Posted at: 02/05/2013 7:29 AM
Updated at: 02/06/2013 11:24 AM
By: Berkeley Brean
It's becoming one of the most frustrating things to deal with when you go to the doctor -- trying to figure out how much it's going to cost. More and more people are on high-deductible health care plans where they're on the hook for the first five to 10 thousand dollars every year. And they're told by their employers and insurance companies to be smart, educated health care consumers.
But how can you be a consumer when you have no idea what anything costs and no one will tell you?
The I-Team is finding out why it is so hard.
Dianne Kober flipped through her bills like baseball cards.
"Here's a bill for lab charges from Rochester General."
"Here's the University of Rochester bill."
"Here's the Highland Hospital bill for actually being at Highland Hospital."
"This is one of the doctors and one of the bills he charged me."
Kober can't make sense of it. "This was one visit. This was one visit to the emergency room. I feel badly for people who have to do this over and over again," she said.
Kober is on a high deductible health care plan, what insurance companies like to call consumer driven plans. So she was being a consumer when she called her doctor's office after she was charged extra for what she thought was a routine physical.
"So when I called to inquire about it I said when I come in next time and I ask you I'm here for a routine physical but my ear is ringing how much is that going to cost me? Can you tell me? They said no we really can't do that but we can certainly let you know afterwards and I said that doesn't really help me because maybe I can't afford it," Kober said.
"This isn't like going to the grocery store and deciding whether you want milk or juice," practice administrator Jane Dobbs said.
Dobbs is the administrator at an OB-GYN practice in Brighton. Her office charges based on what her doctors do at an appointment. If you come in for a routine visit -- that's marked as one code. If you tell your doctor your ears rings -- that changes what the doctor does, therefore changes the code and the price. "And those things can't be decided ahead of time," she said.
And ultimately, Dobbs says she doesn't know what the final cost on a patient's bill is until an insurance company processes the paperwork.
"I mean we have a fee schedule. We can charge our fee schedule, but we can only collect from the patient what their insurance company allows," Dobbs said.
They call that the insurance company fee schedule.
"We were at a doctor's office and they asked us to ask you why won't you or why can't you publish your fee schedule for an individual's insurance plan. Is there a reason why you can't do that?" I asked Jim Reed, Senior Vice President of Sales and Marketing for Excellus Blue Cross Blue Shield.
"Well it's not as easy. Our contracts with the providers are typically a contract and they're a two way agreement that generally the terms of the contract, the financial terms of the contract are considered proprietary," Reed said.
That means -- secret.
"(But) those would be the prices the consumer would pay," I said.
"Sometimes," Reed said.
Reed says it depends on a patient's plan and what's left on a patient's deductible.
This is why it's so hard to figure out a price -- there are so many variables.
But there is a change.
Just days before we spoke to Excellus, the company posted a new treatment cost estimator on-line. It's a list of estimates for particular procedures that include everything from the cost of the room to the anesthesiologist. RGH does the same thing on it's website.
"It shouldn't just be about price right? It shouldn't just be about 'can I get the cheapest knee surgery?'" Reed said.
"Well when you're on the hook for $5,000 price has a lot to do with it," I said.
"It certainly will. It certainly does have a lot to do with it but you also want to look at the quality associated with the physician, the hospital, the procedure."
Dianne Kober understands that: you get what you pay for. But she feels like -- as a healthcare consumer -- her hands are tied and the market is against her.
"I think it's okay to be told to be a healthcare consumer, I would love to be a healthcare consumer because when I grocery shop I like to think I'm a grocery shop consumer but there isn't enough information out there to be a healthcare consumer," Kober said.
That part will change starting next year.
"Figuring out how to get individual people better cost information is certainly a key principle that the industry in general is trying to get closer toward so that true informed consumers are what we have out in the market," Reed said.
"But it's lagging behind what consumers are forced to do now," I said.
"It is lagging behind," Reed agreed.
The industry hopes it picks up next year when those health care exchanges kick in. They're part of the affordable health care act, otherwise known as Obamacare. People will shop for insurance just like they do for a TV.
"It's sort of like shopping on line," Nancy Adams, director of the Monroe County Medical Society said. "People are going to be able to compare apples to apples, which insurance policy they want to pick."
Press play on the video player to see our extended interview with Jim Reed