Medical billing: if you have to ask what it costs…

I enjoyed Tara Parker-Pope’s recent Well column in the New York Times: Getting Doctors to Think About Costs by Pauline Chen, M.D. Dr. Chen opined about how doctors have been typically unaware of how much various procedures, such as CT scans and MRIs, cost when they order them and even whether they are always necessary. She wrote about a non-profit organization, Costs of Care, that is trying to address this issue and help make medical trainees more aware of costs. The article has a link to an educational video, Hotel Hôpital, which illustrates the opacity of costs to the patient with a hotel stay that is billed in the same way as a hospital stay.

I experience my own version of Hotel Hôpital at a dentist visit a few years ago. Maybe I should call the experience “Hotel Dentaire”. I was visitng the dentist for a 6-month checkup. He had found a cracked filling, which he repaired during the visit.  On my way out, I got my pricey surprise. And, I was asked to pay on the spot. I didn’t happen to have my credit card with me and asked the dentist’s staff whether they could bill me. The reason I was unprepared was because up until that visit, they had always billed me. The staff said no, that I had to pay right then. I had been seeing this dentist for many years, had referred many friends, and was surprised at this sudden, rigidly deployed policy. I asked whether, as I long-time patient, they could give me a little consideration as they had in the past and bill me. I would pay them promptly. They grudgingly agreed, since I had no payment means with me at the time. Then, not only did I get a bill, but I received an unpleasant letter from the dentist as well. He said that when he goes to the store, he has to pay for items right away and who did I think I was not to pay on the spot after the service. Maybe he hadn’t noticed that, unlike dentists,  retailers by law have to affix prices to items in stores and not surprise customers at the checkout.  I’m not sure why my dentist got so angry with me, but I decided that I had to find a new dentist. In retrospect, I realized that the dentist had recently taken his son into his practice. Many dental schools are now teaching practice management. Cash on the barrelhead is part of that. I can fully understand the need to monitor cash flow and administrative costs. But hopefully dentists can also pleasantly communicate with patients and afford them a little notice and slack during transitions to new monetary policies. I had thought I was a valued customer/patient. But I guess my infraction left me in the trash heap of deadbeat patients.

When I saw the Hotel Hopital video, exaggerated as it seemed for a hotel, I could totally relate to the unpleasantly-surprised hotel guest in the video. Typically, insured patients have no idea how much any medical procedures cost since they never see the bill (unless they are uninsured). This has led to people feeling that they don’t have to worry about how much procedures costs, since they are never asked to pay out of pocket.

The medical system in the U.S. is suffering from a huge lack of transparency. However, I’m not sure whether instilling cost consciousness in physicians about the whole medical system is going to reduce the ordering of unnecessary tests and procedures as long as they have to be in CYA mode to avoid lawsuits.

Sherry R. Gordon

 
Author of:
Book: Supplier Evaluation and Performance Excellence: A Guide to Meaningful Metrics and Successful Results
CloudDVD: Supplier Evaluation and Performance Management

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