:: What follows below is a rough transcript of a conversation that I just had with a representative from my health insurance company. I waited on hold for 15 minutes before I was able to speak with him.
Before I called, I searched extensively online for the information I needed; but, despite extensive searching, I couldn’t find the information I was looking for, which was simply this:
How much will it cost me to see my doctor?
To me, this is one of the most egregious aspects of our current medical system. No one–not the doctors, not the health insurance–can ever tell you what you will actually end up paying.
In fact, before I ever spoke to the representative, a recording told me that anything they tell me on the phone is subject to later review, and that they would not be bound by any quotes or other money information that they give out during the phone call.
Tangent: That recorded message is like those trucks with signs on the back that tell you to stay back 200 feet because they’re not responsible if rocks flying out of the back of the truck break your windshield. You might not have a choice but to follow that truck–or get close to it at a stop light–but hey, they’re not responsible. (That sign doesn’t hold up in court, by the way.)
Asterisks [*] note medical insurance jargon that the average person probably doesn’t know. Jargon is one way of obscuring unfortunate or egregious policies, and of putting off complainers by making them feel insignificant or stupid. (That strategy doesn’t work with me, or most lawyers I know. It just makes us angry. See infra.)
Without further ado, let’s see how easy it was to find out how much it will cost me to see my doctor.
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Me: My doctor is leaving the hospital where she used to work in a clinic. She’s opening her own clinic at a new site. I need to know how much it will cost me to see her there.
Health Insurance Dude: Will she be a participating provider*?
Me: I don’t know. I’ll pay her, and then I’ll file with you.
HID: Then she’s not a participating provider.
Me: So you require doctors to do the paperwork?
HID: Yes.
[I’m thinking: That’s an interesting way to pass on a cost to the provider.]
Me: Okay. So how much will it cost to see her?
HID: [Reading from a script] You are approved for 26 visits per calendar year. If you would ilke more than 26 visits per calendar year you must file a request for extended coverage with the proper department—-
Me: I already read that online. I need to know how much it will cost to see my doctor.
HID: Your plan requires a 40% coinsurance* per visit.
Me: So you’ll pay 60% of the cost of the visit?
[I’m feeling pretty good about this, at this point. I can pay 40% of her bill, that’ll be like $90.]
HID: That’s correct. We pay 60% of the allowable* per visit.
Me: The allowable? [I’m thinking: uh-oh.] Well, what’s the allowable for a one-hour visit?
HID: I can’t tell you that.
Me: Why not?
HID: I don’t know the code.*
Me: What code?
HID: I don’t know how she will code the visit.
Me: How do I find out the code?
HID: I will be happy to call your provider to find out the code and then provide that information to you.
[I’m thinking: I just spent 15 minutes on hold waiting to speak to this guy. No way I’m hanging up now.]
Me: I have a Explanation of Benefits* from an earlier visit with her. Can you figure out the code from that?
HID: Yes.
[I read him some numbers. He looks up a code. All of my visits have had the same code. I ask him to presume that future visits will be coded the same way.]
Me: So what is the allowable for that code?
HID: $98.
[FYI: My doctor charges $216 for the one-hour visit.]
Me: So you will pay 60% of $98 for a $216 visit.
HID: Yes.
Me: That’s highway robbery.
HID: I’m sorry you feel that way.
Me: No, really. It’s not an opinion. That’s an objective observation.
HID: I’m sorry you feel that way.
Me: @#$%!@$^%$^#%^.
THE END.
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Despite the colorful ending, the point of this story is not to argue about how much doctors should be charging or how much insurance companies should be paying.
The point is to point out the obfuscation. The (deliberate?) hiding of information. It is difficult to complain about a price structure when no one can figure out just what the price structure is.
Transparency, people. That’s all I’m asking for at this point.
