Crowd-sourcing may bring transparency to medical charges, part one
Published 7:00 am Friday, June 9, 2017
By Trudy Lieberman
In a recent column I reported on an effort in Ohio to bring price transparency to medical services.
Ohio state representative Jim Butler had spearheaded passage of legislation that would require healthcare providers including doctors and hospitals to disclose prices for their services.
The law was supposed to take effect last summer, but Gov. John Kasich, the Ohio Hospital Association, and other health groups that oppose transparency have stymied implementation.
The governor’s budget for next year calls for repealing the law.
Ohio’s law may disappear, but the demand for information is not going away. Many readers are downright angry after trying hard – and unsuccessfully – to get information to make good medical decisions.
James Friesen, a lending officer at a bank in Kearney, Nebraska, told me when he wanted to pay cash for a cardiac test his insurer wouldn’t pay for, he couldn’t find out the negotiated price his insurer had agreed to pay the hospital.
Neither his insurer nor the hospital would say.
“The doctor who ordered the test didn’t even know,” he said. “They intentionally keep patient consumers in the dark about pricing.”
When Naomi Johnson, a South Dakota retiree, tried to find out the price of a colonoscopy, she asked her insurer for the billing code the medical business uses to identify various procedures.
Johnson used that code when she called the health facility where the procedure would be performed and asked for the cost of a simple colonoscopy barring complications.
The facility told her they couldn’t even give her a ballpark number until after the procedure because there would be several codes for many different things. “They acted like I was insane for asking.”
A California woman, Saskia Mills, told me getting an estimate for a simple outpatient procedure her family was paying for out of pocket was like “pulling teeth.”
After more than 10 phone calls, they thought they knew they would have to pay $4,750 for the surgery and facility charges.
The bill turned out to be $10,456, including $1,400 in pharmacy charges that were never mentioned beforehand.
Is this the patient-centered care healthcare executives claim they are providing?
Hardly. In reality it’s part of a process cooked up by doctors, hospitals, and insurers that keeps patients from learning how much they must pay and for what.
It’s responsible for those undecipherable bills we all get.