Read This Before You Overpay That Claim

Like Shopping blindfolded at the FLEA market

Tales from the Alternate Universe is a blog by Health Cost Matters.  Using allegories we explore the irrational, opaque and zany world of comparing, selecting and purchasing health costs through storytelling.  We discuss how healthcare differs from all other industries, and also provide tips to help you navigate the world and costs of healthcare.

In today’s tale, we’re going to compare purchasing health care to shopping while blindfolded at the flea market.

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Purchasing healthcare can be daunting. Often we don’t know what services we really need or what to do with the information we receive.  We usually don’t know ahead of time what providers charge, what our insurance will pay or what our out-of-pocket costs will be.  What if other industries operated like this?  Imagine…

Rule #1 for Shopping at the Flea Market:

You can find anything you need at the Suburban Flea Market.  Anything from airplanes to zucchinis and everything in between.  The place is huge, it seems to go on forever and there is no map.  Rule #1: You must enter blindfolded. 

Today you’re here because you need a hammer and a new dress.  You don your blindfold.

Turns Out, You Don’t Need a Hammer

A friend told you about a great hammer vendor and gave you directions.  You find the place, describe your need to the merchant, and he determines you don't need a hammer, you really need a drill.  You know nothing about drills, you don’t even know what questions to ask, so you accept the drill he hands you.  He sends you to the main building for drill bits.  Once there, they hand you a box of bits, band aids, an ice pack, step stool, safety glasses and they examine your hands.  You didn’t request these items; it hadn’t occurred to you that you needed them.  Cost never comes up. 

The Perfect Dress for You

On to dresses.  You know two dress shops that have great reputations.  You find the first, explain what you’re looking for and the occasion.  The owner listens, asks questions and then pulls out the perfect blue cotton dress for you.  You step into it and she zippers up the back.  She says the blue is perfect for your complexion and the waistline accentuates your figure.  You want a second opinion so you locate the second shop.  The owner there selects the perfect red silk dress.  She pulls it on over your head, and says the color is perfect for your red hair and the neckline accentuates your figure. 

You’re blindfolded so you can’t see either, you have no idea which one looks better, nor can you determine the quality of the dresses and (of course) cost is not discussed.  You’re flummoxed, such different opinions!  After pondering, you decide that you like the second vendor better and select the red dress.  You return there, try the dress on again, and the vendor says you’ll need an alteration-ologist because it’s too long.  The alteration-ologist pins the hem and then sends it to the back of the shop to the seamstress-ologist for sewing. 

As you exit the Suburban Flea Market, you pay $50 for the drill, and $50 for the dress.  The vendors will submit their bills directly to your insurance company. 

Then the Balance Bills Arrive:  Surprise!

You receive a payment explanation from your insurance company, and you study it. It’s oddly complicated and lacking information all at the same time.  Three hours later you’re finally able to figure out that the vendors billed $7,220 for all goods and services and insurance paid $540.73. 

A month later, you’re alarmed and dismayed to receive three surprise balance bills totaling $1,145.00:  The main building billed you $350 for the hand exam; your insurance denied this as included in the cost of the drill.  The dress shop’s alteration-ologist billed you $323.58, and the seamstress-ologist (who you’ve never even met) billed you $471.42.  You didn’t realize, but the ‘ologists’ don’t participate with your insurance, and they are billing you the balance of their bills that insurance didn’t pay.

Get Real!  Not How Commerce Works.

When you purchase most goods and services, you make informed choices.  You compare options, research cost, quality and service.  If a vendor suggests accessories for your purchase that you don’t need or a waiter offers dessert that you don’t want, you politely decline.  You control your wallet.

What Makes Healthcare Different From Other Industries?

  • We rarely shop for (or even consider) price when we're purchasing healthcare because we don’t need to.  Even if we asked, a hospital may not be able to tell us the charge because they may not know until after discharge.
  • As ordinary consumers we are often unable to judge or compare quality.   
  • When we get a second opinion that’s different from the first, what do we do with that information?  How do we decide?
  • The more services a provider bills, generally, the more they are paid.  As consumers, we may not be aware of what services are billed or are even necessary.
  • Sometimes we receive surprise bills from ancillary providers (anesthesiologists, radiologists, etc.) who we didn’t select and couldn’t know were non-participating.

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

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 are actions you can take:

  • Before you schedule an elective service, inquire about charges and your out of pocket responsibility.  Shop around, compare cost.  Provider charges can vary widely in one region.
  • Before you pay a claim know what you’re paying for.  Ask for itemized bills, and scrutinize.  Ask questions, know your policy, verify the charges.  Billing mistakes are common.
  • Contact your congressional representatives and tell them you want them to focus on healthcare charges, and not just the cost of insurance.  To find your representative, go to www.whoismyrepresentative.com. 
  • While you're at it, ask how much money your representatives receive from health insurance, hospital and pharmaceutical lobbyists. 
  • Read and listen critically to the media on this subject. Ask yourself who is leading the conversation and do they have vested interest in maintaining the status quo? 
  • 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.

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