Have You Ever been Billed $1,200 For Dessert?

And other ways restaurants differ from hospitals.

Tales from the Alternate Universe is a blog by Health Cost Matters.  Using allegories we explore health costs by superimposing the way we select, compare and pay for health services onto everyday activities.

In today’s tale, we’re going to imagine life if restaurants acted like hospitals. 

Diagnosis:  You’re Hungry!!

You wake up one morning feeling awful.  You go to Bob’s house who you’ve known for years.  Bob is your PCP (Primary Care Phriend), a great neighbor and trusted advisor.  He takes one look at you and he says you need to eat some food! 

Bob takes out his prescription pad and scribbles down the name Suburban Restaurant and some other scrawls that you can’t read.  He calls ahead and makes a reservation for you.  You’re familiar with Suburban Restaurant, you’ve never been inside, but Bob recommends it and tells you they’ll cure your hunger.

To the E.R.! (Emergency Restaurant)

You rush to Suburban Restaurant, hand over the note from Bob.  You’re seated in a booth immediately.  It’s very busy and as Fred, your waiter, passes he says to make yourself comfortable, he’ll be right back.  But you say you’re really hungry, so he brings you a basket of rolls.

A half hour later, Fred returns and asks if you have any food allergies or dietary restrictions.  He doesn’t give you a menu, there is no menu, and you don’t know how much any of the food costs, either does he.  That doesn’t alarm, or even interest you.

You know the rules … you pay a flat $30 tip (called a copay), and your insurance will pay the rest.

Fred brings you a meal that totally satisfies your hunger.  Fred had asked the maître d (called an MD) about your case, and in his opinion you also needed a drink and dessert.  So Fred brings you a pink drink with an umbrella in it, and this helps you relax.  Finally Fred brings you a warm brownie with a scoop of ice cream.  You feel all better, the food was good and you had a great experience. 

Then the Bill Comes Due:  Surprise!

Soon after, your insurance informs you that they won’t pay for the rolls, that drink or dessert.  You hadn’t asked ahead of time if you could have those, and they didn’t think they were necessary.  Suburban Restaurant billed your insurance $11,890.26 for your meal, but insurance paid the restaurant only $235.00.  While you were shocked at the restaurant’s huge charges and the insurance company’s comparatively small payment, you also thought that $235 was a lot to pay for this meal.

Later you’re alarmed and dismayed when Suburban Restaurant bills you $1,500 for what insurance wouldn’t pay: $100 for the rolls, $200 for the drink and $1,200 for that dessert.

Now, Bob, your neighbor, had no idea about the restaurant’s prices.  He correctly diagnosed that you needed food.  Might your hunger have been cured had he sent you, instead, to McDonald’s or to the supermarket where you could buy and prepare your own food?  Sure!  But price wasn’t considered because price wasn’t relevant.  You needed food and you have insurance.

Restaurants Don’t Work that Way

This scenario is absurd, right?  You select a restaurant based on your experience and budget.  Restaurants give you menus with prices.  You choose your meal, you know how much you’ll be responsible for as you order, and you can judge the value and quality of your service.  Most importantly, if your budget hadn’t allowed it, you would have stayed home.

What makes healthcare different from other industries?

  • Neither we nor our physicians know how much our hospitals charge.  We typically don’t need to know because we expect insurance to pay.
  • Provider charges are often irrational and have no relationship to provider cost. 
  • Consumers can easily be blindsided by non-covered services and charges that are not remotely in the ballpark of what one would expect to pay.
  • Even if we could sometimes compare cost or value, would we comparison shop in an emergency? 
  • Unlike many personal expenditures (like eating out), healthcare is often not optional.  If you have a sudden or chronic illness, cancer or an accident, medical care may be a matter of life and death.

All of this results in unnecessary services, higher insurance costs, less coverage and lower quality care.

What can you do?

At Health Cost Matters our motto is:  Informed consumers drive change.  Understanding the problem is the first step, and from that understanding, action happens.  Here's what actions you can take:

  • Help inform others.  If you've read this far you probably have learned something from this article.  Share this article on Facebook, LinkedIn, and any other social media platform.
  • Contact your congressional representatives to tell them you want them to focus on healthcare charges, and not just the cost of insurance.  Ask your representatives how much money they receive from health insurance, hospital and pharmaceutical lobbyists.  To find your representative, go to www.whoismyrepresentative.com and enter your zip code.
  • Read and listen critically to media on this subject. Ask yourself who is leading the conversation and do they have vested interest in the status quo?

How can we begin to cure exorbitant health costs?  There is no one solution, it's a journey … The first step is understanding what it is we’re trying to fix. 

We welcome feedback and ideas from readers and thought leaders from all sides that is reasoned and not politically dogmatic. 

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