When you go to the auto mechanic there’s a sign that clearly tells you how much the hourly rate is. You go into McDonald’s and order food and you know what it’s going to cost before you order. Have you ever thought that before you went to the doctor or dentist you had a rough idea of what the fee was going to be? Why is it that you end up never knowing what somethings going to cost until you get the bill in the mail? The common term is “medical cost transparency”. It’s all by design and there’s some interesting facts around why you’re not supposed to know.

You would have thought that with the passing of the Affordable Care Act (ACA) would include some element of consumer protection for medical services. For those who’ve been shopping for healthcare on the state run exchanges are finding that the exact opposite is occurring and costs are actually going up? Why? Simple – it’s insurance, not medical services. So while it was an attempt to bring down costs, it’s actually bringing them up since there’s now so many more participants in the network, hence overburdening it and raising the average cost for medical services.

Consumer advocates as well as some employers and health plans are pushing for greater price transparency. They argue that if consumers realized that they could receive high-quality services from lower-cost providers, they would seek them out. This, in turn, could encourage competition among providers based on the value of care—not just on reputation and market share.

medical costs

Image: Article on Michigan’s Ratings

Read this story and see if it brings back any memories:

Throughout the exam, the doctor peppered me with the usual questions: how have you been feeling? How have you been sleeping? Have you had any problems with this-or-that? As she wrapped up the exam, she asked if there was anything else I wanted to talk about. After thinking for a second, I mentioned a lump I’d been feeling in my throat with the onset of fall allergies. She took a quick look in my throat, dismissed the problem, said nothing could be done and concluded the exam.

A week and a half later, I got the doctor’s bill. It listed a charge of $180 for the physical, but it also had another charge I didn’t recognize: “EP Visit Low Additional — $100.” Puzzled, and pinching pennies due to my economic situation, I called the doctor’s office to ask what the extra $100 charge was for. Her assistant told me it was for that moment in the exam when the doctor asked, “Is there was anything else you want to talk about?” and I had brought up the lump in my throat. The extra minute the doctor took to dismiss the problem resulted in an extra $100 charge, the same amount she charges for a completely separate, one-issue visit.

I was floored. “One-hundred dollars? For that?” I said. “I thought that question was part of the physical exam! It took the doctor less than 60 seconds to tell me she couldn’t see anything and couldn’t do anything about it,” I said. The assistant told me the $100 charge wasn’t just to look in my throat — that it paid for the cost of the doctor’s attending medical school, which enabled her to look in my throat and tell me she didn’t see anything. I told her that the way this charge was leveled felt like a trick, since the question — “Is there was anything else you want to talk about?” — was asked as though it was a regular part of the physical exam. No one warned me that if I answered this question with anything other than a “No,” it would lead to such a hefty extra charge. How was I to differentiate this question from all the others the doctor asked during the exam?

The assistant declined to offer any further explanation. She didn’t propose discussing it with the doctor, asking the doctor for an adjustment, or any other potentially mitigating measures. The call ended in a stalemate.

Two days later I received a certified letter from my doctor, dumping me as her patient.
See more at: PR Watch

So it’s very clear that Doctors understand what questions will generate particular billing codes that then apply to a visit. So it’s pretty obvious, much like a car check up – that the annual visit should be pretty routine and the fees should be fairly straight forward to determine.

Modern Healthcare posted this comment in an article last year from the Healthcare Financial Management Association:

“I have not drunk the Kool-Aid on price transparency,” said David Newman, executive director of the Health Care Cost Institute, which compiles data on cost and utilization trends and is supported by major payers including Humana, Aetna, Kaiser Permanente and UnitedHealthcare. “There can be adverse effects of price transparency.” In markets where pricing is very transparent, pricing tends to narrow and the average cost rises, he said.  In healthcare specifically, hospitals may become price-competitive only on selective services or those they are required to publicize, he noted.”

Basically, they feel that medical transparency leads to what’s happened with airline prices where one hospital can run another hospital out of business by offering discount services. That sounds like a rash of horse crap!

