Humana Says the Price is a Secret
Note: This is the fourth entry in my price transparency experiment. See the first entry here, the second entry here, the third entry here, and the fifth entry here.
Jay has written several times over the last month about his lipoma surgery and the billing headache that it has become. When we got the bill for 5x the ballpark estimate he had been given, he called the claims department at Humana, our health insurance carrier. We knew that the lipoma was excluded on the policy, since it was pre-existing when we got our coverage with Humana. But we wanted to get an idea of what Humana would consider “reasonable and customary” for this procedure. We had all the billing codes from the invoice the doctor’s office had sent, and wanted Humana’s claims department to look up the codes and tell us what their payment would be if the condition were not excluded. Turns out they can’t tell us. They said that we’d have to call the doctor’s office, since that information is private and can’t be released by the insurance company. So much for transparency.
Health care is not a free market system, no matter how much people want to believe it is. Just because it’s mostly run by private companies does not mean that it operates on the same systems as other free market commodities. If I want to buy a car, the choices are dizzying, but in every case (usually with a bit of probing), I can know for sure what the bottom line price is before I sign the check to pay for the car. I can eventually get to a clear price, which allows me to determine if this particular deal is the best I’ve found.
Advocates of consumer directed health care plans (like the HSA-qualified plan that Jay and I have) are pushing for transparency in health care. The idea is that if the deductible is high and the patients are using their own money to pay for procedures that fall below the deductible, they will become more savvy at negotiating prices and shopping around to find the best deals. We are big fans of the high deductible health plans, and are still quite happy with our HSA qualified plan. But this experience has shown us that it is virtually impossible to “shop around” when it comes to health care if the procedure in question is more complex than a basic office visit. Why would the negotiated price for a procedure be top-secret? When we call with a specific billing code, why can our our own insurance company not give us the price that they allow for that procedure? Transparancy is a bit of a buzz-word right now in the health care industry, but we’ve got a long way to go. Jay and I are agents, and have been working closely with Colorado health insurance companies for over six years. If we are not able to get a straight answer, how is the average consumer supposed to be able to shop around for health care?
How frustrating would buying a car be if you had to struggle just to get a “ballpark estimate” out of them – then after you bought the car and had driven it for a few weeks, you get a bill for 5x their “ballpark estimate”?
I absolutely do not undersand why Humana will not tell you what the “usual and customary” payment is for the procedure??? What is their stated policy against telling you? You are a policy holder and agents too boot !!!! I thought one’s own insurance carrier would “help” their own policy holder. I, too, am an agent trying to help people find affordable coverage, independent, not captive, I have multiple carriers and plans available and I show my clients each and every plan, price included, then they can see the carrier that is competitive and the one that is not. Back to your issue, this is just another reason why the health care industry is such a polictical hot bed right now. Best of luck with your current issue.
Human is playing dirty hard ball with approving Rx. An Rx that I had okayed all of last year, right up to the Dec renweal period, was OK with Human. As soon as i renewed, Human denied the Rx. My doctor has written and faxed trying to overturn Human’s denial, but after three months, Human still denies the appeal. Please be careful of this company–the appeals process is designed to wear people down until they just give up. My wife has AARP and so far no problems.
@ A. DiBiasio
– Are you talking about medicare supplements? If so, the whole medicare part D was setup that way.
AARP doesn’t offer individual/family health insurance to people under 65, only medicare supplements.
Jul 24th, 2007 at 5:51 pm
[...] in the US health care system. See the first entry here, the second entry here, the fourth entry here, and the fifth entry [...]