The Cost of Care

Scott and I have often discussed how disconnected patients are from the true cost of health care.

Two examples:

Having a baby

When I have a baby, I check into the hospital and they offer IV drugs, drugs to speed up labor, an epidural, three + meals a day, snacks, a souvenir water jug for me and every person in my hospital room, pain pills around the clock, nursery care for my baby, a variable checkout time (generally 24 – 48 hours after delivery), and numerous other things throughout my stay.

Never ONCE is cost mentioned. If I hate the unhealthy food, and I decline all meals (like I did last time), does it affect what I pay for my stay? When they casually ask if I’d like to check out or stay another day, how does that affect the bottom line? What is the difference in cost between an epidural and IV pain medication?

When I received my bill, it wasn’t even itemized! It was just a bottom line amount and it was a BIG bottom line.

The discussion of cost is so taboo, it’s almost like you’re at a schmatzy restaurant and you want to grill the waiter on the difference in cost between tap and bottled water, or still or sparkling. He’d turn his nose up at you and say something about the service being worth any cost. (Why would you EVER decline a procedure, medication, or service at the hospital due to something as inconsequential as cost?)

Yet I would argue a significant reason our health care system is so out of whack is that patients have no concept of how much anything costs. We just nod our heads as services and tests are offered, and then groan when we see the bill months later.

Mackenzie’s Emergency Room visit

When she was 2 1/2, Mackenzie had a nasty stomach flu and threw up everything for days. When she became listless and unwilling to drink or eat anything, we decided we’d better take her in. It was a Sunday afternoon and we were on a road trip in another state. We tried urgent care and they turned us away because they don’t administer IV fluids to children. So we reluctantly went to the emergency room.

After spending hours trying to coax her to pee in a cup unsuccessfully (she was 2 1/2 and dehydrated), a nurse gave us a Zofran pill and 30 minutes later, Mackenzie was asking to eat and drink. She perked right up and we headed home relieved. We were billed over $200 for the single pill (when a prescription for 30 such pills was filled for $30 at the local pharmacy the following day), hundreds of dollars for the visit, and hundreds of dollars for the attending physician’s fee, though we never actually saw any sign of a doctor.

But you know what? The bill was less than half of what it would have been if we didn’t open up our mouths. The nurse matter-of-factly told us the doctor recommended an ultrasound (for what? I think maybe an obstructed bowel?) and then proceeded to get Mackenzie ready for it. Scott and I stopped her short and asked for details, and ultimately declined the test. She was shocked and not very polite about it. But we knew Mackenzie’s bowels were fine. She just hadn’t been pooping because she hadn’t kept anything down in three days. We decided to save her the trauma of another test and saved a major chunk of money.

Just the fact that I questioned things and ended up declining a certain aspect of care made me feel empowered and also a little brash.

So how DO you find out costs ahead of time?

At my last OB appointment, my doctor offered me a prenatal screening that included a special ultrasound at our local hospital, and a blood test that I do at home and mail in. She said our insurance “covered” it.

We said we’d consider it and went home with “all the information” to weigh our options.

It’s a non-invasive test which, if positive, would give us lots of knowledge to help us prepare for having a child with certain disorders. So it sounded like something we’d be interested in, but nowhere in the information packet was there any information about cost!! And there was a spot to put your billing information and insurance company so you can bet it wasn’t free. 😉

We decided I’d call and check on the cost before we made a final decision. This was easier said than done for the uninitiated.

1) To find out the cost of the ultrasound, I called the hospitals “price line”. They told me I need the CPT code for the procedure.

2) I called my OBGYN and was routed to the billing department. Wrong department. Called back and was routed to scheduling, wrong again. Finally spoke with a nurse and she surprised me with four separate CPT codes: one for the ultrasound, two for associated tests through the hospital, and one for the doctor’s visit at the hospital.

3) I called the hospital’s “price line” again, armed with codes. They told me that the physician and radiology charges would be billed separately and that if contrast die was used it would cost more, and that any anomalies in the test would cost more, but that the range of cost for the facility portion of the test would be $280.25-$380.28 .

And what I actually pay within that range would depend on my insurance’s contracted rate, I asked? No, the contracted rate could be completely different and I’d only know THAT from talking to my insurance company.

Before hanging up, I got the number of the radiology department so I could inquire about their charges.

4) Radiology said they would charge $137-207, but again the actual rate would need to be determined by calling my insurance company.

5) I called the department of the hospital I had an appointment with directly to inquire about the physician portion of the bill. They treated me like a crazy lady and repeated the same costs I had been told by the price line, and said they have no record of the CPT code that I was told specifically referred to the cost of the doctor’s visit.

6) I called my insurance company to inquire about the contracted rate for these services, armed with the CPT codes. They gave me an “average cost” for each code. Interestingly, the “average cost” they gave for the ultrasound fell a little below the hospital’s range, but the “average cost” for one of the blood tests was $227 and the hospital had said their range was $32-$35 for that blood test.

That’s when I pushed a little harder on getting an actual cost, rather than an average cost. “Oh, we’d need a tax ID number for the provider to tell you that!”

Oh.

7) I called the hospital price line to get the tax ID number.

8) I called the radiology department to get their tax ID number.

