Question the price of drugs and medical procedures

I’ve gotten a much better system — I’ve almost entirely quit going to doctors. Most conditions seem to caused by lifestyle, and they usually can be corrected by lifestyle changes. No consultations, tests, surgeries or drugs required.

Where else does a consumer go where the price of a drug or a procedure is not discussed? Do you buy a home or a car and never ask, “How much?” Do you take your car to a mechanic and not ask, “How much?” Every time I ask my primary care doctor (PCP), “How much?”, he always responds with, “Why do you care? You have insurance, don’t you?” That’s the mentality we must change. Doctors always bill insurance for the highest amount. Always! It will not change this practice until consumers begin shopping around for the best value. If insurance companies have any value whatsoever, it would be to weed out the shyster doctors that are always bilking the system. My PCP will always opt to prescribe a brand name drug over the available generic. When I ask him, “Why?” He always says, “I’m the doctor. I know better than you! Just shut up and go along.” Meanwhile, when I’m leaving, I see three pharma sales reps sitting in the waiting room for their turn to see the doctor. Something stinks really bad!

Even more important than the question of “how much does it cost” is the question of “Do I need this?”  Hypertension isn’t an indication for a stress test or an echo.  The next time, you should ask “what condition is this test for?”, “what is my pre-test probability of having the condition you are testing for?”, and “how will a positive or negative result affect my treatment?”

This is a great article – the main problem with healthcare is the complete lack of price transparency. Doctors who order test do not know how much they cost and patients have no idea how much they are will be billed until months later when they receive a bill. In all other industry price is transparent – I can sit in front of a PC and look for the best deal to Miami – same should apply to healthcare – it’s just another commodity. As a PCP I find myself more and more involved in trying to find the best “deals” for test and drugs because I see my patients paying uncessarily – in the past week I’ve converted several pts from diovan to cozaar which is 10 X cheaper.

I feel I can speak from both sides here.  I am the director of a medical practice but also the daughter of a non-citizen (albeit a legal resident) 85 year old who pays cash every time we visit a physician.  I think the one thing patients tend to forget is that physicians are NOT business men.  They went to school for 12 years to save lives not to work out the cheapest drug on the market for the 20+ patients they see each day. That is for each individual to determine with their insurance company or, if  paying cash, to look up on the internet as did the author.

In general, despite current beliefs, doctors do NOT prescribe drugs because they like the drug representative or they get something for it.  In the past that was the case and, as with every else in life, the minority abused it and everyone suffered.  In our practice, the drug representatives come in to “detail” the physicians on their drug, complete with recent studies showing efficacy, side effects and comparisons to other drugs on the market. There have been too many instances to count where a patient has been stablized on a brand name drug, changed to generic because of the cost and their numbers become out of whack again.  However, many of the drug companies now have cards where you can get the drug for the same cost or less than generic drugs and that is something you should ask your doctor about.

Please also remember that many of the pharmacies have agreements with the generic manufacturers whereby THEY are paid a certain amount for dispensing a generic rather than a name brand drug and that some of the pharmacies have some kind of ownership or partnership with the generic manufacturer.  That’s why they immediately fill with a generic unless the doctor ticks the box that says no generic and never mention that with the card, the name brand drug can cost the same or less with the coupons and/or cards.

That said, as someone who pays for her mother’s doctor visits and procedures, I quite agree with the author, and others who have commented, that you need to do your research and ask for a cash price.  If you are told by the person at the reception desk there is no such thing, then ask to speak to the office manager or the physician.  The same applies for imaging and other tests.  Brian is correct in that when push comes to shove, people become amazingly smart when it comes to their own money.

Actually, my question would’ve been the one Brian mentioned – is the stress test necessary? May have saved me these $938 that you paid as well as all the stress worrying about money and the result. Surely this extra stress wasn’t good for your blood pressure. Not to mention that stress test has false positives, so  this $938 may have lead to more expensive as well tests that also have risks.