#TransparencyNOW

I have spent a lot of time this year in various health policy meetings talking about Surprise Billing and Drug Pricing legislation – very big topics in legislative and regulatory circles. Amid all the proposed legislation (federal and state levels) and regulation (CMS at the forefront) my conversations have been focused on the importance of greater degrees of cost/quality transparency and actionability for consumers. Specifically, there is a LOT of opportunity for improving the flow of meaningful and actionable cost and quality information with consumers. Do you know how much your last doctor’s visit was outside of your co-insurance (if you are lucky enough to have insurance)?

The chronic industrywide lack of cost information became all too painfully clear for me last week in my own quest for treatment. I visited a provider and after receiving the treatment plan and booking my next appointment, I asked, “I know this is covered by insurance but what are the estimated costs?”. The answer was, “We do not know – please call your insurer”. I can’t say I was surprised at the answer, and before this appointment, I did look at my insurer’s “Care Costs” portal to find the answer. Interestingly enough and despite the fact the provider location in question is actually in network, I did not find any cost information in the portal for either the treatment or physicians. (Disclaimer: I will not reveal provider, payer, or portal vendor names, but I can tell you the portal vendor is not my employer). So, two strike outs for me on this question, although the office staff did write down a list of relevant CPT codes and told me to call my insurer with this information (!).

I was determined not to leave the office without some shred of estimated cost information (the irony of this situation given my day job compels me). So I asked if they could give me an estimate of treatment costs for a cash paying patient (i.e., uninsured). I figured I could use such information as some sort of a clue. “Well, we have to talk to the doctor and ask because sometimes they change the prices”.  Are we negotiating now? Cool – I’m game! Are there specials this week?

I didn’t have the opportunity to bargain directly with the physician as he was with another patient (darn). But I did receive a print out with actual line items and costs for cash patients, not just CPT codes. This at least was a starting point, but still doesn’t tell me what my estimated costs are under my insurance. I guess I will call my insurer and rattle off the CPT and diagnoses codes and see what that gets me. I consider myself blessed that I work in the industry and actually understand what CPT codes are and why they matter to the topic. But it shouldn’t be this hard.

I have to run…I need to call my insurer’s member services line. To be continued.