Today we hear a lot of talk in the news on the need for transparency in healthcare. Hospitals, physicians, and other providers are being required to post hat their prices for the services they provide.

The US healthcare system is the only provider of services where people don’t know what the services cost. Could you imagine going shopping at Macy’s to buy a dress and having no price tag on the clothing? Would you give the cashier your credit card or write a check for the amount without a price tag to verify the price? That is what I did last week when I want to schedule my 2nd colonoscopy.

Here’s the story

My last colonoscopy was in February 2016. I wrote a Blog Post on the experience as it was a life-changing event for me. During that procedure, the doctor found polyps and advised me to follow up with him in 3 years to make sure the polyps did not return before the regular 10-year time frame.

After getting a notice from the GI office who did the procedure telling me it was time to schedule the colonoscopy, I made an appointment. On the appointed day, I went to the office. I registered at the reception desk and paid my $50.00 co-pay. I sat down and was soon called by the nurse to get my weight and take my vital signs. We talked for a few minutes and then she showed me to the reception area to wait for the doctor to see me.

I was called in to see the doctor shortly after. He greeted me and reviewed my history. He reviewed my last colonoscopy and agreed that it was time for the 2nd one. He told me he would see me the day of the procedure and then directed me to the scheduler. The scheduler reviewed the process of what would happen before during and after the colonoscopy. She then asked for my credit card so she could make a copy for the day of the procedure. I gave it to her, she made a copy and gave it back to me with my instructions for the prep, and I left her office. On the way out, I thought of something and went back to her office. I asked if the doctor was still a provider for AETNA (my insurance company) she said yes. I then asked is the Surgical Center they wanted me to go to was a provider for AETNA, she answered yes. I asked her for this information as I did not want to get a surprise bill if the doctor and the facility were not in my insurance network.

Satisfied, I left the office to find my husband, who was waiting for me in the car. As we drove home, I shared how the appointment went. When I told him about giving my credit card to the scheduler, he said what the costs of the procedure? I said, “I didn’t ask.” He said, why would you give your credit card to someone and not know what they were going to do with it? You always need to see the cost.

I thought to myself, he is right? That was not smart. This is what I write about in this blog  – to remind people to ask questions. Why didn’t this register to me?

Thinking about it the next day, I called the doctor’s office. Unfortunately, the office was closed. I then called the surgical center and asked them what a colonoscopy costs. The person in billing said they don’t know until the doctor did the procedure. I asked, don’t you have a fee to use the surgical center? Last time there was an anesthesiologist who gave me sedation for the procedure. Doesn’t he have a fee? She said yes, but we don’t give out that information. I asked to talk to a supervisor. The person got mad, and I was disconnected.

I called my insurance company and told the member service department what I was dealing with. He said that according to my insurance policy, I have a benefit for a routine colonoscopy. I would have a co-pay of $350.00. He said that if the doctor saw polyps that it would turn into a surgical procedure and I would still be required to pay the $350, but there might be additional costs. He did not know what they would be until he saw the bill/codes. I asked to check to make sure the GI doctor and the Surgical Center were in the insurance network. He put me on hold to check. When he came back, he said yes, they are both in my insurance network.  He suggested I call the doctor’s office to discuss cost. As the GI doctor’s office was closed, I called the Surgical Center again. This time I asked for a supervisor. She was very helpful and took the time to listen to me. She said she did not have my paperwork on the procedure and asked if she could call me back tomorrow. Once she had the information, she could give me an estimate of the costs. I thanked her and sat down and wondered why this system is so complicated?

I was also mad at myself as I did do what I teach people to do. That is to ask questions, don’t take no for an answer, find out the facts. I have a right to this information. I don’t’ know what I am going to find out, but I will get the information that I need to:

  1. Find out the costs so I could make an informed decision.
  2. If the costs were not reasonable (what is reasonable?) I would try to find another doctor/surgical center. We all have to do research. This can be time-consuming, but if we don’t, we have to accept what we are told to pay.
  3. I will call my insurance company after I get the costs of the procedure to learn what they will cover and what my out of pocket costs I may be.

This is what we do in every other sector of our lives. We shop, we compare, we look at ratings to see if the product we are buying is worth the cost. I need to understand how my money will be spent and if it is reasonable based on my research. Finding this is my responsibility!

Thanks for reading! I hope this post helps you do the research when you enter the healthcare system and told you need a procedure, see a doctors/specialist, or have a diagnostic test.

 

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