The dark ages of health care transparency
Over and over again, the health insurers, my employer and leaders at the State House tell me that one key to controlling health care costs is getting patients to look for the best value in health care.
Last week I spent 30 minutes on the phone trying to figure out how much my insurer would pay a counselor for my daughter. The counselor is “out of network” (a situation more and more of us are encountering) so I have to appeal to get help paying for my daughter’s visits.
There’s a question on the appeal form that asks, “Will your provider accept the network rate?” I’m happy to ask her, but I need to know what the rate is, so I call the 1-800 number on the back of my card. Here’s a summary of the ridiculous conversation I had with the agent (who was nice and tried to be helpful)
Me: (after explaining the form) I am calling to find out the network rate for providers who counsel adolescents. How much do you pay?
Customer Service Agent (CSA): Oh I can’t give you that, there are hundreds of possible codes that could apply to your daughter’s counseling visit.
Me: Well how can I answer the question on the form? Can you give me a range, or some idea of what the reimbursement would be?
CSA: Will you hold a minute please?
(4-5 mins later) Well, let me ask you some questions and I might be able to help you find the right charge.
Is this counselor in a solo practice?
The agent asks four or five other questions about the counselor that I can’t answer to because I haven’t met her yet. I call the counselor, get her machine, get a call back a few hours later, and call my insurer again.
Me: OK, I have all the answers, now can you tell me which code would apply to my daughter’s visit?
CSA: Hold on, let me see what I can find.
The agent comes back in about four minutes, with a price for a first visit, a diagnostic visit and two possible prices of on-going or routine visits. AND THEN SHE DELIVERS THE KICKER!
“But these prices,” she says, “may not be accurate at the time your counselor submits the claim because prices get adjusted all the time.”
OK – so I just spent 30 minutes on a series of phone calls to get a price that is only good for the moment? And this is the system in which I’m supposed to be a more “engaged consumer”?
Wait, the folks in state government say, it will get better soon. How I ask? The state is collecting all the claims made to all the insurers and plans to create a database that we consumers can browse. BUT HERE’S THE CATCH. The data will always be old – it won’t be real time prices. So even when/if this big new database is up and running, I wouldn’t be able to get the price for counseling that I needed last week.