I know, I know, the insurance companies suck! But they are not the whole problem. You are a big part of the problem too! Let me explain.
I use a CPAP machine for sleep apnea at night. After nearly a decade, the machine malfunctioned. Not bad, considering it is used daily for 7 or 8 hours. Just buy a new one, right? Well, not so fast. You need a prescription to get a new machine. Can’t get a prescription without seeing the doctor again.
OK, I can understand a quick visit to see that you still need the machine. Figure a hundred bucks for a visit. Not thrilled, but understand. Go to the visit, hoping to get a script for a new machine. But, the old sleep study isn’t good enough, so now you need to go have an overnight sleep study performed. The price without discount is $2,000. Negotiate this down to $800 or so. Getting a little ticked now, but decided it was probably good to have it updated after 8 years.
We’re at $900 or so, and we haven’t even priced the machine yet! Internet searching shows the cash price for machines running from $500 to $2,500. Knew I was in for some hurt, but jeez! Check with the insurance company to see if they have preferred vendors that I could get a discounted price. (I have to meet a $5,000 deductible, so it’s all on me) They give me 5 companies on their list. I start making calls. First two are out of business. Third one doesn’t sell these products anymore. Number four wants to lease-to-buy, doubling the total cost! Number five isn’t really "in-network" now, but they are a small local company and agree to work with me. Finally get down to $700 for the right machine. But, I still have to wait on the sleep study and a return visit to the doctor to get the prescription in order to purchase the machine.
I do the overnight study, and pay 50% that night. See the doctor the next week to get the script. See the doctor for 15-20 minutes to go over the study and get the prescription. Head to medical supply company the next day to pick up machine. Running costs to date- $100 for doctor’s office visits, $800 for sleep study and $700 for the machine, grand total (or so I thought) $1,600.
But nothing is as easy as it sounds! First, the sleep study clinic now wants to reneg on the agreed upon price. Instead of wanting another $400, they want $600 now. What about the agreed upon amount? They reply, we don’t have anything in writing saying we agreed upon $800, we want $1,000! Well, now I’m getting pissed. But it doesn’t stop there!
A month later, I get another bill from the doctor’s office. Now he wants almost $300 for reading the results of the sleep study. Wasn’t that what he was doing at the second office visit? (It was, but he wants to charge as if he was there at the sleep study.) That $700 machine is now going to cost $2,500.
Now, it would be one thing if I had sauntered into the aforementioned offices and not inquired about costs and fees. But that is not the case. On each step of the way, I announced that the costs were all out-of-pocket and that I had limited resources. Made it real clear I needed to know upfront what the costs were because I couldn’t pay at time of services. Told them I would delay certain items until I could pay. (I was borrowing a relative’s unused machine for the short-term.)
I dare anyone to try to figure this out. Providers want you to pay at the time of services, but they will not tell you what that is upfront. Then when they tell you a number, they won’t keep to it. The doctor says the billing department takes care of it, and they don’t know what it costs. The billing department tells you they don’t know what the doctor will code the visit and services, so they can’t give a firm number.
Well, maybe we need to treat them like auto repair shops. If the cost of service will exceed $100, they must provide the patient with a good faith estimate before any service is provided. Of course, emergencies would be excluded. But they know what an office visit costs. And the majority of their normal in-office procedures costs are known. The fact that they have no desire to be transparent says a lot about their ethics. How can you be an informed consumer if you never truly know what you will be billed? They complain about insurance companies, but they treat paying patients worse than the insurance companies treat the providers.
4:49 PM PT: I note in a response below about a current bill in Florida to mandate posting fees in a doctors office. The part of the article that was telling:
Along with more expected recommendations ("that doctors be as clear as possible when explaining to patients what is covered fully as a preventive visit and procedure"), AMA's experts suggest that practices consider various written handouts and forms" that spell out (and protect the practice from liability for) the possibility of a free or cheap visit turning into a more expensive one.