`Shopping' for care at the ER

November 28, 2006|By Stacy Cowley | Stacy Cowley,BirdsandBills.com

NEW YORK -- The word "consumer" pops up frequently in discussions about solutions to America's crisis of skyrocketing health care costs. Treat medical decisions as you would other consumer purchases, some politicians urge: Shop around, demand information, make educated decisions. Health savings accounts, introduced three years ago and available for 2007 from an expanding number of insurers, emphasize personal responsibility for medical-care costs.

But when my husband had a sudden medical crisis this year, I discovered that it is impossible to navigate the American health care system with an eye toward the bottom line.

I came home from work one evening to find David conscious and responsive but violently ill. Calling 911 was one of the scariest moments of my life. I worried not only about my partner's health but about using resources responsibly. I had never invoked emergency services before. Did his condition demand an ambulance? I wasn't sure. Could I have wrangled him into a cab for the 10-block trip to the local hospital?

That first night in the emergency room was a blur of doctors, machines, drugs and surprisingly little paperwork. I handed over David's insurance card a few hours after we arrived. For the rest of the week he spent in the hospital, no one talked to us about costs or coverage.

Several times, I tried to gather information. If we agreed to transfer him to another ward for a few days of further inpatient care, would it be covered by insurance? While David convalesced, at least a dozen physicians stopped by for five-minute consultations. Were we being billed for these visits? Could we have refused all but the most essential?

Doctors impatiently brushed aside these questions; nurses told me to worry about it later and said they had no idea how individual procedures were priced or billed. When your husband is strapped up to heart monitors and an IV, you're not in a position to negotiate over how much they cost - and even if I were, apparently no one in an ER is trained to field that kind of question.

When David was discharged, we left the hospital without any paperwork. My requests for a billing statement were waved off. It was being handled through our insurance company, we were told. We'd get the details in the mail.

A month later, the flood of paperwork started. Rather than one itemized bill, we received dozens of cryptic ones. A typical invoice carried a single charge, labeled "MEDICINE," for $570.75. A doctor whose name I didn't recognize sent us a bill saying the insurance company had declined to pay his fees and we would need to cover them. When I called his office for more information (our insurer had no record of his claim), I found out that his office had billed the wrong insurance company. That was just one of the half-dozen billing errors I hit in sorting out the blizzard of invoices.

We're among the lucky. My husband and I have health insurance through our employers. Of the five-figure sum his medical bills totaled, we're responsible for paying less than one-tenth. But despite dozens of phone calls and scores of requests for follow-up information, I still have only a hazy picture of the real costs of my husband's hospitalization, and of how much control we could have exerted to keep them down.

Medical services aren't designed to be treated like a cafeteria menu; there are no "rack rates," and something as simple as a pill has a complicated schedule of varying costs. The doctor David sees monthly for follow-up care charges our insurance company $80 per visit; we cover a $25 co-pay. Were we paying directly, the per-visit rate would be $150. The push for consumers to more directly bear costs of their medical care ignores the problem of that kind of pricing differential. How can we effectively comparison-shop for services when the system is stacked against individual buyers?

I would love to see the medical system reformed to be more consumer-friendly; it's absurd that services so vital and so expensive should be so inscrutably priced. But without systematic changes, policies urging Americans to fight rising health-insurance costs by paying for more medical expenses out-of-pocket are recklessly premature. Until my local hospital and my family's regular doctors can offer standardized, itemized cost breakdowns for their services, I'll need an insurance company by my side to help navigate the medical-billing labyrinth.

Stacy Cowley writes about consumer finance issues at BirdsandBills.com. Her e-mail is stacy@covehurst.net.

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