Tuesday, November 18, 2014

Hidden costs: A personal postscript

I recently made my first venture into the world of consumer cost control in health care.

As a baby boomer,  I grew up trusting my doctors to tell me what was needed,  with insurance picking up the tab.  In recent years I've joined many of you in seeing my premiums and out-of-pocket costs rise;  my family is now on a very high-deductible plan.

When my husband got a screening colonoscopy early this year,  we grumbled about being stuck with a $708 bill for anesthesia and pathology ($1,370 before the insurance discount),  but we weren't shocked.  We were mostly grateful to get more than $2,200 covered for the rest of the procedure.

It wasn't until I did an article on hidden costs for procedures that are supposed to be fully covered that I realized we should have asked more questions.  Dr. Rig Patel,  president of the N.C. Society of Gastroenterologists,  offered details on how and why patients can end up with big bills for a cancer screening that's supposed to be covered by all policies.

So when I got my reminder email,  I was ready.  First I followed Patel's suggestion to ask the questions in advance,  rather than making an appointment and quizzing the doctor as the procedure is about to begin.

When I got a scheduling staffer,  I asked about sedation/anesthesia.  She said the gastroenterology practice had changed its approach since the last time my husband and I did this.  Then patients were given Demerol/Versed,  known as conscious sedation.  Now they're put under with propofol,  which our policy doesn't cover,  unless they specifically ask for the old form of sedation.

I also asked about timing.  I'd been told to expect a follow-up in five years.  She said the recommendation was  "four to five years,"  and the practice was giving me the opportunity to do it at four.

Yeah  ...  no thanks.  When I make an appointment next year I'll ask for Demerol/Versed,  which worked fine the first time.  My father,  a surgeon,  always emphasized the slim but serious risks of anesthesia.  Never be put under unless it's a medical necessity,  he told me.  So skipping the propofol seems like a wise medical approach,  as well as a money-saver.

Some would cite this as an illustration of the value of shifting costs to patients:  With more skin in the game,  we stop being  "passive consumers."  I was pleased that the staffer got back to me quickly and had good answers.  But I can't help wondering why it falls to those of us with no medical training to figure out what to ask.  Wouldn't it make sense for the gastronterologist's office to lay out the medical and financial implications of a new approach and give all patients an informed choice,  rather than waiting to see who speaks up?