What does healthcare cost? Who asks that question?

Hi all:

I saw an Orthopedist yesterday for an ankle injury. It was a great reminder of one of the primary problems with healthcare; no one knows what anything really costs. My wife and I have high-deductible insurance through her employer. We have it to protect us against the unlikely but possible financial burden of being very ill or injured. We don't expect it to pay for our primary care or basic medical needs. Similarly, we don't expect our auto insurance to take care of our tires, oil changes and tune-ups. Insurance is a lousy way to finance commonly occurring events. Our society's attempt to use health insurance to finance most services has been a disaster in terms of increasing healthcare costs. Yesterday is a great example of why.

During my visit I was focused on my visit and briefly forgot that ultimately I'm the one paying for services. The doctor's assistant ordered 7 x-ray views of my ankle before the doctor even saw me. I should have asked the obvious questions. How much do those cost and do you really need all of them? Of course, the person ordering them (i.e. selling the services) would have had no idea. We would have had to disrupt the clinic flow to go to the biller to figure that out. However, I never buy anything else without knowing the price. Why is it so natural to do so in a doctor's office? As an aside, at the very least the two views of my heel were unnecessary as the injury is nowhere near the heel.

I regret that I wasn't overly concerned about this until I got home and my wife reminded me that we are way below our deductible for this year, so I really was the one directly paying for those x-rays. In this case, I wasn't passing the cost off to others who overpay for their insurance premiums because too many tests get ordered unnecessarily in doctor's offices. So there I was, reading a novel late at night and wondering how much I had paid for the x-rays I had purchased that day. The feeling was worse because I knew as others might not that at least some of them were unnecessary.

This morning I resolved to figure out how much I was going to owe BCBS. Here's what I found out. The practice would have discounted the fees by 30% if I had paid them myself rather than using my insurance. Sounded at first as if that's the way to go, but I was then told BCBS would only be paying the practice 40% of the listed fees for the service. So I get a 60% discount on the "listed fees" through BCBS or 30% directly. In effect, BCBS is getting a "volume discount" in exchange for the number of patients they send to the Orthopedist. Self-pay patients get a 30% "discount" on a listed price for services that no one actually pays. This begs the obvious question - what is the purpose of the listed fees if no one pays them? That's easy of course. The list price has to be set high enough that the practice can keep the lights on at the 40% reimbursement rate. So the fact that insurance is involved drives the price of care up for everyone except those paying insurance premiums each month so that the insurance companies can negotiate the prices back down for their "members". Does this seem like an efficient way to finance anything? By the way, I never did find out what the x-rays actually cost. No one knows; I'll find out in a couple of weeks when BCBS sends me a bill.

At Ponce Preventive Care, we have a clear fee schedule posted on our website (www.poncepreventive.com) and in the practice. Our patients never wonder what they're paying for what they're receiving.