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The Obfuscation Plan

A physician specialist that I see regularly ordered a diagnostic test to check on my medical condition.  He explained to me that two tests were available and he disclosed which of the two he preferred.  Of course, I did what most patients do—I chose his preference.  Later I would learn that his preference cost almost twice as much as the other test and that I would have to pay more than $500 for the part of the bill not paid by my health plan.  I hasten to add that I am not upset with my doctor.  Rather, I am ticked off at myself and my health plan for how this played out.

I have been critical in this blog of consumers’ lack of interest in managing the cost of their own health care, and now I feel I must eat crow for not practicing what I preach.  However, I am equally upset with my health plan for not advising me of the cost for this scheduled procedure when it was approved.  Though I haven’t received it yet, I know my health plan is going to send me an Explanation of Benefits (EOB) that will detail what the provider charged versus what the plan paid, along with what I am obligated to pay the provider.  Why didn’t my health plan tell me the cost before I had the procedure done?
 

Strategic Health Perspectives founder Ian Morrison refers to this as “The Obfuscation Plan.”  He asserts: “To have truly informed consumer decision making requires that providers and insurers coordinate their communication to clearly tell the patient what it will cost patients at the time the patient has to make the decision to have the service or not.”  Morrison concludes with: “The health care system fails miserably on this simplest of all market tests: You know the price before you buy.”  True that!

Your thoughts?

Comments

The Obfuscation Plan

Submitted by Visitor (not verified) on March 26, 2013 - 9:25am.
If we are to have informed consumers of health care, we need to simplify...simplify the multitude of health plan options and simplify the way the services are billed. As a clinician working to improve the patient's experience, the most common complaint relates to the bill. Patients are frustrated with the cost of their care (after the fact) and immediately blame the provider rather than looking at the type of health plan package they purchased with a $5,000 deductible. But the provider needs to own up to estimating the cost of services and consumers need to be informed how things are costed out..."why does a Tylenol tablet cost so much on my hospital bill?" We understand our auto insurance but we don't get our health insurance. But if I go to my auto repair shop, I get an estimate of what it will cost before the services are rendered. In healthcare, we can't get that right because health plans are so confusing about what they will or won't pay (covered benefits). With the focus on healthcare, you are right, consumers are becoming more interested in the cost of their care. But there needs to be some consumer education on how to interpret their health insurance...coupled with re-engineering of how we produce a bill. That Tylenol costs so much because the pharmacy and nursing care necessary to deliver it safely must be incorporated somewhere; so it gets buried in the pill rather than under clinical services fees. Just like when you get your auto repair bill...it says the part will cost "x" and the labor will cost "y." I hope we, health care providers, can do more to clarify for our consumers so they truly do understand what they are paying for! What does the future hold?

Comments

The Obfuscation Plan

Submitted by Visitor (not verified) on March 26, 2013 - 9:25am.
If we are to have informed consumers of health care, we need to simplify...simplify the multitude of health plan options and simplify the way the services are billed. As a clinician working to improve the patient's experience, the most common complaint relates to the bill. Patients are frustrated with the cost of their care (after the fact) and immediately blame the provider rather than looking at the type of health plan package they purchased with a $5,000 deductible. But the provider needs to own up to estimating the cost of services and consumers need to be informed how things are costed out..."why does a Tylenol tablet cost so much on my hospital bill?" We understand our auto insurance but we don't get our health insurance. But if I go to my auto repair shop, I get an estimate of what it will cost before the services are rendered. In healthcare, we can't get that right because health plans are so confusing about what they will or won't pay (covered benefits). With the focus on healthcare, you are right, consumers are becoming more interested in the cost of their care. But there needs to be some consumer education on how to interpret their health insurance...coupled with re-engineering of how we produce a bill. That Tylenol costs so much because the pharmacy and nursing care necessary to deliver it safely must be incorporated somewhere; so it gets buried in the pill rather than under clinical services fees. Just like when you get your auto repair bill...it says the part will cost "x" and the labor will cost "y." I hope we, health care providers, can do more to clarify for our consumers so they truly do understand what they are paying for! What does the future hold?