Health $care: How Much Will You Pay for Health Care?


What Little You Can Do

In my experience, doctors try to help patients sort things out. But as one of my doctors admitted to me, he is having an increasingly difficult time navigating the system, himself. Just as we don't know what we are paying, your provider doesn't know what he is getting paid.

You can insist all of your providers, from your doctors to the labs who process your blood work, remain in network to help contain costs, then pray your request will be honored. (That's not always the case.)

You can repeatedly call your insurance carrier and demand answers. Ask for names to establish a modicum of accountability and, if you don't like what you hear, escalate the matter to a supervisor or hang up and call again. Trust me, the story often changes depending on who picks up the phone.

Some insurance companies have added cost predictor calculators to their websites to estimate bills. But because it's impossible to predict all of the variables, they frequently aren't accurate.

Carriers have also begun hiring on-staff advocates whose job it is to guide patients towards the best outcomes. But considering that their paychecks are signed by the insurance company, that's a bit like allowing the fox to tour the chickens through the hen house. Better to hire an independent advocate -- an expensive option, to be sure, but one that at least puts a champion in your corner and provides some peace of mind.

The Bottom Line

The advent of third-party intermediaries is a new wrinkle for health care consumers to deal with. By sucking what's left of accountability, logic and humanity out of the health care system, they will only expand the divide between patients and caregivers.

In my case, I hang up the phone, not knowing how much this procedure I need will set me back. I am forced to do a rapid analysis between cost of care and quality of care. It may be cheaper to have the test somewhere else -- no doubt the third-party intermediary believes it will be cheaper for my insurance company -- but I decide to stay where I am.

And when I get home that night, there is a letter from the very same third-party vendor telling me my test has been approved and is in network but this does not guarantee the charges will be covered.

Getting sick is scary. The uncertainty over the cost of getting sick is downright terrifying.

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