Not Ready for Prime Time: 3 Stories from Healthcare Consumers

Being a healthcare consumer isn’t easy.

Recently I was explaining what Smith does to some friends. Pretty quickly the conversation turned toward health insurance and healthcare costs—mainly HSAs and high-deductible plans. Cutting to the chase, folks aren’t happy.

Our HR clients are tasked with explaining the necessities, values and details of what often is called healthcare consumerism. In theory, consumer-driven healthcare has three key components:

  • More healthcare choice, information and responsibility is placed in the hands of employees
  • Employees come out-of-pocket for more of their health spending
  • Healthcare consumer choices create market forces that control rising healthcare costs

It seems reasonable and I hope it’s working.

However, theory and reality often diverge. Listening to my friends share their recent experiences helped shed light on real difficulties employees have as healthcare consumers. It seems that the market they are accessing is largely detached from reality in terms of pricing, accountability and transparency.

These three stories are illustrative because my friends all tried to be proactive, informed and careful healthcare consumers.

Patient-friend A needed corrective jaw surgery that was outside the parameters of his health insurance. His treatment plan with his dentist, orthodontist and oral surgeon came to around $8,000. This included $900 for the use of an outpatient surgery center, which was to be prepaid—a real bargain.

When he arrived at the hospital, to sign forms and pay the $900, he was informed that the bill was now $19,000. That’s right—$18,100 more than what he was expecting. He was shocked. He called his doctor while in the waiting room to “freak out” and cancel the surgery. Upon closer examination, the surgeon’s office manager realized that she coded the order incorrectly, neglecting to note that the patient would self-pay. She spoke with the hospital admissions person, sent over the corrected order, and guess what? The bill went down to $900.

Doesn’t that give you pause? Why is an insurer/employer billed 20 times more than the hospital will take in cash for the same service?

Patient-friend B needed her gall bladder removed. She chose the hospital because it was in-network and her surgeon’s practice was also in-network. Since her deductible had been met for the year (the reason why she elected to do the surgery when and where she did), there were no out-of-pocket costs for the operation.

However, after the surgery was performed, she received a separate $4,000 bill from a contract surgical nurse who assisted during the surgery. This nurse was not in-network, so the insurance wouldn’t pay the bill. It took months of wrangling, threatening and fighting to get the hospital and insurance company to intervene.

What’s an unconscious consumer to do?

Patient-friend C (OK, this is me) tried to determine the cost of a doctor’s visit to decide whether to do it in December or January as part of my healthcare budgeting. My family has a $7,000 deductible and we manage most of our healthcare costs through our HSA and FSA.

The visit wasn’t critical; I could have waited until my annual physical and it would have been covered. Still, I wanted to close out my FSA. Use it or lose it. My doctor’s office refused (claimed to be unable) to tell me how much I would pay for a visit beforehand. The only option I had was to have the visit and find out how much it cost at the conclusion. The cost ended up being more than I had in the account, thank you.

I wouldn’t agree to this scheme with any other purchase.

Employees are depending on us.

A recent study showed two things about employees and consumer-driven health plans. First, employees don’t fully understand these plans. Second, they count on employers to educate them on the details. If the stories I’ve shared are part of a universal experience, we all have a lot of work to do to help empower employees to receive good care in a difficult marketplace.

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