In June of 2023, I was routed to the ER because my fever of 104.7°F wasn't responding to over-the-counter medication and my tonsils were starting to impede my breathing. In July of 2023, I had a medically necessary tonsillectomy.
In total, I received 31 different bills from 13 different healthcare providers. We were fortunate enough to have excellent employer insurance through Blue Cross Blue Shield.
My ENT let me know before the surgery that we would owe about $1,800. The day of the surgery, the ambulatory surgery center surprised us by saying that we owed them $2,700. After my surgery, I continued getting fragmented surprise bills for anesthesia, facility fees, involved practice groups I never met, labs, and more. We're still not sure what all we owed but have probably paid north of $10,000?
I don't agree with everything in this article, but it is thoughtfully written and makes some compelling points.
In general, I think free markets can create efficiency and maximize value for consumers (i.e., patients). As Wainer writes, "
There are plenty of cases in healthcare of private-equity investors steering a business they bought through a transition of rapid performance improvement by streamlining billing and scheduling, later selling it for a profit—the same efficiency they can bring to other businesses."
However, freedom of consumer choice is a crucial element in free markets. Freedom of choice cannot exist with opaque pricing and services information and lacking competition. Wainer also points out how this is lacking in much of healthcare:
"...payers and patients often have no choice but to accept exorbitant charges. What’s more, consumers aren’t cost-sensitive because their employers and health plans cover most of the charges and because they lack pricing information to make a decision. Before a patient goes under, she has no idea how much the anesthesia bill will be."
I saw two ENTs who actually had availability to take me for comparison. Others would have been a 6 month wait at least to see me, let alone get a surgery scheduled. This wait would have increased my risk of repeating ER visits. No one was able to give me accurate cost estimates from the 31 different bills I received, including the lovely Blue Cross Shield customer service managers and provider billing department heads who spent countless hours also confused in trying to sort through everything.
I recommend reading this Wall Street Journal article. I'd love to hear your opinions. What do you think?
https://lnkd.in/gNhCxXhV
"You Can Thank Private Equity for That Enormous Doctor’s Bill" - David Wainer, The Wall Street Journal
#healthcare #patientadvocacy #patientsasconsumers #access #sdoh #burdenofaccess
