my husband was telling him.

“No, that $10 is just the co-pay,” he insisted.

Patiently, my husband explained that he knew what a co-pay was (he’s married to me, after all!) and, no, the $10 was not a co-pay, but simply what his levothyroxine cost.

The doctor was stunned. Apparently it had never occurred to him that you could buy prescription drugs without using your health insurance!

Doctors are isolated from cost

Most doctors don’t know what healthcare costs. Ten, twenty, thirty years ago, doctors were self-employed and set their own prices for office visits, procedures and surgeries. Now they are employees, and the prices are set by somebody else, far removed from actual patient care. The doctor only needs to write down a diagnosis code and a procedure code and send it to the billing department.

The same is true of prescription medications. Or ordering diagnostic tests, or scheduling surgery.

There is a movement to encourage doctors to add cost as a risk factor when discussing pros and cons of medical treatments with their patients. In my experience, however, many doctors don’t have conversations with their patients about anything, let alone costs. Talking takes time, and that is one thing doctors have less and less of in our current healthcare culture.

The burden’s on you, the patient

Unfortunately, this puts the burden on the patient (even when the patient is a doctor!) to find out what drugs and procedures cost, and then shop around.

It’s not easy as prices are still anything but transparent, but you can use online cost calculators, such as I have listed on my Resources page, or talk to a patient representative at your insurance company. It’s in their best interest to keep your costs down, too. You can also talk to your pharmacist, or the hospital/clinic billing department to learn about costs and possible cheaper options.

I still make it a habit to discuss the cost of tests or medications when I meet with my physician, and I would encourage everyone to do the same. I want her to understand that I have a budget and I although I have health insurance, it comes with a high deductible.

In the old days of family physicians and house calls, doctors knew the socioeconomic status of their patients and provided care accordingly. They suggested less expensive drugs, or did without tests if they didn’t think they were really critical. (This was before lawsuits and cover-your-a** medicine, too). The doctors worked with patients to provide care at a reasonable cost.

I hope we can eventually reclaim that old doctor-patient relationship, but until then it’s best to realize doctors don’t always know what healthcare costs, and you might even be able to educate them on this topic.

Sláinte,

Frugal Nurse

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