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Monday, April 19, 2010

Breaking the Taboo: Tools for Talking Price with Your Doctor

Each time I go to my neighborhood Publix I experience two pricing models. The difference between these goes to the heart of what's wrong with our health care costs as a nation. I drop my prescription off at the pharmacy, and then head off with my wife (without whom I couldn't find the front checkout much less any food item, but I digress) to grab our food for the week.

When it comes time to check out I swing by the pharmacy and pay three $10 co-pays for three generic maintenance drugs. Then we go to the checkouts and pay for everything else. By the time we're at the checkouts I can tell you almost to the dollar how much we're going to spend because I've watched that with each item that's gone into the cart. I have absolutely no idea how much my prescriptions actually cost me because "they're $10 each." That's a lot of what's wrong with health care costs, and why HSA accounts are reshaping our thinking.

With FSA accounts and PPO plans we don't care about the real cost, the balance of which is paid for by our insurance plan. We don't care, that is, until the next renewal when our premiums, deductibles and co-pays rise sharply. With our last renewal, however, we had 80 employees elect the high deductible plan, and most of these opened an HSA. Now I'm hearing encouraging changes in perspective that I want to pass along to encourage everyone.

One person stopped me in the hallway recently and said that his family was comparing drug costs for all their prescriptions at all local pharmacies. They intend to move their business where the overall monthly bill is lowest. During renewal several people in our Accounting department asked about the physician and hospital discounts in one network vs another. Both of these instances show what happens when the HSA money is yours to keep, and whatever you spend comes out of that account. Now all of the sudden we care about the full price of our health care. We should have all along and I'm as guilty as anyone.

If we start to shop at the grocery store pharmacy with the same care that we shop the rest of the store we become several hundred negotiating consumers rather than a herd of insured bodies taking whatever we get at whatever price. While some may say that health care is not where you want to save money, it is a false choice between quality and price. You feed your family within your budget without buying spoiled produce and rancid meat, don't you? You do that by being smart consumers, and that same intelligent decision making can accomplish the same result in your family's health care.

It also happens that those physicians and institutions with the highest quality often have the lowest price. The number 1 maternity facility in Nashville is Baptist Hospital, which also has an excellent reputation and is ranked on our Blue Cross Blue Shield website as having the lowest cost rating in this market. During the health care reform debate The Cleveland Clinic was cited many times as having the best outcomes simultaneous with the most reasonable pricing model.

So if you want to compare price and outcomes between doctors and hospitals, where would you get this information? For those of us enrolled in the Thomas Nelson plan with Blue Cross Blue Shield you can get it off their website at Register if you haven't already. Once you have, look to the lower left column to find typical discounted pricing information for a variety of treatments, cost rankings for area hospitals by type of procedure, and dental cost information.

Armed with this information you can do one of two things. You can ask your providers up front what they intend to charge for this procedure and compare that to the market. If you want to be less confrontational, you can check some of your old Explanation of Benefit (EOB) forms and see what they've charged you in the past. You can then ask your doctor's office why they charge more than the market average, or consider moving to a doctor whose charges are more in line. Listen for the tenor of their response; the greater their indignation the greater the likelihood that you've struck a nerve and are being overcharged.

Remember, anything is negotiable and now is the time to adopt this new posture. I recently had a dispute with one of my providers over a $25 late-cancellation charge that I declined to pay. I thought we'd have a fight, but they gave up without a word. While in there for my next appointment the provider remarked to me that their patient load was off significantly due to the number of unemployed people who had lost insurance. Remember, these are businesses and not philanthropic institutions. Now is the time to confirm where your providers charge vs. the market and, if you don't like what you discover, push back.

1 comment:

Anonymous said...

Hey Jim,

Just a note about the employee that is shopping around at different pharmacies for the lowest price. Hopefully this will help them – I believe Kroger is advertising that they will meet another competitor’s price so this may be something for them to consider.

I have also compared 30 day prescriptions to 90 day prescription costs and we as a family, for most of our prescriptions, have come out better asking our doctors to write them for 90 days.

Malinda Bivens