The other day I got home from work and sorted through the endless amounts of junk mail and bills that I receive day after day. One piece specifically caught my eye this time – what looked like billing from my OB/GYN’s office. When you’re closing in on nine months pregnant, any piece of mail from your OB’s office is of utmost concern.
I immediately ripped open the envelope and scanned the complicated document to read on the final line, “you owe $3,875.89.” I was floored! Yes, I realize I have had what seems like hundreds of ultrasounds due to minor pregnancy complications and monitoring, as well as additional prenatal care, but almost $4k out of my own pocket just didn’t sound right.
See, I work for an insurance company – not only am I self-covered by my work insurance, but I’m also covered by my husband’s. In fact, during my first prenatal appointment, I met with my OB’s billing department to find out exactly what I would need to pay out-of-pocket when this ordeal was over. As most everyone, we live on a budget too. I was quite impressed when they gave me a complete listing of how much each portion of the care costs, why it costs that much, and more. I was also told that because of my pleasant “double- insured” situation, that I would have to pay very little, if anything, out-of-pocket after delivery.
So why the sudden $4k?
The next morning I contacted my doctor’s office and was told to “ignore” the statement – that my situation was the same despite the additional testing I had undergone, and “not to worry about it.” Only problem is, if you read the fine print it also states that if I don’t pay the $4k by X date, I’ll be charged interest. However, after questioning the billing department again, and contacting both insurance companies, I’m still unclear as to what I’m really responsible for when this is over. But what can I do other than just wait for another bill in the mail?
Has this type of thing happened to anyone else out there? I’m sure it has. That’s why I got a kick out of this video called “Checkout.” Watch it, and let me know what you think. Here's a link to it on WhatsTheRealCost.org http://www.whatstherealcost.org/wtrc/toolbox/connect.html?video&site=.
Tuesday, October 13, 2009
Sunday, September 27, 2009
Why aren't we tackling the real problems?
The other day I got an email from the salon where I get my hair cut. They wanted to let me know they're moving to a new location — a much bigger space. Uh-oh, I thought. And indeed, at the very end, the email said just what I suspected — that as a result of the bigger space, the cost of a haircut would increase $5. I’m not happy about the price increase, but I can't really blame them. They're doing what any business does: passing the cost of their higher rent onto the customer. I think health care works the same way.
Last week the Senate Finance Committee released its health care reform proposal. To pay for universal coverage, the committee’s recommendations mainly came down to pushing the cost of change back into the system. The proposal does little to fix why the costs are high to begin with. It offered no remedy for the high costs of prescription drugs (biologics can cost up to $200,000 per year); repeat billings for the same procedures (like having an MRI twice in the same month because your doctor’s don’t all know each other and talk to each other); and other issues that are plaguing health care.
See, the Senate Finance Committee's idea to pay for reform focuses on new fees on insurance companies and drug makers. This is like taxing car insurance because the mechanics and the factories that make car parts have increased the cost of fixing cars. We know who pays for everything in the end: us, the consumers.
Okay, I work for a health plan, but help me understand this: Doesn’t the Senate know that imposing a tax on health plans just makes coverage more expensive for people? Because the health plans have to pass on that cost of doing business. Sixty-one percent of private health plans are nonprofit — they don’t have a way to absorb this cost. And if the Senate thinks for-profit plans will just reduce dividends, they are not being realistic.
Would it be possible for my salon — where I love getting my hair cut — to keep their prices the same even if they're paying more rent? You know the answer.
Taxing the “messenger” of increased costs does nothing to reduce medical spending or fix the real problems with the system, plus it just makes private coverage more expensive for people. The cost problem will just continue to get bigger. That doesn’t sound like real reform to me.
Thinking about the “big picture,” what really matters? What will have a transformational effect?
Get ideas and share your thoughts at our Facebook page.
Last week the Senate Finance Committee released its health care reform proposal. To pay for universal coverage, the committee’s recommendations mainly came down to pushing the cost of change back into the system. The proposal does little to fix why the costs are high to begin with. It offered no remedy for the high costs of prescription drugs (biologics can cost up to $200,000 per year); repeat billings for the same procedures (like having an MRI twice in the same month because your doctor’s don’t all know each other and talk to each other); and other issues that are plaguing health care.
