There are very few actions or aims of the current administration of the United States Executive Branch with which I agree, but one such rare alignment won a legal victory this week when Judge Carl J. Nichols ruled against the insurance-dominated medical establishment in favor of American patients.
The U.S. District Court ruling† agrees with the White House that it is reasonable to force medical service providers to publish a full accounting of negotiated prices for their services. Disclosing the price a patient would pay if s/he elects to pay cash will also be required.
Insurers say their negotiated prices are their own secret treasures to share with providers, and that we—the consumers, the patients, the worried loved ones—don’t deserve to know what they are. I say that insurers offer so little value relative to the enormous fees paid to them that their wishes are irrelevant and a distraction from the goal of almost all Americans to have better health care with fewer going bankrupt to pay for it.
I believe that the administration of the U.S. medical care system could be improved in almost every way. That said, cost transparency requires no bipartisan agreements on contentious issues such as rationing of care or how much in dollars a government owes each citizen in the provision of health care.
Price transparency will cost almost nothing save a few hours of administrative work by hospital staff. Typing up and publishing these lists will take a minuscule fraction of the labor hours currently spent on insurance billing. In exchange, and, for the first time in decades, cost-conscious consumers of health care—the ill, the injured, the infirm—will have at least a passing chance to vote with the pocketbook by taking business to more efficient providers.
Obviously, publishing a price list will do nothing for those arriving at their nearest provider by ambulance in a true emergency. It is, however, a first step toward an actual free market health care system, which I believe is the stated goal of at least some notable fraction of Americans.
Note that I’m not advocating for a purely free market health care system, but I do support measures that immediately force the existing system to become more functional for those who actually matter: care providers and their patients.
It strikes me as fairly obvious that Americans now suffer under the worst of all worlds: profit-oriented insurance companies making decisions about how care is rationed with almost zero possibility for predetermining potential costs by someone who wishes to pursue care outside of a mostly closed system.
My own best example of this lack of transparency came a couple of years ago when my doctor prescribed me a CPAP* machine. This is deemed “Durable Medical Equipment” (aka, D.M.E.) in insurance-speak. That meant my insurance company would pay some portion of its cost for me, but I had to go through an approved sub-contractor in order to access my medically necessary device. I asked my insurance company how much I would have to pay for a CPAP machine. I was told that depending upon which DME provider I “chose.”
In common parlance, a DME provider is simply a DME, at least on the internet, so I’ll follow suit in the following paragraphs.
I called both of my DME options. I asked for price lists. While still on the phone with the second provider having hung up after quickly striking out with the first, I was told that no such price list was available. Why? Because rates were determined via negotiation with each individual insurance plan.
“I[t’s] like…buying a car and being told I won’t know how much I owe until I’ve driven it off the lot, gone home, and waited a month for the first bill to arrive”
Having provided my specific insurance information, I thought I could then access a list of prices for my given CPAP. I was told that, still, no such listing existed or could even be generated for my specific account. Shocked, I told the customer service agent at the DME that was insane; “Isn’t that like my buying a car and being told I won’t know how much I owe until I’ve driven it off the lot, gone home, and waited a month for the first bill to arrive?”
She couldn’t see how the car metaphor applied at all.
So I read through the list of consumable parts from my doctor’s CPAP prescription and asked her to quote me the negotiated price I would pay for each one—a filter, a pre-filter, a tube, a silicone mask… I scrawled the amounts she gave me into my CPAP reference guide next to the suggested replacement schedule which varies for different parts. I spent about 45 minutes of phone call hell with this woman and her peers‡.
As it happens, every single price the DME employee gave me over the phone was wrong. Not a single number aligned with the mysterious dollar amounts printed on my monthly bills over the next ten months as I chipped away at my required co-pay for the insurance provided CPAP device.
Remember: I’m one of the lucky ones. I have “excellent” health insurance. I’m a college graduate who reads and speaks English well. I don’t have to worry about a variation of $20 or more per month on a bill to remain sure of my financial footing.
I am one of those most able to afford to play the Insurance/DME game, but it infuriates me… and I lost the round! I did every bit of homework I could possibly do to understand my costs, and I failed absolutely in gaining a clear picture of what I would actually pay under the current system.
Health insurance in America is a pathetic joke masquerading as medical care, and the rest of the world is laughing at our expensive expense. Hospital price transparency won’t make America “great” again, but at least it takes a little bit of the ass out of asinine.
The American Hospital Association says it will appeal Judge Nichols‘ decision. I’m sure the lawyers’ fees they’re paying for this nonsense represent a wonderful investment in the health of our nation.
† Of Tuesday, 23 July, 2020
* CPAP stands for Continuous Positive Airway Pressure and is most commonly prescribed for obstructive sleep apnea. I recommend the forum at http://www.apneaboard.com for those who’d like to learn more from an independent minded group of CPAP device users. If you’ve been prescribed CPAP, please read up before blithely accepting what a US-based insurer or DME tries to sell you!
‡ I was transferred several times as average customer service agents could not answer a single pricing question. I believe the woman I spent the most time on the phone with was in an accounting department, not customer service.