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My Health Care Runaround

by Allen L. Gee, MD, PhD, FAAN, neurology specialist

As a provider who runs a medical practice, I am absolutely stunned by the maze of barriers that patients are forced to confront.

I can speak from personal experience. One of my daughters recently needed surgery. The conversations trying to get to the surgeon's office went something like this...

“My daughter needs wrist surgery. How much will it cost?”

“Well, sir, if you have the CPT codes we can give you an estimate, but it may change at the time of surgery.”

With the applicable CPT codes handy I reply, “OK, well what will you charge for these CPT codes?”

“$15,000”

“How much does it actually cost you?”

“We don't know.”

“How much will you take to do the procedures?”

“We don't negotiate. We just do the medical billing. You will have to speak with patient financial services.”

#

“Hello, patient financial services. How much will these procedures cost me if I pay directly?”

“Don't you have insurance?”

“Yes.”

“Well, we have a contract with your insurance company and that determines how much we will accept.”

“But I have a large deductible and will be paying most of it myself and would like to negotiate a better rate.”

“If you do so, your insurance won't pay because we have a contract with them. We can give you a 30% discount if you pay in full.”

“What rate does my insurance company pay?”

“We can't tell you. You need to contact your insurance company.”

#

“Hello, insurance company. What is your negotiated contracted rate for these procedures with this institution?”

“We can't tell you. You need to speak with a patient care consumerism specialist.”

#

“Hello, patient care consumerism specialist. What is the negotiated contractual rate for my insurance company with this institution?”

“I can't give that to you now but will email it to you.”

(It turned out to be 30% discount. Interestingly, the same as cash pay.)

#

“Hello, institution. I would like to negotiate.”

“You can't. Your insurance company has a negotiated rate with us.”

“But I don't, and I'm paying the bills.”

“Sorry. Have a nice day.”

#

Exhausted, I resigned myself to “the system” only to be grated the night before the procedure was scheduled. After an eight-hour drive for the consultation on a Monday and surgery Tuesday morning, the surgeon did not know why we were there. During the time the surgeon was sorting things out and decisions were being made on the appropriate procedures, the clinic financial counselor demanded a signature agreeing to full cash payment for the surgery (as pre-authorization had not been completed)...or the surgery wouldn't be done! BUT WE HAVE INSURANCE!

"I still must have a $5,000 check right now or there will be no surgery.”

While patient accountability is absolutely critical to improve healthcare, how can we expect patients to be informed consumers when the system so aggressively prevents their/our interaction?

Do you have knowledge or an experience to share?

The author is an athenahealth client.

View full profile and posts from author

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