I’ve recently been shopping for health insurance. My current coverage (which is subsidized by my former employer) expires May 31. I work for myself now, and I am looking for coverage for me and my family. Presumably, there are hundreds of health insurance choices with a mind-numbing matrix of choices about coverage, deductibles, co-pays, doctors and the list goes on. But, if you have a serious pre-existing condition (heart disease, diabetes, cancer, etc.) suddenly the choices are greatly narrowed, nearly all of them not good.
If you find an insurance carrier who will take you as an individual, pricing is all over the board. Some monthly premiums are competitive, but comparing the details between each of the plan offerings is taxing. Some plans have higher deductibles, which translates into lower monthly premiums, while others cover a lower percentage of office visits and charges (80% vs 70%, etc.). Throw in prescription medicine coverage options, and you’ve got… a mess.
The biggest issue as I see it is the lack of pricing transparency for the consumer (that’s you and me) in regards to office visits, lab tests and other services “recommended” by doctors to patients.
In nearly every other industry, there is pricing transparency that benefits the consumer. Thinking of buying a car? There are more sources of information available that you can count on your fingers and toes. Internet sites, subscription services and other methods will reveal the wholesale cost of the vehicle, any special incentives available and even the “back end” money that dealers get from the manufacturer that they can choose to pass on the savings to the customer (or not).
Digital cameras are another example. There are literally thousands of websites and blogs that will compare prices, share reviews and provide inside information that points you towards selecting the camera from the retailer that offers the best value.
Have you ever known the price of a doctor office visit before you go? Maybe if you go to an urgent care where the prices are posted on the wall, otherwise, no. How about lab services? The doc says, “we need to draw blood to do some tests,” do you know how much those tests are going to cost? Or, how much out of pocket you’ll have to pay? Nope. Have you ever asked? Most of us haven’t. There was no need to; that was the point of having health insurance. The “system” took care of it; you just paid the premiums.
In today’s new world of pushing total responsibility for health care onto the backs of the individual, we have to start asking those questions. Otherwise, tests get ordered, things get requested, you’re footing the bill, prices keep going up and the system keeps its foot on your throat.
Wouldn’t it be nice to tell the doctor, “Ok, make a list of the test you’re requesting and I will compare prices and service from providers A, B, C and have the results sent to you.” Then, you could shop the list of tests among accepted providers and get prices, service time, results, communication, and then select the provider offering the best value.
Sure, there’s a risk that some providers may not perform as well as others, but that’s the case now. So, no difference in my book. That would be a start to pricing transparency that benefits the individual, since the individual now has to wrestle with these issues after they’ve occurred – when the prices and amounts to be paid can’t be changed.
Until that level of transparency is achieved, we, as consumers, should begin asking tough questions of our medical service providers, “are those tests really needed?, what’s the price of that test, so I can calculate my portion of payment?” Once we begin doing that, it makes the doctor aware that we’re aware and begins to bring much needed change to the system and moves the pricing power towards the consumer – where it belongs.
Let me know what you think about pricing transparency and if you think it’s a realistic goal for healthcare and insurance issues.
If you find an insurance carrier who will take you as an individual, pricing is all over the board. Some monthly premiums are competitive, but comparing the details between each of the plan offerings is taxing. Some plans have higher deductibles, which translates into lower monthly premiums, while others cover a lower percentage of office visits and charges (80% vs 70%, etc.). Throw in prescription medicine coverage options, and you’ve got… a mess.
The biggest issue as I see it is the lack of pricing transparency for the consumer (that’s you and me) in regards to office visits, lab tests and other services “recommended” by doctors to patients.
In nearly every other industry, there is pricing transparency that benefits the consumer. Thinking of buying a car? There are more sources of information available that you can count on your fingers and toes. Internet sites, subscription services and other methods will reveal the wholesale cost of the vehicle, any special incentives available and even the “back end” money that dealers get from the manufacturer that they can choose to pass on the savings to the customer (or not).
Digital cameras are another example. There are literally thousands of websites and blogs that will compare prices, share reviews and provide inside information that points you towards selecting the camera from the retailer that offers the best value.
Have you ever known the price of a doctor office visit before you go? Maybe if you go to an urgent care where the prices are posted on the wall, otherwise, no. How about lab services? The doc says, “we need to draw blood to do some tests,” do you know how much those tests are going to cost? Or, how much out of pocket you’ll have to pay? Nope. Have you ever asked? Most of us haven’t. There was no need to; that was the point of having health insurance. The “system” took care of it; you just paid the premiums.
In today’s new world of pushing total responsibility for health care onto the backs of the individual, we have to start asking those questions. Otherwise, tests get ordered, things get requested, you’re footing the bill, prices keep going up and the system keeps its foot on your throat.
Wouldn’t it be nice to tell the doctor, “Ok, make a list of the test you’re requesting and I will compare prices and service from providers A, B, C and have the results sent to you.” Then, you could shop the list of tests among accepted providers and get prices, service time, results, communication, and then select the provider offering the best value.
Sure, there’s a risk that some providers may not perform as well as others, but that’s the case now. So, no difference in my book. That would be a start to pricing transparency that benefits the individual, since the individual now has to wrestle with these issues after they’ve occurred – when the prices and amounts to be paid can’t be changed.
Until that level of transparency is achieved, we, as consumers, should begin asking tough questions of our medical service providers, “are those tests really needed?, what’s the price of that test, so I can calculate my portion of payment?” Once we begin doing that, it makes the doctor aware that we’re aware and begins to bring much needed change to the system and moves the pricing power towards the consumer – where it belongs.
Let me know what you think about pricing transparency and if you think it’s a realistic goal for healthcare and insurance issues.
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