Place the frustration of cost uncertainty on health insurers

Place the frustration of cost uncertainty on health insurersAs we enter 2012, many patients will be changing to new insurance plans.

And for a few, deductibles will be rising.

One thing that’s emphasized in the Affordable Care Act, however, is that preventive services would remain “free.”

However, consider this story of a man, who thought he wouldn’t have to pay for his screening colonoscopy, instead was charged over $1,000 for the procedure.

From USA Today,

Bill Dunphy thought his colonoscopy would be free.

His insurance company told him it would be covered 100 percent, with no copayment from him and no charge against his deductible. The nation’s 1-year-old health law requires most insurance plans to cover all costs for preventive care including colon cancer screening. So Dunphy had the procedure in April.

Then the bill arrived: $1,100.

The reason? During the procedure, polyps were found and rightfully removed. But in doing so, it changed the colonoscopy from a screening procedure to a diagnostic procedure, thus making it applicable to the patient’s deductible.

Such semantics are important, as insurance companies will seize them at every opportunity to pass on costs to both patients and hospitals.

Physicians, however, are caught in this firestorm as they get blamed for surprise bills. And that erodes the trust between patient and doctor.

Patients need to be told up front that it’s impossible to guarantee that any screening colonoscopy will be “free,” and that the possibility of removing polyps will always be there.

This speaks to the larger problem of price transparency. Patients frequently want to know how much an office visit costs. But under our current health system, the answer is invariably, “it depends.” Yes, it’s a frustrating answer, but true. Cost is dependent on the complexity of the visit, which is impossible to ascertain prior to being done.

Putting patients in touch with their insurance companies at an early stage will place the onus of cost uncertainty on health insurers, rather than physicians, who often get unfairly blamed for surprise bills that’s out of their control.

 is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

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