Tales From The Patient-Centered Health Care Front. It's Not Pretty
The Republicans, emboldened by the Trump Presidency, have trotted out the idea that a Patient-Centered approach to health care will drive down costs.
This is not as easy as it sounds, as the following tale of woe will attest.
My wife was scheduled for a regular mammogram. We have good health insurance, from one of the major national carriers, and this important preventive service is part of our coverage. At her doctor visit, it was suggested to her by the doctor that she request the 3D mammogram rather than the traditional 2D because the 3D provides a much clearer image and this makes the diagnosis much more accurate.
Because she is aware of the Patient-Centered proposal my wife thought it would be a good test. She would find out the cost vs the coverage and make an informed decision.
Wife: "How much extra will the 3D imaging cost?"
Doctor: "The difference is $73 to you and the rest will be picked up by your insurance."
Wife: "So my insurance will cover it?"
Doctor: "Not necessarily. Some carriers cover it, some don't. You should check with your insurance carrier."
OK. So far so good. She then called our insurance provider.
Wife: "My doctor suggested that I get a 3D mammogram and I would like to know if this is covered."
Insurance: "I don't know. Do you have the code for this service?"
Wife: "No. They did not give me a code. They just said 'Ask for the 3D mammogram'"
Insurance: "I can't tell you if it is covered without a code."
Wife: "You can't look up 3D mammogram and tell me if it is covered?"
While frustrated, my wife was not deterred. She placed a call to the doctor's office to get the code.
Wife: "My insurance company needs the code for the 3D mammogram so they can tell me if it is covered. Would you give me the code, please?"
Doctor's office: "I don't know the code."
Wife: "Can you look it up?"
Doctor's office: "No."
Wife: "Well, that is odd. Can you tell me if my insurance carrier covers this service?"
Doctor's office: "Some do, and some don't"
Wife: "Well, if I go through with the service, and the carrier does not cover it am I only out the $73?"
Doctor's office: "No. If the insurance does not cover it then you are responsible for the additional charge for the service."
OK. Decision made. She opted for the basic 2D mammogram, even though her doctor recommended the 3D scan, because no one could tell her what her costs would be.
Houston, we have a problem.
It is extremely hard for patient's to get information from a system that is designed for doctor-insurance communication. Apparently, you can order a service by just requesting "3D mammogram" from the lab, but you can not find out how much it costs, or if it is covered unless you have "the code".
In other words - it is easy to spend money on services by speaking common English, but you can not manage costs unless you speak Code.