Healthcare is F*cked, Part 416 – Public Service Announcement

Regular readers knew it was only a matter of time before I’d write about healthcare again.   My views on our healthcare system are based on my experiences as an individual subscriber in The System, and I’m still learning something new every time I interact with the system, unfortunately.  I do not profess to have any magic bullet cures for what ails our healthcare system, but the more “problems” I discover, the more I hope it can help shape a solution at some point.

So I’ve got a medical issue.   Without getting into TMI territory, my twitter followers will already know that I am having some sort of kidney/bladder stone issue.   Pain isn’t an issue (yet?), but I decided to see a doctor nonetheless, as there’s something definitively abnormal going on (cliff notes:  “sand” in my pee).   A few months ago I booked an appointment with the urologist several weeks out – after arguing with the new patient coordinator who wanted me to see my primary care physician first.   Not wanting to waste time or money, I explained to the coordinator that I didn’t need a referral with my PPO plan, and that this was clearly a urology issue.   I learned long ago that patient self-advocacy is huge in healthcare and that you have to take care of your own interests – something I learned an even harder lesson in later, but we’ll get to that.

Anyway, I had what I thought was a more urgent issue prior to my urology appointment, but they couldn’t get me in any sooner, so I got in to see my primary care physician ($225).   The only problem I have with the bill for this appointment is that he didn’t even examine me: we had a discussion about some stuff – he said he didn’t think I had any sort of infection that would demand more urgent attention before my urology appointment, but yielded to my request to get a urinalysis anyway.  It would have been easier and cheaper for everyone involved to do this sort of consultation online or over the phone – I imagine we’re gradually heading to a place where much more care/consultation will be done this way.

So my primary care physician orders the urinalysis, which I did in the lab in his practice’s building.   A few weeks later I got the bill/explanation of benefits.  I have a high deductible health insurance plan ($ 8k), so I basically pay for all my care anyway after the insurance company puts their negotiated rate on it.   The lab billed $146 for the urinalysis and I was responsible for $15.   This made me angry, actually:  not the fact that I had to pay $15 – I’d pay $15 any day to get this test done – but the fact that the lab tries to bill $146 for it and will accept $15.   In one sentence, this is what’s wrong with our healthcare system.

Anyway, I saw the urologist ($200 – pretty odd that he, as a specialist, gets less than the primary care guy got for an appointment where the PCP didn’t even examine me), who was stumped.  He recommended an ultrasound or CT scan as follow up.  I told him I thought I’d wait, for now, but then my wife yelled at me when I got home.  She, rightly, says that we’re compromising our care by denying ourselves procedures that we may need because we have to pay hefty costs for them.   So I called back and told them I wanted the ultrasound.  They set it up at the hospital which is roughly 400 yards from building where the urology group is.  The urology group booked the appointment for me and everything.

Which brings us to the nexus of today’s post:  I didn’t know that when you get imaging done at the hospital you may be paying three to five times as much as what you’d pay to get the same imaging elsewhere!   It turned out that my ultrasound came back “normal,” which made the urologist want to do a CT scan.  Now, I told him I’d call my insurance company and see if it mattered where I did it – thinking that this was a much more expensive procedure than the ultrasound.

Anthem was as helpful as they’ve ever been, with the lady on the phone telling me what I wrote in the paragraph above about sky high hospital diagnostic costs.   Silly me thought that the negotiated rates for in-network facilities would be in the same ballpark for the same procedure.  I hadn’t even thought to “shop” around for my ultrasound, which I assumed was a simple procedure that would cost about $300.  Whoopsie – but we’ll get to that in a minute.

The Anthem rep told me that a comparable hospital’s fee for the CT scan was $2500, and that my hospital didn’t list their cost, but that my hospital is by far the most expensive one around.   At this point I was ecstatic when she told me that there was an imaging center who charged roughly $500 for the CT scan.   This imaging center is located in the same office park as the hospital – it’s actually adjacent to the urology group.  I thanked her for her help and hung up.

At this point, I started to freak out about how much I’d get hosed for on the ultrasound that I’d already had done – so I called back and, after several minutes of the rep searching for the procedure in her computer, was told that the hospital charged $932 and the imaging center charged $298.   FAHHHHHHHK.

So I’m pissed.   Look – regular readers know that I’m a big fan of free markets, and I’m also a big advocate of personal responsibility.   The problem with healthcare is that it’s not a free market – it’s regulated enough to completely screw it up.  How about that personal responsibility thing?   Ultimately, my care is definitely my responsibility:  I wasn’t in an emergency situation where someone else was making decisions or where I needed care right away.   Still, though, I’m pretty pissed at the urology group for auto-booking me at the place that costs 3 times as much when there was a place next door to them that could have done the same thing.    Note: this procedure was booked several days out: it’s not like it was a same-day thing or an urgent procedure.  Of course, opacity in pricing is another (perhaps the MAIN?) issue (good luck trying to find the costs of these procedures online anywhere) – although Anthem was able to give me some information when I called to ask about the CT Scan, I’d assume that the urologist’s office, referring patients for these kinds of procedures all the time, might have some sort of helpful guidance for where to go for a much better price?  Or maybe it’s the opposite – maybe they get kickbacks for funneling patients to the drastically overpriced option.    In any case, this is another “problem with healthcare in one sentence” – incentives are most certainly not aligned.   The urologist called my insurance company for pre-certification: perhaps the insurer could have stepped in and advised that the procedure could be done next door for a third of the cost?

I write this post as somewhat of a public service:  avoid hospital diagnostics whenever possible.   I haven’t even gotten the bill and EOB yet, but I already contacted the hospital to voice my displeasure.   I can’t imagine what percentage of the patients that the urology group refers to the hospital end up shopping for the same procedure elsewhere:  10%?  less?   Of course, when everyone pays a massive premium (or has their insurance cover it), it should be no surprise that the costs of The System are sky high.

anyway…

My prior posts about health insurance

-KD

keywords:  Renal ultrasound cost, abdominal CT scan cost, pelvic CT scan cost

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