By now, and unless you’ve been living under a rock, you know that healthcare is in a state of flux. The Affordable Care Act has become a daily conversational piece and a topic of many heated debates. Is it the panacea for solving our healthcare crisis or simply another bureaucratic nightmare that we must learn to live with? This introductory blog posting is not intended to answer this question, but rather to initiate a conversation about how you can take charge of your own healthcare.
The Bangor Daily News is fortunate to have many well-versed individuals covering this topic, but I wanted to provide the perspective of an independent, practicing family physician whose only motivation is to empower my patients, their friends, family members and colleagues to take charge of their own healthcare.
By using the phrase “take charge of your healthcare”, what do I mean? I’m referring to every aspect of how you receive healthcare, how you collaborate with your physician, where you receive your healthcare and how to best achieve cost-effective care for you and your loved ones.
For the first part of this series, I want to take some time to talk about the increasing cost of receiving healthcare. Recent reports indicate that for those of you that have insurance coverage (either through your employer or independently purchased), your monthly premiums will double if not triple by the end of the year and the benefits you receive from your insurance carrier will continue to dwindle. Out of pocket costs for your medications, tests and office visits are projected to continue to increase. As such, you will be paying for more services out of your own wallet! You need to know what these costs will be *before* you are charged for the services!
With an increased national focus on transparency of health care costs, patients may have more opportunities to get better cost estimates of anticipated medical services. Requesting this information makes you an educated health care consumer, a “smart shopper” if you will. After all, it is your dollar that you are spending.
So what are your options?
A call to your insurance company can be an exercise in patience and diligence! I am increasingly convinced that the answers you receive to the questions you ask is dependent on several mystical variables such as the phase of the moon, the price of tea in China and whether or not you are holding up your left hand while on the call to ensure good reception. How hard should it be to find out what an office visit is going to cost? Or a physical. Or an EKG. Or more importantly, how hard should it be to find out if these services are even covered as a benefit? More times than not, your call ends with more questions that you started with! Oh, wait, “it depends” on whether or not your doctor’s office, hospital, lab or x-ray center is “in network”, “out of network”, “in system”, “out of system”? Really? Perhaps you should start the call with, “yes, my doctor lives on this planet!”
Of course there is always the incoherent and confusing “benefits manual” from your insurance carrier, but you would probably need a PhD in legalese to decipher it!
How about asking your doctor? Or calling his or her office? How about calling the business office for ABC Healthcare organization? Well, unfortunately, they are unlikely to be able to provide any significant assistance. As they are not your legal representative, they are not in a position to obtain information for you from the insurance company.
Complicating this is that most physicians aren’t aware of what the charges are for the various services. It is virtually impossible to expect physicians to know all the details of what benefits are available with your insurance plans (and what your insurance company will and will not cover). As a general rule, private practice physicians are likely to be more knowledgeable about the charges, but we are, after all doctors, not insurance interpreters or negotiators! We need to focus on taking care of you.
As a patient who has tried for the past two months to find out how much it would cost to have an annual physical, I can attest to the fact that this information is…well, nearly impossible to obtain. By the way, I’m still waiting on a price!
In regard to my own practice, I will be publically posting my charges to my practice’s website (I do all the website coding…yeah, I’m kind of a technogeek without the pocket protector, so it’s taking me a little more time to publish this element of my practice’s website redesign)
So what is a patient to do? Be persistent!
Demand to know what how much a service will cost, particularly if you are paying out of pocket! Get a “plain english” breakdown of what your insurance company covers and what it does not cover (if you have insurance). Be a consumer. Fortunately, there is more than one lab, in our area, to have your cholesterol checked (or any other test for that matter). Think the $4 list is a good deal for your medication? You’d be surprised to know that it’s not as good of a deal as it sounds. Need an x-ray, MRI or CT scan? You’d be interested to know that there are vastly different prices between the available facilities.
Above all….take charge of your own healthcare.