I am convinced that I should not have to be an insurance agent before I can visit a doctor.
(Please excuse me while I vent a bit today. They say that writing out your thoughts can help you make sense of them . . . and I’d love to make sense of this mess that has been rolling around in my brain and taking up so much of my time recently!)
Since signing up for an HSA, I have become more and more aware of the mess that is our healthcare system. This week, it all came to a head when I realized that I would have to pay more out-of-pocket for a simple check-in with my primary care physician than I paid for a visit to an urgent care clinic that included multiple lab tests. Both offices are in-network providers for my healthcare company, so I began to ask questions.
Apparently, there are certain codes associated with each visit and procedure in any doctor’s office. The insurance company has an “allowable amount” for each of these codes, but the allowable amount differs by state, and they change from year to year. I have to begin my hunt for affordable healthcare by gaining access to the allowable amount my particular insurance company is willing to pay for each code. But there is no easily accessible list of these amounts for me to find. I have to contact the company each and every time I might visit the doctor to find out how much they will cover of the code for that specific visit. Which is tricky, because it means that you have to get the code for your visit from the doctor’s office before visiting.
The doctor’s office does not like to tell you the code before your visit, because things may change if the doctor has to perform additional tests once you arrive. So far, I have been able to secure codes for two kinds of visits, but I was only able to do so after an appointment.
(I also found out that my out of pocket expenses for at least one of the visits would have been less if I had been uninsured! I am paying for insurance and then paying more for a simple doctor’s appointment? Something seems amiss . . .)
If I have a code ahead of time, I can call my insurance company to find out the plan’s allowable amount for the visit that I might make to the doctor’s office. Once they tell me how much they will cover of that code, I can call multiple doctor’s offices to ask what they would charge for a visit coded that way.
Since I now have two codes in my possession, I plan to call a few practices in my area to determine comparative costs for the same treatments I have already received. If I find an office that charges my insurance company less than my current office does, I will probably be moving my family to a new practice. If the doctors will tell me what they charge. My state does not require doctors to share their fees with patients or potential patients.
Before I purchase almost any other product or service in the world, I have the opportunity to shop around and find the best deal. Discovering what I will actually pay out-of-pocket for a visit to the doctor, however, is nearly impossible. But one state has recently made a way for consumers to begin understand how much they can expect to pay for healthcare, and I am a bit jealous of people who live there.
Since October 1st, insurers in Massachusetts have been required to provide price estimates for many procedures. Doctors are even required to tell patients what they charge for certain procedures if the patients ask!* Though I am excited that insurance companies are helping Massachusetts residents decipher their healthcare costs, I would love to see more states require that the doctors themselves reveal what they charge for care.
I’m sure costs vary because different offices use different equipment, employ more staff, or factor in any number of other variables. If price lists are made available to the public, doctors may have to begin to explain what differentiates their practices from one another in order to validate their cost differences. The increased competition might just drive costs down. The increased need for explanation might even make a visit to the doctor a bit more intelligible.
After hours on the phone with doctors and insurance companies, I am ready for a change. I am ready to be a patient and a consumer instead of a researcher, an insurance expert, a doctor, and a financial counselor.
What about you? How have you navigated the jungles of healthcare this year?