The official healthcare.gov open enrollment season is upon us. (Interrupting this broadcast for an important Public Service Announcement: this year open enrollment starts on November 1, 2017 and the doors close on December 15, 2017. If you are self insured, then please head on over to healthcare.gov as soon as possible as the process can, unfortunately, be a bit challenging. Check out my friend Brian’s post on his journey for more details. Back to your regularly scheduled programming.) Since the season is officially upon us, I wanted to take some time to address a healthcare cost question that bewilders and frustrates us all.
Why on earth can’t you just call someone and ask how much a healthcare procedure will cost before you get that procedure done?
Outside of this blogging side gig, I actually specialize in healthcare. More specifically, I specialize in digital patient engagement. Given my role, I know that most of the changes in health insurance are resting on the premise that if we let the healthcare consumer take more responsibility for the payment of their care, then they will make better, more cost effective, choices for the care they receive. However, we are leaving a very important part out of this equation. We aren’t actually equipping the healthcare consumer with the really vital cost of care information they need to make such choices.
This challenge was brought home in this well produced video on Vox.com entitled “Giving birth costs a lot. Hospitals won’t tell you how much.”
Why is this the case?
Well, it just so happens that I interviewed a doctor on the 10 big healthcare questions. On this topic, this is what she had to say:
We do need to get better about providing cost transparency. In pediatrics, I seldom get asked about the cost of tests or imaging studies. If asked, I would not be able to answer as I am not given that information in a readily available form, if at all.
Until price is made transparent to physicians, there is little hope it will be passed on to patients. It is a major source of frustration for me. However, there are still things patients can do.
Well, that’s depressing. Fortunately, she leaves us off with some good advice.
If you are planning a pregnancy or a surgical procedure, then research your physician. Check their rate of c-sections (you want it to be low) or surgical complications, including post-operative infection. If the surgeon is sloppy, it can cost you a lot of time and money in additional procedures later on down the line.
That’s great advice, but I have even more advice to give on this all important topic of healthcare price transparency. I’ll use my own travails with my tailbone as an example.
Process You Should Follow to Find Out the Cost of Care
- Visit with your doctor: This journey typically starts in a doctor’s office. Say you fell down the stairs two years ago, and since you half ass nothing, you broke your tailbone. Let’s say that your tailbone is still broken, and you want to visit a tailbone specialist out of state for treatment. You know, hypothetically.
- Get the Name of the Procedure: Your first step should be to ask your doctor for the specific name of the test or procedure. Create a note in your phone or piece of paper and jot down the procedure name. For a quick estimate, you can head to a site like Healthcare BlueBook to get the typical cost of such a procedure in your zip code.
- Ask for the Cost: You could also throw all caution to the wind and actually ask your doctor how much the procedure will cost. Unfortunately, healthcare providers are still quite uncomfortable talking cost of care with patients, and they oftentimes just don’t know. This needs to change, and a very passionate army of patient advocates like me are working on your behalf. Ask anyway. The healthcare industry needs to get more accustomed to this question.
- Get Procedure Codes: Now, let’s get more specific. You will want to ask the doctor (or whomever your doctor refers you to) for some code numbers. Just as there are barcodes on each item in the grocery store, there are code numbers for the procedures you get. Unfortunately, the fact that there are two types of codes doesn’t make things much easier. There are “CPT” codes and there are “ICD-10” codes. Ask them for those codes, and add them to your note. While you are at it, you should ask the person who gives you the codes how much it will cost. Fingers crossed. I was told the CPT codes are 99201, 99211, 98940-22, 97110, 97112, 97140 and the ICD-10 codes are M99.05, M53.3, M62.830. In my particular case, I got lucky. I was given the total cost that the doctor would bill, and the total was just over $1,000.
- Call Your Health Insurance Company: Using the 800 number on the back of my insurance card, I will call my insurance company. If I hadn’t already known how much the procedure would cost, I could ask here. However, I am calling anyway because I want to know how these costs will be applied against my insurance. This is also an important call because I can be sure to receive pre-approval from the insurance company for the procedure. That way I’m not the one stuck paying the entire $1,000 bill.
I hope that was helpful for you. On behalf of the healthcare industry, and those passionate advocates I mentioned, my apologies.