See, the Senate Finance Committee's idea to pay for reform focuses on new fees on insurance companies and drug makers. This is like taxing car insurance because the mechanics and the factories that make car parts have increased the cost of fixing cars. We know who pays for everything in the end: us, the consumers.
Okay, I work for a health plan, but help me understand this: Doesn’t the Senate know that imposing a tax on health plans just makes coverage more expensive for people? Because the health plans have to pass on that cost of doing business. Sixty-one percent of private health plans are nonprofit — they don’t have a way to absorb this cost. And if the Senate thinks for-profit plans will just reduce dividends, they are not being realistic.
Would it be possible for my salon — where I love getting my hair cut — to keep their prices the same even if they're paying more rent? You know the answer.
Taxing the “messenger” of increased costs does nothing to reduce medical spending or fix the real problems with the system, plus it just makes private coverage more expensive for people. The cost problem will just continue to get bigger. That doesn’t sound like real reform to me.
Thinking about the “big picture,” what really matters? What will have a transformational effect?
Get ideas and share your thoughts at our Facebook page.
Monday, September 14, 2009
Keeping the real health reform focus
Did you catch President Obama’s speech to Congress on health care reform last week? He gave an accurate summary of the problems people have in getting, keeping and affording insurance. He even mentioned that medical costs will swamp the federal budget. But he didn’t talk much about how to curb those costs, especially once everybody gets coverage.
And I was disappointed that when he reeled off the list of groups who were on board with reform, he left out health plans. That’s such a bummer because they were the first ones to the table, offering to reform their industry to get rid of the practices that people complain about: pre-existing conditions that prevent coverage or payment of claims.
All the insurer reforms the president mentioned were offered by the industry itself, yet he left the impression these changes are being “done to” the one part of the system that volunteered for reform.
I get it from the letters to the editor that some people think the only reform that matters is offering government insurance and/or getting rid of private insurance. But no matter what kind of coverage method we have, it’s really important to fix the whole system, not just who signs the check.
Here’s the deal: 87 cents of our health care dollar goes to doctors, hospitals, pharmaceuticals and other health care goods and services. That’s $8000 a year for each of us. Experts say maybe a third of that is wasted. That’s scary and reform has to fix that, too. So, where’s it going?
In a system of “disease care” 75 cents of each health care dollar goes to preventable chronic conditions
We use a lot of treatment that may not improve care and may expose us to risk: MRIs, CTs, etc
Quality issues can curb costs but they aren’t widely implemented, even simple ones like checklists, that reduce hospital-borne infections.
Doctors and hospitals are paid based on procedures, not better health; only last year, Medicare quit paying for “never” events like cutting off the wrong limb
Fraud takes tens of billions a year, a low estimate is 3% of all our health care dollars, from a variety of schemes: dummy companies getting Medicare funds for phantom equipment to unnecessary medical treatment.
Dollars wasted by duplication and uncoordinated care could be recovered with wide use of electronic medical records to put patient information in doctors’ hands.
Getting everybody covered is easy. Curbing costs so our country can afford it is hard. I don’t know about you, but I want to see health care reform accomplish both of these.
And I was disappointed that when he reeled off the list of groups who were on board with reform, he left out health plans. That’s such a bummer because they were the first ones to the table, offering to reform their industry to get rid of the practices that people complain about: pre-existing conditions that prevent coverage or payment of claims.
All the insurer reforms the president mentioned were offered by the industry itself, yet he left the impression these changes are being “done to” the one part of the system that volunteered for reform.
I get it from the letters to the editor that some people think the only reform that matters is offering government insurance and/or getting rid of private insurance. But no matter what kind of coverage method we have, it’s really important to fix the whole system, not just who signs the check.
Here’s the deal: 87 cents of our health care dollar goes to doctors, hospitals, pharmaceuticals and other health care goods and services. That’s $8000 a year for each of us. Experts say maybe a third of that is wasted. That’s scary and reform has to fix that, too. So, where’s it going?
In a system of “disease care” 75 cents of each health care dollar goes to preventable chronic conditions
We use a lot of treatment that may not improve care and may expose us to risk: MRIs, CTs, etc
Quality issues can curb costs but they aren’t widely implemented, even simple ones like checklists, that reduce hospital-borne infections.
