As a properly insured, expectant mother, I learned this week firsthand how difficult it can be to get answers when it comes to the cost of medical services.
In order to prepare financially, I set out on a mission to get a ball-park figure of what my out-of pocket costs would be (after insurance benefits) for the normal delivery of my child. First stop, the doctor’s office. They directed me to their billing department which happened to be a third party billing company that claimed they couldn’t give me any answers. The third party billing company referred me to the hospital billing department who also told me they couldn’t help and essentially treated me as if I was speaking a different language. Final stop, my health insurance company, who politely informed me that they can only give me information about my benefits but aren’t able to tell me the contracted rate they have with my doctor or hospital. They did refer me to the cost calculator on their website, which turned out to be the best resource I have found thus far.
And, for your sake, that is the cliff notes version of the story…
So, how is a patient supposed to prepare financially for a surgery, labor or even a minor medical procedure if they can’t get any information about out of pocket costs?
A recent article in Modern Healthcare cites physician’s concerns about patient questions and sensitivity to costs in the wake of high deductible health plans.
“This whole system makes no sense at all… that cost sharing is going up across the board in a one-size-fits all fashion,” Dr. Mark Fendrick, director of the University of Michigan Center for Value-Based Insurance Design told Modern Healthcare. “As we make people pay more for something they buy less of it.”
The article suggests that the main concern physicians have is a lack of patient follow through on recommended care plans simply based on the potential financial burden. Especially considering that it seems the market is moving more and more in the direction of these types of plans. The article cites a new survey by the National Business Group on Health that found in 2015, 32% of companies intend to offer only a high-deductible, “consumer-directed” plan to their workers.
The real debate on this issue is whether or not it’s a reasonable part of a physician’s responsibility to discuss cost with the patient. Larry Loonin, a retired college theater professor, expressed his frustrations with the seeming “indifference” physicians have about cost to the patient. “They owe it to patients to say something about it,” Loonin told Modern Healthcare. After receiving a bill for over $400 after his doctor referred him to an out of network laboratory for a skin biopsy, Loonin has learned to grill his doctors accordingly.
But in the defense of physicians and their staff members, the process of calculating a patient’s out of pocket costs can be daunting – particularly since physicians have not been in the practice of doing this in the past. To track negotiated rates for several plans, for all different procedure codes sounds like a tall order.
Moving forward experts speculate that physicians will have to adjust their practice models to accommodate cost- sensitive patients. Physicians may need to adopt patient estimator tools and hire staff resource/insurance/cost specialists to specifically explain out of pocket costs to patients.
But as physicians try to figure out how to adapt to these new payment models, patients (like me) are asking questions now. In my particular case, I have no choice but to follow through with the care, regardless of cost. But for many patients, the cost, or lack of information about cost, can make or break their decisions to pursue vital care plans.
“We are replacing a physical ailment with a financial strain,” Dr. Christopher Moriates, a hospitalist and assistant professor with the University of California San Francisco told Modern Healthcare. Unfortunately, some patients may opt for the physical ailment.