The Health Care Transaction (and the need for price transparency)

price transparency

As a third party administrator, we are in tune with the “transactions” that occur in the health care system. The basic concept in which (1) a service is provided, (2) the service is run through insurance, and (3) the insurance company responds with what will be paid by insurance vs. the consumer. Our goal as a pre-tax account administrator is then to ensure the consumer has convenient access to the funds that have been set aside for their portion of expenses. But, many times there is a missing link…price transparency.

Like many consumers of health care, I was recently overwhelmed by the “transaction” of it all. It starts the moment you enter your provider’s facility for the “service” or “procedure”. The patient receives a barcode (also referred to as an identity bracelet). Then each time an item is used with the patient, the patient is scanned and the item is scanned. In my head, I inevitably was adding up the dollar signs with each “transaction”. With a $4,000 deductible and a $6,000 maximum out-of-pocket, my only comfort was knowing I will not spend more than $6,000.

I begin to imagine a bill something like…

  • One permanent marker (used to mark the incision site and thrown out). Retail: $2.50, Billed: $20.95
  • Three popsicles. Retail $0.50 each, Billed $29.95
  • One giant tube of ointment (of which a pea-sized amount was used and remainder thrown out). Retail: $6.95, Billed: $29.95
  • Bed parked in pre-op room for 20 minutes. Billed at $550.
  • Bed parked in post-op room for 40 minutes. Billed at $1,100.
  • Bed parked in recovery room for 1 hr. Billed at $1,500.
  • Surgery room cost. Billed at $2,250. 
  • Primary physician, primary physician’s resident, anesthesiologist, anesthesiologist’s resident, pre-op nurse, surgical nurse, post-op nurse, post-op recovery nurse, ….Your guess is as good as mine.
    Total cost = $8,000…$12,000…$50,000 ???

I then take a more practical approach. Sites like Healthcare Bluebook (and many others offered through your insurance carrier) are trying to provide better visibility into the cost of care. A quick search on the procedure and zip code reveals an estimated cost of  $7,800. The charges are broken out into facility charges, physician charges and anesthesiologist charges. It indicates the estimated length of procedure so you can make adjustments up or down based on your actual experience. While the specific charges will likely vary, I now have a better understanding of what to expect and what I need to be prepared for when the bill does arrive. To provide added comfort, I know I have been funding my Health Savings Account (HSA) and I can access those funds when it comes time to pay the medical bills. The Health Care Transaction just got a little less stressful!

By Becky Seefeldt