The Frustrating Truth About Being a Healthcare Consumer (and How I Hacked the System)
For too long, Americans have been in the dark about the cost of their health care until they receive a bill. The Transparency in Coverage requirements will empower consumers to shop and compare costs among various providers before receiving care. Because consumers have an important role to play in controlling health care costs, consumers must have meaningful information to generate the market forces necessary to achieve lower health care costs and reduce spending. - Centers for Medicare & Medicaid Services
This sounds great. I want to be a market force lowering health care costs so I decided to try shopping for healthcare. When I called hospitals for quotes on an elective procedure, I encountered two main types of responses.
When I pushed for a ballpark estimate, some providers gave me a few medical procedure codes (CPT codes) and suggested I check with my insurance, while others only provided the price for the initial consultation but not the procedure itself.
Most people I spoke with seemed either tired or uninterested. A few are genuinely helpful and empathetic. I told one lady, as a patient with a high deductible plan, I couldn't make informed decisions about my care without knowing the full cost upfront. I asked her, 'If I start the process with an initial consultation and diagnostic tests, only to find out later that the rest of the procedure will be unaffordable, am I supposed to stop halfway through or start searching for a more affordable option?' She laughed, and recognized the absurdity of the situation.
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After a frustrating day of phone calls, I'm left with soaring blood pressure and still no clarity on pricing. I swear if there is a provider that can give me transparent pricing, I’m going there for the rest of my life, period.
But hold on a second—didn't CMS mandate hospitals to publish their prices? If they won't tell me, I'll find out for myself. Armed with the collective wisdom of Redditors who've been through similar procedures, I pieced together the typical categories of spending: physician consultations, diagnostic tests, the main procedure, and medications. From there, looking up the relevant costs associated with them. At the end of the day, one provider charges more for ultrasounds (considered 'shoppable' by CMS) than another, but when you tally up the entire procedure, the differences are not significant in the grand scheme of things.
The power of knowing the price upfront is incredibly empowering, perhaps even more so than the ability to shop around. Ever seen the game show 'The Price Is Right'? Contestants guess the price of products, and if they're right, they win a prize. I propose we need a similar setup for healthcare.
Consider a sleep study (CPT 95810), listed as a shoppable procedure by CMS. Guess how much it costs? Click the link below to find out.
Benefit Geek, Jarhead, Geriatric Millennial
6 个月And we havemt even touched quality. Its ana ct of god to get price but the more importamt question hasnt been addressed. Both of these components are required for a market to work in economics!
Formerly The Vice President of Aon
6 个月I had a recent personal experience with a new prescription that was a good example of this. The script my doctor wrote me cost over $2,000 so I asked the PBM to give me pricing for alternative drugs and what those would cost me after insurance. It was a struggle even to get the names of some alternatives, and pricing? Forget it. What little I was told turned out to be false as well as based on different # day supplies. It gave up in the end and went with what my doctor prescribed.