The dark ages of health care transparency

July 2, 2012 in Insurance Bills, Medical Care

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.

Well folks I’m trying and getting a little tired of banging my head against the wall I hit when I ask my insurer or doctor or hospital how much anything costs.

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.


3 responses to The dark ages of health care transparency

  1. Mary said on July 2, 2012

    I had a similar problem once. I was trying really hard to find out how much it would cost for me to get a prescription injection done. I couldn’t find out. I was being specifically careful to ask if I was going to get charged for the room that I was seen in (because on another visit to just get a medical form filled out I was charged crazy money for the “room”).

    You can’t get a straight answer. And I have some pretty mad skillz for getting information I need. And as a good shopper, I’d be delighted to find the best deal. But without the information you simply can’t.

    I can’t imagine what it would be like to price out a heart attack.

  2. Hey Mary – the charges on bills are often crazy.

    It’s amazing how hard it is get an answer to a simple question – how much will it cost to go see this counselor? You would think I was asking for some secret code.

  3. It’s kind of like what Nacy Pelosi said, “you have to pass it in order to know…” In this case, the clinician has to see and bill in order to know the costs incurred.

    In defense of the Insurance Company, they are unsure what the clinician will bill and what codes will be utilized during the visit. If that clinician is not in network, then they have not negotiated rates with your insurance company.

    It’s a “slam your head against the wall” issue. Do know that most clinics will work with you if your end result bill is outrageous.

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