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?