The inability to locate price anywhere in the hospital

A torn meniscus. It did not disable but it impaired, and unpredictably. My stomach learned quickly to tighten at the sound of A.’s peculiar whimper in response to a crippling pain that would shoot through her at seemingly innocuous movements of the afflicted leg. We have health insurance of sorts, the type that will help you keep your home if tragedy strikes, but that does not shield you from the brunt of what most of day-to-day health care cost is about. We’re well practiced in deferring and foregoing care. Here however, we reluctantly acknowledged that a hospital would need to be visited and a doctor consulted.

Tests and a physical examination made clear that an operation was unavoidable. The doctor was a thoughtful man who conscientiously went through what the operation would entail. Surgery would take half a day, then back home by afternoon, convalescence over the following few weeks, with complete recovery the usual outcome. While not painless, the procedure seemed reassuringly routine. His tone was caring and his outlook about our case optimistic.

The admirable candor with which medical personnel have learned to speak about difficult topics concerning our bodies and our care did not extend to the costs involved. The question of what the procedure would cost, gently broached, initially baffled the staff, eliciting answer-deflecting counter-questions about the adequacy of our insurance coverage, but resulted in no quotes or estimates. With my insistence on the point, an assistant promised that a figure could be determined, if we needed it, once the surgery was scheduled. “But not before?” I was now the baffled one.

A person who linked dollar amounts to medical procedures was eventually found and I was seated at her desk. She required a billing code however, and without a scheduled surgery there was none to offer. As we danced around that issue, my concern over the cost of repairing A.’s knee was replaced by another curiosity: “Is what I’m asking not routine?” It was not. A billing code was finally lifted from the paperwork of a previous operation, and after some minutes a dollar number was produced. It was a sizeable figure, but less than what I’d been led to believe such things cost, at least in the United States. I suspected something still was not clear. “This is then what I’ll pay, roughly, to have the procedure done?” I asked in a half questioning, half confirming tone. “No, that’s just our part of it, the hospital has their charges, of course.” “But we’re in the hospital and I’m asking you for an estimate of what this operation will cost.” She explained, with some frustration, that the operation itself was only a fraction of the pie; she had no way of knowing what the hospital might charge.

This was not actually true – she was far better situated than I to know what the hospital charges would be. It was if I had asked for the price of a new car on a showroom floor and had been told by the car salesman that only the engine could be quoted – other components’ prices would need to be discovered separately, by me. In the real world, the total price for most services and products are conveyed to the consumer by the seller or provider at the end of a long chain of added values. In this case, the multiple components of the medical care provided a shield to simultaneously obscure the cost and justify its lack of availability. The billing person scribbled down a number for me to call, then asked if there was any other matter where she could be of assistance.

Hoping for a face-to-face conversation, I asked at the hospital information desk for directions to the office matching the telephone number scribbled on the scrap of paper. “That’s not in the hospital”, the information desk attendant declared, “but the call is toll-free”. We went home. For some reason, the inability to locate a price anywhere on the hospital premises for an operation that would take place there shook us as much as would have an encounter with a manifestly incompetent doctor. Though A. and I talked only briefly of the cost, or rather the opaqueness of it, we were both invaded with a foreboding that a thing so untethered to its own cost would be in some unspoken way unreliable, dangerous. That night, A. announced that she wanted to do the procedure overseas … anywhere but here.

Eric Lespin is a patient.

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  • http://twitter.com/bnikhil Nikhil Bhojwani

    Excellent story about the difficulty to get price information. Even if you were to get full price information there’s no guarantee that the price would apply to you personally!  And I don’t think the billing person is entirely to blame, it’s a systemic issue.

    One solution I’ve come across to generate “fair price” estimates by zipcode and procedure is the third party free resource called Healthcare Blue Book at http://healthcarebluebook.com.  Their quotes can be used to negotiate a price cap prior to the intervention.

  • http://ClinicalPosters.com ClinicalPosters

    Been there. Done that. Perhaps hospitals should post a sign:

    ——————
    PRICE LIST
    Examination $$?
    Lab work $$?
    Surgery $$$$$?
    (Sorry. This is as specific as we can get.)
    ——————

    Patient should get real concerned when asked about property holdings.

  • Jeff Rice

    This story sounds very familiar.  Unfortunately most hospitals function (or dysfunction) this way.

    For this patient, and many others, there are other providers who can provide needed services and surgeries. In this case, the patient could have considered an Ambulatory Surgery Center.  In my experience in working with 1000′s of patients, most ASCs can quote you a fixed price without a delay or they typical run around.

    In addition, most ASCs would charge a lot less than the hospital (50% or more savings) and you don’t have to haggle for discounts and prove financial hardship to get a fair price.

    Jeffrey Rice, MD, JD
    CEO, Healthcare Blue Book
    http://www.healthcarebluebook.com

  • Jeff Rice

    This story sounds very familiar.  Unfortunately most hospitals function (or dysfunction) this way.

    For this patient, and many others, there are other providers who can
    provide needed services and surgeries. In this case, the patient could
    have considered an Ambulatory Surgery Center.  In my experience in
    working with 1000′s of patients, most ASCs can quote you a fixed price
    without a delay or they typical run around.

    In addition, most ASCs would charge a lot less than the hospital (50% or
    more savings) and you don’t have to haggle for discounts and prove
    financial hardship to get a fair price.

