Payment Transparency

One of my interests in healthcare is transparency in payment. I have not always known this as being as issue,however, it is certainly part of the picture for overall healthcare reform especially when it comes to cost reduction. About 15 years ago, my spouse had a co-worker who was undergoing cancer treatment and had to obtain an injection on a regular basis. Once this person had to be out of town and had arranged to receive the injection in the other city which was easily accomplished. This person was alert to reading the next EOB wherein it was discovered that the very same injection was $3000 more than previous ones. The patient had good insurance and was not impacted, however, felt that it was certainly not fair to the insurance company to have to pay that increase and form then on the person stared asking what procedures costs.

That story prompted me to be far more inquisitive about my healthcare procedures and to become more acquainted with the payment processes involved by provider, patient, and health plans. I had always asked what repairs cost when I took my vehicles in for maintenance and I ask what my health procedures cost. At one hospital where I received my annual lab tests there was a brochure for patients to explain the billing. While the brochure was nicely printed, it was a long way around saying that they could not really not want to tell me as a patient what their procedures costs.

As a consumer of healthcare, I challenge everyone to read your EOB’s or just ask what procedures costs. FAIR Health is a good resource and CMS has a new tool to use. Health plans have to negotiate rates and when you watch what charges are being made and seethe difference between what is charged and what is paid you will get some idea of the costs in healthcare. You can also ask what the charge would be if you did not have health insurance. As consumer we inquire often about costs of vehicle maintenance, clothes, etc., so we can do the same with healthcare.