Friday, February 22, 2013

How Much Was That Doctor Bill?

As I have pointed out many times before, the healthcare system in the US is broken.  You don’t fix a broken system by adding to it or making it bigger.  Basic relationships are flawed; control is in the wrong hands.  Costs will not be controlled until these relationships are fixed, but no one seems to want to do it.

Our relationship with the doctor/hospital is a care relationship, not an economic one.  Ask your doctor the cost of what she is doing or proposing and you will get a shrug.  My former doctor told me that he didn’t even want to talk about insurance or costs.  That was delegated to a clerk in the office.  Meanwhile companies and private insurance are promoting high-deductible plans to motivate patients to control costs, yet, as this NBC article from just last week points out, prices are highly variable from one provider to the next and often impossible to discover ahead of time.

They call us patients, not customers, because they don’t perceive us as customers. When the visit ends, they sends the bill(s), not to us, but to our insurance company – sometimes months later.  There the bills are processed and split between what we owe and what they will pay based on a (secret to us) contract between the company and the provider(s).  In case of an error or discrepancy, we are caught in the middle.  We may have to call a healthcare advocate to mediate the problem.  This entails signed releases to address privacy law issues, and resolution may take more months.  In the case of a complicated procedure, bills are submitted, processed and trickle back to your mailbox individually.  Half a year later you try to recall what took place and which charges are valid.  (I spoke to a friend recently who finally received the $75 bill for a vaccination received over two years ago!)

Without prior access to costs, there is no chance for us to control them.  Costs and contracts are kept private, limiting competition between providers to who has the latest equipment and techniques not who is most cost-effective.  With the kind of variability pointed out in the above article, hip replacements from $10,000 to $125,000, how do we, the insured, begin to deal with cost?

The system is broken:  unnecessarily complex and secretive.  Making it more available and inclusive will not make it better or drive costs down. 

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