by Beverly Barsook, Guest Blog
Recently, I visited an eye specialist to discuss an elective eye procedure. I had two options: do the procedure in a nearby facility or possibly have it done in the doctor’s office.
By chance, I knew that this procedure could be done in the building where my current doctor practiced since I had the procedure done there by another doctor a number of years ago. I also knew that my insurance (an HMO) would cover this procedure as an office visit with a co-pay; however going to a separate facility to have the exact same procedure done, would incur a facility fee on top of a doctor’s fee, increasing my out of pocket costs perhaps several hundred dollars or more.
It is important to always ask what your out of pocket costs will be BEFORE you proceed. It is not always about whether your providers are in the insurance company’s network. In this case, both the doctor and the facility are in the network, but the location where the procedure is done determines the cost you might pay.
If we are ever able to get control over our health care costs, we all need to be informed consumers. You do the same thing when you buy a car, a house, or an appliance. It should be the same when it comes to your healthcare. In an ideal world, our costs would all be laid out up front.
I suspect that many doctors are only casually aware of the costs of many of the procedures (or drugs) they recommend. There is also a darker side to the lack of transparency in health care costs. Sometimes (not always) the doctor has a business interest in the facility they want you to go to. While the law does require this to be disclosed, if you are not aware that another facility might have significantly lower costs, you could end up paying out of pocket and the insurance company ends up paying more as well. This can lead to higher premiums down the road. That’s a contributing factor to what they mean when you hear or read that ‘health care costs are rising.’
Here are two other quick examples to drive my point home: First, a friend of mine was prescribed a medication. It turns out the cost of the medication was $40 per month and there were no generic options available. After calling the doctor to ask whether there was a less expensive medication that would do the same thing, a new medication was prescribed, which would cost $15 per month. Now at least it can be determined if the less expensive medication will work just as well. Second, I scheduled a medical test mandated as covered under the Affordable Care Act. The doctor was in the network, the facility in the hospital where the doctor is licensed to practice is not in the network. The test had to be rescheduled and it likely saved many hundreds of dollars for the patient — me!
We need effective legislation to encourage and incentivize true cost transparency from all providers. The sooner we move in this direction, the sooner we will all be players in controlling healthcare costs. Let’s get rid of the medical version of ‘don’t ask, don’t tell’.
Beverly is a volunteer with Boomers Leading Change in Health. Click here to learn more about Boomers Leading Change in Health and Advocacy Academy classes.