Who’s looking at Costs?

Take a look at guroo – www.guroo.com.

The Health Care Cost Institute launched a website called Guroo, which enables consumers to search for average prices for 70 services in more than 300 cities. Prices are drawn from medical claims for 40 million Americans covered by Aetna, Assurant Health, Humana and UnitedHealthcare. Consumers can identify the low, average and high prices within each market, including all services to treat certain conditions.


What’s neat about Guroo is you can actually search costs by looking at the clickable body map. But it doesn’t come without controversy. For example, a particular hospital may provide a price on a procedure, but it doesn’t indicate that they may order more procedures than a comparative hospital. This is the age old question on “how much is enough”…….but browse the tool and judge for yourself.


Mobile Doctor is Driving Change

In Dubai, there’s a new program called Mobile Doctor – a concierge service that allows you to connect with a doctor by a set of criteria and you can get a determination at least of quality, cost, and availability. This is an example of where technology is driving change.

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In New Jersey, Raritan Bay Medical Center started posting flat fees for what they refer to as standard procedures.  “While there are only five weight-loss procedures listed so far, the hospital is planning on listing more and more surgeries in the near future, said Lynette King-Davis, the vice president of marketing and business development for the  hospital.” @NJ.com – Raritan Bay Medical Center also lists some of its surgery prices on a website called Pricecare.com, which is a start-up that debuted this year – and is no longer online.

Problem: Who’s saying how much something costs?

Use your smartphone and go download two apps. The first app is ZocDoc. The second one is United Healthcare Company’s app – Health4me.


Image: UHC’s Health 4 Me has a “Estimate Costs” Section on it’s app.

These two apps start to break down typical office visit costs as well as estimated procedure costs. It may not be totally specific, but it certainly educates you on what you can, and should be asking BEFORE you agree to move forward with any doctor.

UnitedHealthcare is among the first national health care companies to enable all consumers to comparison shop for medical services using a “guest” version of myHealthcare Cost Estimator™, a mobile medical price transparency service available through Health4Me. Consumers can download for free the Health4Me app through the iPhone and Android apps stores.

The fact is simple. Until people start asking these questions, the doctors are going to avoid answering. And until we get Legislators that have some balls, it has to be up to the consumer to change the game!

Problem: A key concern  with financial disclosure from doctor to patient is Doctors rarely know how much their patients actually pay.

UK Fees

I’m not sure that really matters, because Patients are covered by a variety of insurers, all of whom offer several plans, for which any individual patient has a different co-payment and deductible, which he may or may not have met. So they really don’t know. To me, that argument doesn’t hold up. Just because I have insurance shouldn’t change the discussion on the charge. JUST START SOMEWHERE. Legislate that there needs to be some general services listed and priced.

Problem: Do Quality Doctor’s charge higher fees? Sure they do.

But you’ll never know because you’ll never determine a fee until you get charged.

Problem: Insurance companies vary, locations vary, where you go in the hospital varies, if you go to the Emergency Room it varies.

Plain and simple, they ALL vary but still each situation could be solved if the doctor was forced to list their core fees. DEMAND that someone states costs in writing in advance.

Problem: Prescriptions

Remember when you never knew what medication prescriptions cost? Well there is now a solution to this.

Medication is now shoppable. Check out apps like Blink Health and Good Rx and see how the prescription industry is changing. Finally representing consumers using technology. Both apps are free.

blink health logo
good Rx_logo

Additional Suggestions

There are many things that you should do as a patient.

First, start asking your Doctor what things cost in advance.
It’d be important for you to just learn what your Doctor says to you.

Secondly, here’s what needs to happen:

  • Congress needs to get involved.
  • Insurance Companies need to get involved.
  • The public needs to start demanding consumer protections.
  • Millennials need to get into this – Disrupt, use technology, and come up with new ways to reinvent how medical services are delivered.

If I were in grad school, this would be my thesis.

What do you think?

Originally posted: March 2016