Getting personal about the cost of care

Even being a doctor doesn’t necessarily make you immune to hassles about health care costs, as Dr. Jeffrey Rice, chief executive of Health Care Blue Book, described recently at the Costs of Care blog.

Dr. Rice’s 12-year-old son needed to undergo relatively minor surgery on his leg. The family had a high-deductible health plan and wanted to know in advance what it would cost.

Dr. Rice explains:

I called the hospital to request a price for the surgery and they said they couldn’t really tell me. They offered to send the procedure codes to an external reviewer who would provide a general idea of the anticipated charges. Three days later the answer came back at $37,000. I reiterated that I had high deductible insurance and needed to know the actual price they would bill me after an insurance adjustment to the network fee schedule.

The hospital next referred me to my insurance company. The insurance company referred me to their PPO network. The PPO network said that they could not reveal the prices until after the case was performed.

Health care consumers are often criticized for not thinking about the cost before seeking care. But when doing your homework involves negotiating an obstacle course worthy of the Green Berets, it’s not hard to see why many people give up after encountering the first few barriers – or worse yet, don’t even try.

Luckily Dr. Rice was persistent. He decided to ask the surgeon if the procedure could be done at an independent ambulatory surgical center. The answer was yes. “One phone call and 10 minutes later I have the exact price for his surgery – $1,515,” Dr. Rice wrote. “My son had his surgery and is doing well. We got a fair price because we demanded more of the system.”

Stories like these are a real-life example of how cost intersects with the care patients receive and how challenging it can be to link the two in a meaningful way.

Costs of Care, a nonprofit organization based in Massachusetts, is looking for stories about the cost of care for its second annual essay contest.

Consumers and providers are invited to submit personal anecdotes illustrating how cost awareness led to high-value care and/or cost savings, or how a lack of cost awareness led to an unexpectedly high bill or difficulty figuring out what a test or treatment would cost.

Four $1,000 prizes will be awarded to the winners. The contest deadline is Tuesday, Nov. 15. Finalists will be announced Dec. 15; the winners will be announced Jan. 15. Click here to read more about the contest rules and how to submit an entry. And watch this space for contest updates and links to the winning entries.

For what it’s worth, I don’t buy the argument that it’s too difficult for health organizations to give patients an estimate ahead of time for what their care will cost. Here in Willmar, Minn., Rice Memorial Hospital has been doing this for the past year with the help of a software tool called CarePricer. By all accounts, it’s quite accurate, even taking into account how much of the patient’s deductible has already been met for the year. I’ve heard anecdotally from hospital staff that in a few cases, patients have decided to delay elective surgery after learning what their out-of-pocket costs would be. It takes work to put this kind of process into place but clearly it can be done, and done successfully.

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