e-Patient Dave deBronkart’s blogpost chronicling his ongoing journey to find affordable prices for his healthcare needs is particularly pithy because it begins to untangle the ratsnest otherwise known as “healthcare shopping” today. By “ratsnest” I mean what any of us may encounter when trying to find the best value—that is, price for quality services—when we need it.
Like Dave, some time ago I tried shopping around my town for the price of a CT scan (in my case, potentially for our daughter). I had a bit of an easier time of it, but Dave’s experience, my own, plus my experience some years back around having my 50-year-old benchmark colonoscopy are all textbook examples of how crazy the scene is (at that time my insurance required pre-auth’s, so I pre-authed the procedure thinking it was a done deal, only to get billed $500 for the facility [um, the procedure took place in the back of the office, which evidently became a “facility” when you rolled off the carpet and onto linoleum, groggy in a gurney] and the insurer refused to “post-auth” this charge, which hadn’t been disclosed to me. Got that? When the office wag I was on the phone with back then told me that I burst out laughing and, when I regained control, blurted out” well you ought to have a pay phone there so I could have called for the facility pre-auth…).
Dave likens the business workings of a hospital to those of two different restaurants in some mall—mere presence in a single building don’t necessarily make a connection. Although you’d think that since *you* are the connection between departments in a hospital and there’s no relation between the restaurants—oh, I can’t even bear to keep typing; you get the idea, I hope.
I like to simplify things, and today’s simplification is this: always inquire something along the lines of “how many separate charges from which separate entities together comprise this thing called “a procedure” which I am in the market for?” Answering that question may take you down a rabbit hole but you will be one wiser and possibly empowered healthcare shopper at the end of that “procedure.”
One thing to be sure to check on is whether any out of pocket (“self-insured”) expenditure you make can be applied to and accrue toward your deductible. It’s possible that you may save $500-1,000 on a CT scan but that the $500 you do pay will do nothing to lower the out of pocket balance on your annual health insurance ledger.