I’ve written previously about my family’s experiences choosing a health plan and opting for a higher-deductible plan. Our hands-on consumer education continues, as we recently navigated the muddy waters of cost transparency (the lack of cost information prior to incurring the cost and seeing the bill).
It all started when my youngest son’s doctor suggested we get an imaging procedure to help identify the root cause of his acute but sporadic asthma episodes, in an effort to point to a more effective path of treatment. Now that we are in a plan where many services are no longer subject to copays, but rather deductibles before coinsurance kicks in (and our deductible is higher), we did something we’ve never really done in the past: we actually called the insurance company and potential providers to see how much things could cost and how they would be billed and covered.
What we learned was that there is a huge difference between having the procedure done in a hospital outpatient setting (our $500 deductible + 20% coinsurance on the remaining cost, for a procedure that could easily cost over $1000) vs. a free-standing imaging center that would bill this as a specialist in-office visit ($40). It wasn’t the doctor’s first choice for us to go to a facility where he was less familiar with the radiologists, but once we explained what we had learned about the cost difference, he had a hard time arguing against the free-standing facility.
Even with all of our research and double-checking, we still crossed our fingers that the information we had been given was correct and that we really were only going to pay $40. Turns out that our research and diligence paid off. As this little snippet of our bill shows, we were charged only $40. One other thing to note is that the starting cost of the procedure at the free-standing imaging center was significantly lower than the quote we received for the hospital outpatient procedure ($936 vs. upwards of $1500).
I think we’re going to see consumers doing more of what we did as they shoulder more of the responsibility for their healthcare costs. The challenge is that this is still not easy for the majority of consumers. My husband, who did much of the time-consuming legwork of tracking down the cost information, was completely frustrated by the process and flabbergasted by the lack of transparency in obtaining the information we needed to make a smart decision. I feel like my 25+ years in the industry helped us know what questions to ask and when to challenge the information we were receiving, but most consumers don’t have that advantage. In addition to educating consumers about how to be savvier with their healthcare choices, the industry really needs to do something about cost transparency. This can and should all be so much easier.