Rarely do people think about medical costs when there is a medical emergency or an urgent need for a test. Recently, I was in such a situation.
A few days after a 22-hour international flight, the calf muscle in my right leg began to ache. If it were not for the recent flight, or if I were not a doctor, I would have just let it pass.
But long periods of sedentary inactivity, whether sitting on an international flight or lying in bed after a hip surgery, can lead to a blood clot in the leg. This clot can then travel up to the heart, pass the valves and lodge in the lungs, causing a pulmonary embolus. More than 300,000 people each year develop a blood clot in their legs or lungs.
In my career, I have witnessed dozens of patients die before my eyes from a pulmonary embolus. So I became concerned, and called my primary care doctor.
I needed a venous ultrasound, a wand-like probe run up and down my leg to visualize the blood vessels, to make sure there was no blood clot causing my calf pain.
But where would I go for my procedure? It was January, and I did not want to take a big bite out of my deductible. So I asked my doctor for the cheapest facility and went there for my test.
When we go shopping for a television or for some clothes, we keep the price in mind and choose accordingly — a dollar store, Wal-Mart or Macy’s. But in health care, we assume costs will be the same. That is not the case.
So after my test, I decided to explore whether I had really gotten the best price. I called local hospitals and outpatient facilities with a simple question, “Can you tell me what will be the cost of an ultrasound of the right leg to rule out a blood clot?”
One hospital operator transferred my call to the radiology clerk, who then sent me to the admissions coordinator, who then put me through to the scheduling clerk. In the process, I got two possible estimates: $313 or $377. Yet this was just the technical fee for doing the ultrasound. The radiologist’s fee was a separate cost for which I had to call the radiology group, where I felt as if the receptionist had never fielded such a call. Then, after consulting a colleague, she referred me to their billing company, which gave an estimate of $84 as the radiology reading fee.
When I called another hospital, the receptionist transferred me to radiology, which then sent me to a billing coordinator, where a voice message asked me to leave a voice message and someone would get back to me in two business days. I decided not to leave a message. I had just about had it with the automated responses: “If you know your party’s extension, please dial it now …” or “Your call may be monitored for quality purposes.”
Then I called the outpatient facility my doctor had recommended. Within a few minutes, I knew the technical and doctor’s fees, $272. This could be lower if I paid cash at the time of the test and was not filing for insurance. We are charged more if we have insurance? Imagine if they did that at Wal-Mart: prices varying by your income status. Now, imagine if I had done my medical-procedure-shopping when I feared a blood clot in my leg possibly floating to my lung.
The problem is that our health care system lacks price transparency. Patients are shy about asking how much a test will cost, and doctors and hospital administrators are not forthcoming about prices for procedures. Sadly, I must confess, I don’t know exactly the charges of the procedures I deliver every day.
At one level, we cannot blame the health providers. In health care, there are thousands of procedure codes, and it’s unclear what will be needed prior to the service. A colonoscopy may be one price, but a colonoscopy with one biopsy or five biopsies may be another. Also, the payment by patients may vary by nearly two- to three-fold if a patient is self-pay, Medicare or commercial insurance.
The lack of transparency becomes a medical mystery when we get our medical bill. Columns with numbers are for “Amount Charged” “Amount Paid” “Amount Adjusted” “Deductible” and cryptic descriptions like “DUP. VENOUS EXT. UNI/LIMIT”
Honestly, even after 14 years of postgraduate education, I have difficulty making sense of medical bills, so before writing a check, I double-check with my wife “How much do we really have to pay?”
There is a bill in Congress, HR4700, which could simplify this process by mandating transparency in all pricing in health care. It has 67 co-sponsors, Rep. Steve Cohen being one of them. But we cannot wait for Congress to act before getting our next medical procedure.
One website, healthcarebluebook.com provides general information on a fair price for medical procedures in our area. The information can help us know the general price for a procedure and then allow us to cost-compare. Ultimately, this will drive the providers to provide more competitive pricing or, least of all, be price transparent as a start.
Another site, changehealthcare.com provides employees, employers and health plans a tool to compare local prices.
As it turned out, the ultrasound showed there was no clot in my leg. My muscle cramps were likely caused by the higher dose of the statin drug I had initiated a few months earlier. Once I stopped it, the pain went away — leaving me with a medical bill and some important lessons about pricing in our health care system.