Voodoo: A Patient’s Explanation of Health Care Costs

When I told my husband that my ob-gyn had recommended two diagnostic exams, he requested that I try out the the insurance company’s online “cost estimator” tool. This exercise was about being an educated patient, not necessarily going with the lowest cost facility, he assured me. “So, we’re going to shop for health care the way we shop for refrigerators?” was the sarcastic response edging its way closer to the tip of my tongue.

The cost estimator couldn’t monetize the investment of time I had made in my existing doctors or the quality of care a doctor could provide. For the last 13 years, I have been treated by the same teams of ob-gyn and primary care doctors. They are all part of the same hospital, so my records are easily shared between providers at that hospital. I am an established patient at both practices. New patient appointments can be tough to get, and no one wants to be a new patient at the moment a health care crisis arises. These doctors had shepherded me through two pregnancies and deliveries, not to mention years of physicals, pap smears, and breast exams. Their assistants conducted my ultrasounds and stood witness while the doctor inspected my vagina, uterus, and all my other bits and parts. Didn’t all of that history and trust have a place in my medical decisions as well?

Despite my reservations, though, I knew that, if this tool was at our disposal, then we would both feel compelled to use it, until or unless it proved useless. My husband and I are pragmatists, experts in the art of gathering  information to make educated decisions or to drive ourselves crazy–whichever comes first.

So, here’s how the tool works: Say your obstetrician-gynecologist recommends you undergo a sonohysterogram; (guys, use your imagination here to fill in the blanks; women do it all the time). You type “sonohysterogram” into the cost estimator which then provides you with options that are similarly spelled.

But, already there is a snag. Because you realize there is a variety of sonohysterograms out there, and you didn’t know that when you were sitting in your doctor’s office, so you didn’t know to ask “which one is this?” And, even if you had, would the health insurance’s terms match your doctor’s?

So, you select the most likely option from the list–despite that you have no idea what any of the options actually mean. The estimator then returns a dollar figure: the average cost of that procedure in your area, per the ZIP code you provided. Next, it gives you a list of providers near you that provide that service, along with the cost that they charge for that service.

But, here, you get caught on snag number two: After scrolling through the first two pages of results, you don’t see your doctor’s practice. With many pages of results to go, you try to shortcut the process. You search by facility name, but, still, your provider’s practice is not returned. You try different variations of the facility’s name, but…nothing.

Now what? In my case, I didn’t even check the results list (actually, I didn’t know it was there–this post forced me to test out the system a second time). I took a deep, irritated, and anxious breath and called my ob-gyn’s office.

Why anxious? To quote my friend, I felt cheap. Well, cheap is not a feeling. The feeling is actually shame brought on by the concern that others will think I am too poor or too miserly. If the former is true, then I was being completely classist (which is really why I should feel shame); if the latter is true, then damn you, Mr. Scrooge, for laying waste to the charms of frugality. In either case, it is ridiculous to feel self-conscious about second guessing hundreds of dollars of expenses.

So, I dialed the doctor’s office, stammering out my question about the cost of the particular exams the doctor had ordered. The fumbling response from the receptionist reinforced my discomfort. What seemed evident is that she was not accustomed to answering this question. But she obliged, as best she could. Without knowing with certainty which tests I’d be taking, though, she could only provide me with some of the possible costs. And, there is snag number three. Even if you call your doctor’s office, getting the costs for your exact procedure could be difficult.

Where did all of this partial knowledge leave us? Pretty much where we started. Sure, at this point, assuming the insurance company’s site was accurate, we knew the average costs for the exams we thought I was taking. And, we knew some of the costs that the doctor’s office was likely to charge. But, without more time, more questions, more experience, and more inquiries with the doctor and his staff, we would not truly know where my doctor ended up on the cost spectrum.

So, I decided to put off the tests until next year or until we met our very high, almost unattainable deductible (just achieved, by the way). Having jumped through these hoops, was I a more informed patient? Not in a way that mattered. I basically reaffirmed what I already knew: the health care system is confusing and to make educated choices, I would need to be intimately familiar with its innerworkings. As my husband said, in referring to the unbelievable news that we had reached our insanely high deductible, “It’s voodoo.”

If the insurance companies are going to proselytize patient education, they need to do more than talk to patients about a cost estimator. They need to teach us what questions to ask of our doctors. They need to talk to doctors’ offices about how to address patient concerns over costs. Or, perhaps, this is a role for doctors as well. But, like our school teachers, at what point are we asking them to be more than what their training prepared them to be?

Those procedures I chose to put off because I saw them as optional? Well, when I went in for my annual physical with my primary care doctor, he clarified something: One of those exams, the sonohysterogram, was by no means intended as optional. Get it done, he said. So I did, with my regular ob-gyn, before we met our deductible. The health care system’s fee structure may be voodoo, but sound medical advice is not.

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