Why Consumer Driven Health Care is Not Working
Posted on October 30, 2006
Filed Under General |
I used to do a lot of work in the health care industry, but gave up because the system was so hard to change. Much has been made of the idea of consumer driven health care as a way to make the system more cost effective. The idea is that you shop for health care like any other product or service.
I decided to give consumer driven health care a try. My daughter injured her shoulder in a soccer game recently and was told to get an MRI by our pediatric orthopedic specialist ( a guy we have seen to much of due to other injuries). The doctor referred me to an imaging clinic to get the MRI.
We have had other MRI’s done and they can cost a lot of money. Also, it seems that lots of clinics around will do an MRI and that there is probably much less difference between MRI clinics than between doctors. Given the expected high cost and more commodity like aspects of the procedure, I thought it would be good to check on the pricing.
I asked the person who called me to set up the appointment how much it would cost and she said I needed to talk to the insurance company to get the contracted rate for the procedure. She gave me their company name, their tax id and the procedure code.
I call the insurance company - they can’t tell me the contracted rate, I need to get it from the clinic. So I call the clinic and they refer me to their billing office. The billing office can only tell me that they will bill the insurance company between $1,200 to $2,000. I ask if I have to pay 30% of that. No they answer, I will pay 30% of the contracted rate. So, what’s the contracted rate? They can’t tell me and refer me to my insurance company.
I call the insurance company and have a long discussion with them and finally ask to speak to someone higher up the chain. I nice lady answers and we talk it through. She tries to access some system, but it won’t let her in. She tells me she will have to go research it with claims or provider relations and will need to get back to me. I ask her if this seems strange not to tell the consumer what the rate is, and she says it is strange that the clinic is not telling me the rate.
I decide to try the clinic again. This time a nice clerk tells me it will be $1,200 but doesn’t know the contracted rate. She tells me that she will contact someone in her company and have them call me.
Two hours of phone calls and no answer on what their price is for a common service. Imagine calling your phone company and they can’t tell you how much a phone line will be, or your cable company can’t tell you how much HBO will be, or any other service provider outside of health care for that matter.
If consumer driven health care is going to work, consumers need the ability to shop. Every insurance company should have section of it’s website where you punch in your zip code and the procedure code and it tells you who is authorized to preform the service and how much it will cost the consumer if they go there. It does’nt have to be for every procedure, just the common, commodity ones, like getting an MRI of your shoulder.
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About The Bitt
My name is Alex Nesbitt. This is my blog. I publish Digital Podcast where I evangelize new media and marketing innovation, with a focus on digital media, social media, social networks, social analytics and influencer marketing.
I help companies with strategy, operational effectiveness and the new economics of media. I am in the market for consulting and employment opportunities
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You are so right. Its all a scam, am having a hard time getting my insuarance to approve my MRI. I wish we could have a menu to see all the healthcare procedure costs.