    Jeffrey Rice, MD, JD

    CEO, Healthcare Blue Book

    http://www.healthcarebluebook.com

  • http://www.facebook.com/people/Craig-Koniver/100001463176810 Craig Koniver

    Great piece! How about the comment: “But your insurance will cover it,” as a response to the question of cost. We have let healthcare become completely disconnected from the economics and it only seems to be getting worse. Much better is a system that is transparent with one fee. Thanks for sharing.

  • http://pulse.yahoo.com/_2LRZNHDZS6DU45WQ567LPQ7CMI ninguem

    Do you need to shop price for a knee surgery?

    I don’t know. My HDHP-HSA insurance kicks in at a certain deductible, which is almost certainly reached with knee surgery. My health insurance “shops price” it’s called a network.

    I “shop price” when I got sticker shock at a prescription by my doctor, and asked for a generic alternative.

    Now all that being said, you SHOULD be able to “price-shop” for knee surgery, and your failure shows that more needs to be done.

    To the extent that we’re getting any price transparency at all, it’s because of consumer-directed healthcare.

    • Anonymous

      Isn’t it presumptuous for you to assume your insurance/financial situation is the same?  The woman who cuts my hair uses Aflac for disease specific issues.

      I’m confused.  Which is more valuable “the network” or direct pay?   They aren’t the same.

      • http://pulse.yahoo.com/_2LRZNHDZS6DU45WQ567LPQ7CMI ninguem

        Yeah, you’re confused all right.

    • http://twitter.com/FairCareMD Alex Fair

      You can do this on our site 24/7.  If we don’t have docs in your area we will even get you 3 quotes within 1 business day usually.

  • Anonymous

    No happy happy joy joy for the docs either.  A little chunk of my day:  How much will the drug cost?  Well, it depends on your insurance.  Well, can I find out ahead of time? No, it has to be run through the system.  Run through.  Oh, it costs too much.  Can you give me a different one? Ok.  Next case. How much will the drug cost? Well, it depends on your insurance.  Well, can I find out ahead of time….
    Serenity now!

  • http://twitter.com/FairCareMD Alex Fair

    Yes, this story has been told before.  It is time to write the new
    story, where going direct and being transparent with fair pricing is a
    no-brainer, automated, and efficient.  Patients and Physicians and even
    Hospitals are writing this story every day.

    Our site and many others list real doctors, top ones in the country, who list, contract, and even enable negotiation for their services online through Keynsian, efficient marketplaces.  Orthopedic Surgeons list their all inclusive or broken-out knee surgery costs and you can get three price quotes anywhere in the country within 1 business day, or in seconds if any of our hundreds of thousands of offers match your needs.

    For example, you can get this meniscal/ arthroscopic repair in Arizona for $3,200, in New York for $4700, or elsewhere from some of the best Orthopedic Surgeons anywhere.  Many physicians also list their services at undiscounted “Charges” and let the patient request lower fees that are fair.  This is good for the physician who isn’t ready to argue with payers about why direct (prompt-pay) rates are different than indirect (slow-pay) rates from insurance companies differ.  Speaking from experience and with legislation behind us, this is not a legitimate concern anymore, but we respect the right of every physician to set their own rates however they like.

    Everybody wins because the Physicians and Hospitals get paid directly at the time of service, vastly reducing overhead and generally improving reimbursement rates and patients like Miss A. get fair prices, often less than an average insurance company pays as a result of an efficient marketplace that rewards innovation that rewards quality, service and fair pricing..  Here is a typical search: http://www.faircaremd.com/findcare_searches/new?patient_seek=knee+surgery&patient_zip=&patient_radius=&search_now_button.x=95&search_now_button.y=22

    Indeed, most hospitals are slow to adopt these methods but physicians love it, they get paid better and faster and get more patients and who doesn’t want that?  The Hospitals we have signed up have done so at the behest of our member physicians.  As others have noted, the HSA, coding, and High Deductible uncertainties are challenging, but the motivated, empowered patient is watching their pocketbook and as long as you do not accept assignment of benefit, it is a non-issue for your practice.  Get paid at the time of service.  No muss, no fuss.  The patient deals with their carrier.  There is also the question of what to do in the event of complications but we all know that we take risk when we do DRG coding and many just build that into their offers.

    Physicians, Dentists, Surgeons, Physical Therapists, labs, online pharmacies,… around the country have realized the benefit of this approach and more sign up every day.  Jeff Rice, MD published fair prices years ago on HealthcareBlueBook.com and we all can easily figure out what things should cost.  Patients are asking for actual care at these costs thousands of times a day.  It behooves us all to encourage our administrators and practice managers to meet the patients half way by making a direct-pay policy. 

    Personally, I know I would have appreciated access to fair pricing it rather than walking around with two torn ACLs throughout my 20s as an undergrad and Ph.D. student.  Millions of Americans are similarly foregoing care today for the sake of non-transparent medical pricing.  Change the story at your practice or institution.  It is your choice.

  • http://twitter.com/EmilyKaminski Emily Kaminski

    When my son had to go the ER, I knew more about billing than the people collecting my information.  I asked about how much the visit would cost.  No idea.  I asked if I would be billed separate charges for the doctor’s services in addition to the facility.  I was told no.  Then, I read a her a sign above her head that said yes and she looked confused.  How is it that the people who work in the facility day in and day out can have no idea and no tools to access the information?  This is the information age for heaven’s sake!   

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