Monday, January 07, 2008

Provider Misinformation

My wife and I are blessed in many ways, not the least of which is our health. We don't have many of the health issues that plague most people our age. We are not on medication for hypertension or elevated cholesterol. We do not use anti-depressants or sleeping pills.

The only health issue is my wife, who has dry eye syndrome. While this may seem like a lame medical condition I can assure you some of the issues associated with the condition are not pleasant.

But this is not about her condition so much as it is her doctor.

One of the treatment plans for dry eye are punctal plugs. In dry eye syndrome the glands on your eye either produce low quality tears, or the volume of tears is decreased. Punctal plugs are like tiny drain stoppers that are professionally inserted in the tear ducts to trap tears in hopes of fully lubricating the surface of the eye.

Rachel's doctor has been pushing this treatment for some time and she finally agreed to have the procedure.

She has decent insurance through her work and punctal plugs are a covered expense. The procedure is considered outpatient surgery, subject to the deductible and coinsurance.

Last week during a follow up visit, we decided to move forward and have the plugs inserted. We tried to find out the cost of the procedure in advance to no avail. While sitting in the examining room Rachel asked the doctor how much the procedure would be since his front office staff was no help. He had no idea, so his medical assistant was dispatched to collect the codes and pricing.

She returned and announced the plugs were $471 . . . and the bill for professional services would be $440 . . . per eye.

The doctors reaction?

"You're kidding!"

The assistant tried to minimize everything by saying insurance companies never pay full price, they discount everything.

Rachel persisted and asked how much the discount would be. The assistant said we would probably pay $50 if that.

I am in the room.

We have a deductible of $500.

It is January 4th.

There is no way this is going to cost us $50.

Rachel looks at me and I nod that we go ahead with the procedure.

There are 6 docs in this practice and I have no idea how many PA's and support staff. I am sure someone in there could have given us the network discounts but we didn't press the issue. We had figured before going that we would be out of pocket the deductible and probably a bit more.

I will point out that Rachel and I had researched treatment options, including punctal plugs, and had decided we were ready to move to the next level regardless of the expense. We had a general idea of the cost but were looking for something specific from our doctor.

Our doctor was no help.

This points out the disconnect in the medical community regarding the cost of treatment and how insurance works. Doctors are quick to promote a treatment plan without regard to cost . . . especially when a carrier is paying for it.

The same happens with patients . . . especially when a carrier is paying for it.

No one really knows how much health care costs because no one really pays for health care.

By the way, Rachel has noticed some improvement since her outpatient procedure which is what we hoped to achieve. As soon as the EOB is posted to our account I will provide the break out of billed pricing vs. carrier allowances.

That should be interesting.

This just in . . . the EOB for Rachel's visit has been posted. We owe $200.28.

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