Dear Mr. President
Saturday, July 31, 2010
Dear Mr. President,
I told my doctor the pain in my chest felt like a sharp, stabbing pain, followed by a dull ache, and was intermittent for a couple of days, although I hadn’t experienced it for about a week. And without any examination, based solely on my explanation, she referred me to a cardiologist for a stress test. After the testing, the cardiologist could not determine a cause, but based on the test results, concluded my heart was healthy.
A week later, I was in my chiropractor’s office and told him how the cardiologist could not identify the cause of my chest pains. So, my chiropractor asked me what I’d been doing, days prior to the pain. He asked if I’d been painting – as he knew that ever since we bought our new house, I’d been painting various rooms. That jogged my memory, and I said "that’s exactly what I’d been doing" and immediately recalled how the pains occurred the day AFTER painting. So, he probed further, and we eventually felt certain that I’d been experiencing nothing more than normal muscle aches from using muscles that I’m not accustomed to using.
Then, weeks later, I received my EOB (Explanation of Benefits) from my health insurance company, showing the total amount billed for ALL the procedures that went into the stress test was over $5700. I was appalled!
But, what brings me to the heart of my communication to you is this: Before, blindly scheduling the stress test, I felt it wise to do my due diligence about the cost of the procedure AND to know what my financial responsibility would be. But, I found it impossible to get any conclusive information from the cardiologist’s staff. They could only validate the amount of my co-pay. But, just like when requesting any service, I inquired as to the total cost of the procedure, but they were unable to tell me. And the cardiologist’s staff also did not know how much the insurance company would pay the cardiologist. When I called the insurance company myself to ask for the specific cost, I was told they are not allowed to tell me because that information could only be discussed with the doctor with which they have a contract. But even when I requested that my doctor call my insurance company to obtain the cost, the insurance company still would not confirm an exact price. Thus, the cost of medical services are withheld until AFTER the services are complete. That is not right!
I have come to realize that in this “health insurance controlled system,” the total cost is withheld from the consumer. So, with that understanding, I shifted my focus to zero in on MY financial responsibility. I re-asked repeatedly if my co-pay would be my ONLY financial obligation, AND that I would NOT receive a bill for services after the fact. And I was assured that was the case.
So, not only was I shocked at the total cost of $5700 for services rendered, but the EOB stated that I owed an additional $130. I couldn’t believe it was possible that I owed ANYTHING in light of asking every conceivable question I could think of, to as many different persons I knew to ask. And the reason I asked so many questions upfront was because I suspected that without knowing the cost upfront, there was nothing to stop the doctors or health insurance company from billing an unexpected amount, because we didn't have an agreed upon price, to which I could hold them accountable, and thus I could easily fall prey to being billed for something after the fact, which I tried so hard to avoid, but what happened anyway. I was so frustrated and felt overwhelmed by how my sense of control was taken from me, from this ALL POWERFUL entity. I felt lied to by a system that I had little experience with, and felt I was entering a new arena where the rules are stacked against me! And since knowledge is power, I realized I had none, and the health insurance company had it all. This was my first experience of this kind since it was new for me – having never had health insurance before. And I felt certain that I was not alone in this, and that millions of other Americans were experiencing the same thing.
Yesterday, I received an EOB showing $13,000 was charged for a procedure I had expected to be less than $1000 – and my financial obligation is $9000! AND, this is just the first in a series of 4 procedures that are necessary for my husband to continue to have the freedom of walking. So to date, this is the third time where I was told one thing, and then experienced something else when the EOB arrived.
My biggest outrage is that I cannot get anyone to tell me the cost of a procedure before committing to it!!!
We live in a consumer nation where Americans make purchases every day; that’s what we do! We are a cost conscious people. We would NEVER ask a salesman to load a new big screen TV into our car without knowing what to expect at the cash register. Nor would we test drive a car without looking at the sticker price and tell the salesman “I’ll take it” without first negotiating a price. Again, this would NEVER happen.
My experiences with the health care system have clarified these thoughts: How is it, that as the consumer of a medical service, we’re not ALLOWED to know the price BEFORE making the commitment to have the service? That is how it works in EVERY other service business in America. We always know the cost before committing to the purchase. But, somehow, in this country, health care doesn’t follow the same rules. The price of medical procedures is a tightly held secret from the very consumer that is committing to the service. This is WRONG on so many levels. This robs the consumer of the right to know what he/she is committing to. This robs the consumer of the right/responsibility to BE an accountable steward of their financial commitments.
If I had known in advance that having a stress test would have cost over $5000, I WOULDN’T have done it. Had I known, that would have prompted me to ask many more questions before committing to it - to ensure it was necessary. Also, I believe if my doctor was aware of the costs, she too would have considered alternative options that were less expensive before referring me for a stress test. But, when the doctors AND consumers are in the dark about total cost, our ability to make responsible choices are limited or removed completely. I believe in my case, having a stress test was a waste of money. And even though, my co-pay was small compared to the entire bill, I am aware that the health care premiums that I pay each year are determined in part by the total dollars of claims filed by the associates at my company for the previous year. Therefore, I do my best to be responsibly mindful of the claims I file.
I am calling for another kind of health insurance REFORM. Consumers of medical services have the right to know the cost of medical procedures upfront – FULL DISCLOSURE. I am calling for REFORM from the secrecy that is held so tightly by health insurance companies. Consumers have the right to know how much they are being charged for services, in order for them to make informed and responsible decisions. I trust in the integrity of Americans, and believe if we were fully aware of the costs, unnecessary procedures would be greatly reduced. We would ask more questions, and demand more answers. And doctors & insurance companies would be accommodating in providing those answers because whether we do business with them of not would be determined by the quality of their answers.
I believe my call for FULL DISCLOSURE OF THE COST OF MEDICAL PROCEDURES IN ADVANCE has significant ramifications for the American people’s wallet and to the overall economy.
The only reason I can see that this practice of cost secrecy has gone on for so long is because the American people have been conditioned to accept it because “it’s how it’s always been done.” But, I am calling a HALT to the practice of simply accepting what’s always been.
Americans want to be responsible and want to do their part for bringing down the cost of health care, but cannot when they are kept from knowing the costs. Instead, Americans are held prisoner by the health care system when they find their health is in jeopardy. Few people have the influence or power to bring about this kind of change, but I believe YOU do.
Please, Mr. President, I beseech you to respond to this call for FULL COST DISCLOSURE reform to require insurance companies to make all Americans fully aware of the cost of medical services prior to making the commitment to have the medical procedures, thus giving us back our control of what services we choose, and what procedures we are willing to undergo. I also, believe if we know the costs upfront, this will stimulate healthy competition because as Americans we will compare doctors & procedures based on the quality of possible effectiveness AND cost.
I for one, feel robbed of my right to know, thus my right to feel empowered because of the way the health care system is at present. What does it say about a system whereby we are asked to blindly commit to something without full disclosure of the cost associated with the service? This is irresponsible spending. It would be no better than shopping for new clothes without looking at the price tags and paying for it with a credit card. Then, when the statement arrives, being shocked at the cost. It’s the very act of looking at the price tags that we are empowered to make a responsible decision to determine whether or not this item is affordable, whether we will look for some other option, etc. Price tags arm the consumer with full disclosure for the purpose of making wise & responsible decisions. The health care system is flawed when they can do business without disclosing cost information upfront, and as Americans, we deserve better.
A responsible American,
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