9) I looked online for information about the blood test I’m sending away to a lab. That lab’s website had the CPT codes AND their tax ID number listed clearly. Woop!

10) I called my insurance company back, now armed with all the CPT codes and three separate tax ID numbers. (Remember this is all for “one” prenatal screening test.)

They were super friendly and nice, and said they would call me back with the contracted rates for these services sometime tomorrow. They were able to tell me the blood work I’m sending away is considered “in-network”. That was good to know.

After an hour and a half and 10 phone calls in which I talked to 15 different people, I was at least confident I’ll get a good idea (tomorrow) of how much my bill will be if I opt to have this test done. But after they called back several more times to clarify the tax IDs*, and a hand-off to a supervisor, I never did hear back. I ended up canceling the appointment. (*Apparently there are a million different physicians and departments registered under the hospital’s ID and there’s a different contracted rate for each.)

It’s absolutely insane that it took that much effort to find out how much I’m promising to pay when I make an appointment! They do WANT us to be able to pay the bill they send, yes?

Can you imagine opting in to any other type of service and having no idea how much money you’ll be obligated to pay? No wonder hospital bills bankrupt so many. We demand the best possible care at whatever the price, not acknowledging that the price should actually inform our healthcare decisions.

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About beanland

Scott is a family practice doctor and Anne is a full-time mother and teacher to three beautiful girls and one boy.
This entry was posted in Living with a doctor, Nothing but random, Pregnancy. Bookmark the permalink.

8 Responses to The Cost of Care

  1. st says:

    Wow! WOW!
    Admire your persistence.
    Truly, healthcare has become much too complicated and we are not asking the questions about cost that can help us make good decisions. And the rates are astronomical – $200 for one pill that is available at the pharmacy for $1 (30 pills for $30 you said); its daylight robbery with impunity.
    Thanks for your thoughts; we need to learn and ask more.

    Like

  2. Lauren says:

    I sympathize…because we both have the same insurance and I personally hate it. I also call about every little thing because I have been shocked about what is covered and not covered. I learned my lesson after some gross bills have come my way. Now I call and call and get the run around and call again.

    I also have to decline tests that my doctor recommends…I feel terrible about it because he looks at me like I’m completely crazy….but I have to be picky about what’s really necessary. You discover just how crazy the whole system is when you start asking questions. I’m sure I’ve pointlessly lost thousands of dollars because I failed to ask questions.

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  3. littleraskills says:

    Ahh yes. A healthy dose of skepticism! :o)

    Congrats on baby #3!

    Like

  4. cwcohio says:

    Mmm, do i sense a politictal advocate for better healtn care! I know, i just always knew that it would be $20 per visit and $35 for a specialist and $350 for any type of hospital surgery/stay.our OSU insurance rocked! I loved it. But i never really knew the actual costs. I know some people have health savings accouts and since they do pay out of pocket are better at knowing the costs, perhaps. All very interesting….sounds like too many people are involved…..

    Like

  5. Katie says:

    This totally blew my mind.

    Also, speaking of health care and getting the run-around, I totally want to talk to you about how to get all the nutrients I need if I’m cutting out meat, dairy, and eggs. (Or maybe why I shouldn’t completely cut them out if that’s your opinion.) I feel like you and Scott would be really knowledgeable on the subject.

    Like

  6. megmagic says:

    Oh, it’s all insane. I feel fortunate that I have good insurance so my out of pocket costs are low, but I still like to know what I am actually billed and those “insurance adjusted” costs make it nearly impossible. Surely people don’t have to pay the “full” amount initially charged for procedures if they don’t have insurance coverage at all?

    When I decided to work with a midwife and deliver this new baby in a birthing center, I was shocked when they told me, upfront on day 1, exactly how much they charge for their entire package of prenatal care, delivery, and postpartum visits. Just like that!

    P.S. the Zofran at the ER was probably name brand, which does cost $200/pill vs. the generic, which is more like $200/week without insurance coverage. It’s crazy.

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  7. Lonica says:

    Having just taken Amelia to the ER in January and delivered a baby in February, I’m facing this head on. The bills just keep coming in and it is crazy to see how much they charge. It’s frustrating to never be able to get a straight answer from anyone on the cost before you actually receive the service. In cases like your pregnancy tests here, it’s nice to be able to actually do a bit of research (albeit, annoying circular research), but what happens when say, your daughter falls out of the shopping cart, knocks her head badly and you find yourself at the ER. How do you decide then whether she actually needs the cat scan they all recommend? You certainly don’t have the time to call the insurance company and glean all sorts of information on what the procedure will cost. You certainly can’t show up at the ER and then refuse the one procedure they recommend. Especially when there is head trauma involved… how does that make you look as a parent? $1,500 later (what our ER bills currently total) we now know that Amelia hasn’t suffered anything more than a big goose egg on her forehead… thank heavens. So frustrating though.

    Like

    • beanland says:

      Yeah Lonica, that’s a tough one. Honestly I think when you decide to head to the ER for head trauma, you’ve already made the decision to pay for a CT scan, whatever the cost. It is frustrating to not know upfront what to expect, though.

      I’m glad Amelia is ok and I would have almost definitely made the same call if I were in your shoes. With head trauma, it’s better safe than sorry… and second-guessing hours and days later would be awful.

      Like

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