Practice Due Diligence Can Save Patients Money

A tale of two patients (apology in advance to Charles Dickens). It was the best of choices, it was the worst of choices. It happens to the best of us, even those of us who should know better.

A colleague of mine scheduled his annual wellness visit, covered in full by his health plan, made the appointment, and chalked it up as another testament to healthy living and good choices. Until he got a $2,400 bill, charged in full against his deductible from the hospital his doctor's office sent the complete blood count (CBC) and prostate specific antigen (PSA) samples to for processing. Tests covered as a part of the wellness exam by his health plan, if they were sent to their designated lab.

After hours of teeth gnashing, snarling, cajoling, and related health care negotiating techniques, the bill got reduced to under $400, and serves as a lesson for us all. What is convenient for physicians' staff, or in recognition for that lunch or box of cookies a sales rep brought in can be, and almost always is, costly for patients.

The second-almost-victim is my wife, who needs an outpatient procedure. She works for a major, self-insured, for-profit hospital chain. She checked her insurance plan, selected a doctor, and was about to go for her procedure to another hospital system's in-hospital outpatient facility. The facility was chosen by the doctor's staff, who assured her that the cost would be covered after her deductible.

If she had the procedure done in one of her employers' facilities, her total responsibility would be a $125 co-pay. Her surgeon's office, well, her former surgeon's office-she must find another who goes to an approved facility-was totally unaware of the consequences to their patients. It almost cost her $3,000

Taking care of your patients' financial health

With whom you do business has real financial consequences in this age of "patient responsibility," in the form of co-pays, co-insurance, and deductibles –the thousands of “first dollar of care” expenses your patients pay out of their own pockets before the insurer pays a dime.

Hospitals and specialists fight every effort to introduce price transparency, mostly because the myth of $20 and-aids is no myth. Nor is a $50,000 colonoscopy with a "fly-in" $25,000 over-read, or a $100,000 single-level cervical fusion compounded by a $200,000 hospital bill.

Pharma price predation gets all of the press, but it's far from alone. For an industry as highly regulated as healthcare, your patients are on their own, unprepared and unaware. And this all happens before they even know it.

Practices and physicians can help by educating your staff, encouraging your patients to call their health plans to confirm coverage options, and, working with or joining a physician-owned and operated accountable care organization that will equip you to take equally good financial care of your patients as your clinical care.

If you are marketing your practice, I could not think of a more powerful value to promote to your community.