[quote=livinincali]
Thirdly why aren’t there consumer protection laws that apply to medical services. If you go to the mechanic they have to give you a written estimate of the price. They can’t just demand that you pay them $2,000 to get your car back. Why aren’t medical providers held to this same regard when it comes to routine services. I understand emergency situations are somewhat different.[/quote]
I feel your pain, I really do. One of my kids had to have a surgical procedure a few years ago and we had a plan with a $10,000 deductible (this was before the ACA and I was consulting so had no employer-sponsored insurance). Since the surgeon had admitting privileges at two hospitals, I thought I’d call around to find out rates from each one. Ha! That never happened. Both hospitals said there was no possible way to give me even a ballpark idea of how much we’d pay for the surgery and associated costs like anesthesia. I asked if they could treat us as a cash patient since our 10k deductible basically made us uninsured for this procedure and even though they were willing to do that, the billing office told me they had no idea if the negotiated rate our carrier (BCBS) had for the surgery would be cheaper than the hospital’s cash rate. Part of the reason was that it was proprietary info (treating their negotiated rates like a closely guarded secret) but mostly they said their systems were not set up to estimate costs before a procedure. They said we needed to specify up front if we wanted to be treated as a cash patient or wanted them to submit to BCBS, where the charges would be adjudicated according to the BCBS negotiated fee structure, and then we’d pay our 10k share according to this fee schedule. There was no way to find out which was a better deal for us as consumers. We could only wait and see after the surgery the charges that were spit out of their system.
Crazy that the consumer just has to blindly go in to have surgery without any idea of the charges. We’re lucky that we’re in a position to cover any costs and had obviously enrolled in the high deductible health plan with eyes wide open to our risk, but for many, that kind of plan was all they could afford at the time (pre-ACA). Even now, many people face the same issue. For those people, trying to do the right thing by being insured, it’s a huge blow to be handed a bill for thousands of dollars with no ability to predict or budget beforehand. Many surgeries, although medically necessary, are technically elective so someone in a different financial position than ours may have opted to put it off until they could budget for it or had a different insurance plan. But again, no one would have been able to give them the tools to arrive at an estimate.
I’ve been in the health insurance/managed care industry a long time, and for many years the industry buzz has been all about empowering consumers to make better/wiser/more efficient health care decisions, yet the health delivery system does not have the tools or more accurately, is not willing to use the tools on behalf of the consumer, to get us all the way there. This is something that the ACA will help do but getting there will be a long time coming, in tiny baby steps.
