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Justin Graves

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The Best Way to Bring Down Health Care Costs

Posted: 09/07/2012 10:29 am

The current national debate on health care reform was lost on me until two recent events brought it crashing home. They made plain to me how health care cost can affect a family's finances and also inspired some thoughts as to how we can change the system.

The first took the previously unknown to me form of a debt collector. I had two identical dental procedures a few months apart. Prior to both I checked with the doctor's front office staff to ensure the procedures were covered by my health insurance. On both occasions I received an affirmative answer. However, unbeknownst to me in the month or so between procedures, something happened, my insurance's dental coverage changed and despite having assurances from the doctor's front office and their being identical procedures, the second claim was denied whereas the first was approved. Due to the financial liability form which patients sign prior to receiving treatment, I was now on the hook for $730. Full of indignation, I attempted to dispute this claim and in the process it was referred to two different debt collection agencies, which each added their own fees bringing the amount they attempted to collect up to $1,134.00.

The second event transpired this past week following a change to a new primary care doctor. After researching new physicians on my insurer's website, I called the insurer's customer service representative line and made the switch. My first appointment was very pleasant with the new doctor, who practiced in a small medical building near work. Last week I received a claim denial from that office visit stating that (again due to the financial liability form) I now owed $170.00 for using "a non-network physician". Fortunately this time I was able to dispute the denial successfully but receiving it was a shock and the dispute process consumed easily an hour of my time.

The debt collector has now been paid and the second dispute resolved but my credit rating has taken a hit in the process, which is in turn delaying a refinance on a property I own. It's been a painful lesson, small medical matters can snowball in to large problems with far reaching financial consequences.

There must be a better way to process health insurance claims in this country so that the patient is not left holding unexpected debt. Perhaps a move from the health insurance model, where claims are processed post facto to a health coverage model where approvals are given prior to treatment and pricing is clear and up front?

When we make "big ticket" purchases as consumers we know prices in advance and can make informed decisions. In this era of modern technology, health care should be no different. An office visit shouldn't leave you to hope that the procedure was covered. Indeed one should be able to go in, have the office submit the bill for pre approval and tell you any associated costs prior to treatment. Then, if there is a Hobson's choice to be made between getting treatment or postponing it, the patient can make it with all the information in hand, instead of receiving an unexpected bill for an unknown amount of money.

In addition to mandating a pre approval process, we should also mandate up front pricing. There are no prices posted in a dentist's office, or on the paper work you give to the phlebotomist. There are clear prices in restaurant menus and above the counter at muffler shops, why should health care be any different?

The national debate focuses a lot on containing costs. There is an element of profit (in some cases huge profits) in our health care system. The best way to bring down or control costs would be to give patients the tools they need to be informed consumers of health care. Pre approval and up front pricing would allow patients in many cases to plan how to pay for their care instead of being ambushed by denied claims. Upfront pricing would allow them to research costs at different providers and perhaps also introduce a word that's practically never uttered in our system... competition. Let's let the same force that drives our free markets work in health care. If Dentist A charges $200 for a filling and Dentist B charges $300 and everyone can clearly see their prices up front, then a lack of patients will soon enough bring Dentist B's prices down.

The ideas of health coverage, not health insurance and informed consumers, not powerless patients through the mandating of tools such as pre-approval and up front pricing, need to find a voice in our national debate.

 
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