A symptom of a broken system
A recent trip to my primary care physician highlighted one of my biggest complaints as a “healthcare consumer”: a complete lack of transparency about what things cost.
How are patients (I hate the word consumer) supposed to make thoughtful, cost-conscious decisions about healthcare when it’s impossible to know what any service costs before we buy?
Out-of-control costs is just a symptom of underlying illness. Actually, our healthcare system probably has several horrible diseases (co-morbidities, we call them), which is partly why it’s so difficult to treat.
Our healthcare delivery system is inextricably entwined with our health insurance system. Over the decades, they have turned into one big, co-dependent mess.
It makes me so angry that my health insurance is increasingly expensive, and I’m expected to pay more in co-pays and deductibles so I’ll have “skin in the game” and choose more cost-effective care.
Fine. I’m frugal and smart with my money. Just give me the information I need!
Primary care or specialist?
I’ve been watching a small mole on my lower leg for the last year or so. It has doubled in size since last summer. It’s very small, only 3-4mm, so that’s not too worrisome. The edges aren’t as clean as I would like, however, and it has varying shades of brown and tan.
Overall, it ticked enough boxes for melanoma, and it worried me when I really looked at it, so I decided to be prudent and have it checked out.
I knew it would have to be biopsied. Not that I would insist on it, but because “failure to diagnose” is a leading cause of malpractice suits, most physicians will opt for a biopsy if a patient comes in worried about a skin lesion.
Best case I catch a melanoma early; worst case it’s just a mole (nevus) and I don’t have to look at it again.
My first decision was whether to see my primary care doctor or go straight to a dermatologist. Cost definitely affected my decision. I could see my PCP for a $40 co-pay; a new patient office visit with a specialist would be at least $250, probably more.
I decided to see my PCP. If she thought I needed to see a dermatologist, I would ask her for a referral.
She examined the mole and agreed with me. It was small, but because it had grown over the last year, was slightly irregular and multicolored, she advised removing it.
She could refer me to a dermatologist, or she could do it in the office. Today.
“How much would it cost?” I asked.
“I don’t know,” she admitted. “I only submit the code. The billing department attaches the fee.”
Now I had to make another decision.
I liked the idea of just getting the biopsy over with and knowing what the mole was. It would be a simple scrape biopsy, but the entire lesion would be removed.
Or I could go home and try to find out the price of a scrape biopsy, reschedule my appointment, and pay for another office visit (full price, since I had used up my last $40 PCP visit).
Or, I could see a dermatologist. I would have to pay for an office visit and probably a wider excision. I might not get an appointment for several weeks.
More than time, the cost again influenced my decision. “Take it off!” I said.
In my head, I figured the fee would be about $250. Wrong.
Prices are not only opaque, but variable
I still haven’t received the pathology report, but I have received the bill for the excision: $415.
Really? For a procedure that used a few cents of lidocaine, a disposable blade and a bandaid? And took all of 2 minutes?
I found the procedure code (11100) on my Explanation of Benefits (EOB) and plugged it into two different price comparison tools.
I called customer service at my insurance company and asked if that charge was correct. She couldn’t really say, because she wasn’t a billing specialist. But she offered to flag the charge and have it audited. She warned me to keep my expectations low, as the price probably wouldn’t change.
While I had her on the phone, I picked her brain about how a patient was supposed to find out prices before getting slammed with a bill. Did the HMO have a price list or fee schedule for office visits and common procedures? She was apologetic, but no, nothing like that existed. She said it was possible to request a fee estimate for a procedure, although that could take up to two weeks and would only be an estimate. The actual cost could only be determined after the fact.
It’s like going grocery shopping, only there are no prices on the food. Or maybe just a range of prices with an asterisk that tells you the price may be different at checkout. Or you will only know how much that bag of groceries costs two months from now, when you finally receive the bill in the mail.
Is any other industry allowed to act this way?
What can a patient do?
Not much, unfortunately.
States, mine included, have tried to pass legislation to force more transparency in healthcare, but the insurance industry and big health corporations are against it.
Price transparency would not be good for their bottom lines.
Call or email your state lawmakers. Let them know transparency in healthcare is important and worth fighting for.
Otherwise, my best advice would be to keep asking questions and not suffer this financial abuse in silence.
Making an appointment? Ask how much it costs.
Your doctor advises a test or drug? Ask how much it costs.
A charge seems unreasonably high? Ask both the provider and the insurance company if the charge is correct and if you can appeal to have it reduced.
Perhaps a loud, collective voice demanding price transparency will eventually be heard.
Healthcare consumes a larger and larger portion of a family’s budget. Yet we aren’t allowed the most basic information we need to make significant financial and health decisions.
btw, I haven’t received the bill for the pathology report. I dread finding out how much that will cost me. But cost aside, I still think having the mole removed was the most prudent choice and I would probably do it again.