The Wheel of Misfortune

downloadHow hard is it in today’s Healthcare climate to pin down a price? I thought I would test this query by making some phone calls to our local premier children’s urgent care facility. I proceeded to call the nearest location to my house to inquire about the cost of having my (hypothetical) healthy 9 year old evaluated for possible strep throat.

The very pleasant lady on the phone told me if I didn’t have insurance that it would be a minimum of $75.00. I told her that while minimums are nice to know, I was really more interested in the maximum. I asked the next most logical comparative question which was what the price would be if I had insurance. She said it all depended on the co-pay and the benefits, whether or not a met my deductible and so forth. I asked what amount they would bill to my insurance for an evaluation by the provider and only a rapid strep test and prescription if needed. She could not tell me what they would bill an insurance company, stating it “depends” on what was done; despite me telling her the parameters. I went back my original request about a cash price to try to nail down how much it would be out-the-door for the scenario described. Again, the answer was $75 minimum. I asked her to assume no other tests or complicating factors, but still no price could be quoted. The call ended with her being very empathetic, if not apologetic, and stated she could not give me anymore information about pricing.

I called their next closest facility and was pretty quickly transferred to the billing department where I was met with a lunchtime voice mail about hours of operation and a friendly suggestion that I could pay my bill online if I desired.

I called their third location and let’s just say I heard something about a $75 minimum several times. She could not even tell me how much a strep test was or the price of the doctor’s component of the visit. Needless to say, I was not given a final estimate, let alone a guaranteed price to have a healthy child evaluated for simple sore throat. She did mention twice that I had the option of visiting the emergency room (this is a sore throat remember) where I wouldn’t owe anything at time of services, but that the final bill might be higher! Duh! When I asked her if she thought it was odd that a cash-pay patient could not find out the final price before agreeing to services, she told me “that is just the way it is done, unfortunately”.

Well, I guess she had not heard about the wave of thousands of doctors opting for a more patient-friendly, pocketbook friendly care model called Direct Primary Care.  See insightful articles on Direct Care here, here, here, here, here and here.  There are a host of transparent pricing models coming on the scene on the provider side and the financial services side.  Read more about how prices became opaque and secretive, and what to do about it here.  Visionary start-ups like CareTrader, an online marketplace listing service for providers to list their cash prices in advance of services.   There are others like Cost of Care, whose mission is to empower patients and their caregivers to deflate medical bills.   MediBid was one of the first to put a rift in the price secrecy curtain

So, if nailing down a price on something as simple as a sore throat is next to impossible, how much more so for a complex medical issue. We have a long way to go and don’t hold your breath that the ACA or any legislative remedy is going to fix what ails the market in healthcare. Until then, welcome to the wheel of misfortune!

For more about transparent pricing in healthcare, search “transparency” at The Sovereign Patient 

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