Doctors and hospitals are paid based on procedures, not better health; only last year, Medicare quit paying for “never” events like cutting off the wrong limb
Fraud takes tens of billions a year, a low estimate is 3% of all our health care dollars, from a variety of schemes: dummy companies getting Medicare funds for phantom equipment to unnecessary medical treatment.
Dollars wasted by duplication and uncoordinated care could be recovered with wide use of electronic medical records to put patient information in doctors’ hands.
Getting everybody covered is easy. Curbing costs so our country can afford it is hard. I don’t know about you, but I want to see health care reform accomplish both of these.
Wednesday, September 9, 2009
Medical records: a better way
It's pretty amazing how many aspects there are to the ballooning cost of medical care. As I wrote in my last post, prescriptions are one place where we can be more savvy. Another savings area might be less obvious: the storing of medical information.
The root of the problem here is inefficient communication. Think about a time when you had to repeat the same information over and over again. Maybe you were calling your cell phone or credit card company to ask a question, and you kept getting transferred. It's frustrating, sure, and it wastes time — and we all know time is money.
For health care, the issue is medical records. How many times have you filled out forms for your medical history? We've all seen those floor-to-ceiling files of manila folders in each doctor's office. All that information is on paper, and there's no easy way to share it between different health-care providers. The result can be agonizing delays and costly duplication of tests.
Maybe your 85-year-old grandfather needs surgery. He goes to the hospital, but soon they realize they can't do the surgery because they don't have clearance from his cardiologist saying his heart can survive the strain. A few weeks earlier your grandfather went to a cardiologist, but the surgical team never received the records from that visit.
What to do? Wait? Or repeat the tests with yet another cardiologist? Two very inefficient options.
Maybe you’ve experienced this already. The doctor sends you for a test and follow-up to discuss it, but when you get to the follow-up, the test results aren’t back. So the inefficient system just wasted your time, your doctor’s time, your money and maybe resulted in the unnecessary duplication of tests.
A friend of mine recently moved halfway across the country. In dealing with the million details of her relocation, she never had time to visit all her doctors and get copies of her records. Every once in a while she remembers those files hundreds of miles away and worries that she'll have to repeat many of the same procedures again with new doctors. Another friend actually did send all her doctors the request for files to be transferred to a new doctor, but found out the hard way several years later that the files never showed up. She’s lost about 10 years of her medical history.
One study by a think tank estimated that $81 billion could be saved annually by computerizing patient records. Both the Bush and Obama administrations have pushed for the creation of a system for local hospitals and physicians to electronically share medical records, because it could save lives and money. So why hasn't it happened? True, there are upfront costs. But other perceived barriers, like concerns about privacy, shouldn't really be barriers at all. The banking industry has overcome them, which is why we can use ATMs anywhere. I can e-file my taxes and check my financial history online at a credit agency, so we know issues such as privacy, security, misplaced competition and compatibility across technology can be addressed.
A computerized system would mean doctors could immediately see lab results and read specialists' comments on their patients. It would mean that if you show up in the emergency room, your medical history is already there — your allergies, previous blood work, past Xrays and more. That sounds like a win-win for everybody, doesn't it?
What do you think? Share your ideas at our Facebook page.
— Susan with Regence
The root of the problem here is inefficient communication. Think about a time when you had to repeat the same information over and over again. Maybe you were calling your cell phone or credit card company to ask a question, and you kept getting transferred. It's frustrating, sure, and it wastes time — and we all know time is money.
For health care, the issue is medical records. How many times have you filled out forms for your medical history? We've all seen those floor-to-ceiling files of manila folders in each doctor's office. All that information is on paper, and there's no easy way to share it between different health-care providers. The result can be agonizing delays and costly duplication of tests.
Maybe your 85-year-old grandfather needs surgery. He goes to the hospital, but soon they realize they can't do the surgery because they don't have clearance from his cardiologist saying his heart can survive the strain. A few weeks earlier your grandfather went to a cardiologist, but the surgical team never received the records from that visit.
What to do? Wait? Or repeat the tests with yet another cardiologist? Two very inefficient options.
Maybe you’ve experienced this already. The doctor sends you for a test and follow-up to discuss it, but when you get to the follow-up, the test results aren’t back. So the inefficient system just wasted your time, your doctor’s time, your money and maybe resulted in the unnecessary duplication of tests.
A friend of mine recently moved halfway across the country. In dealing with the million details of her relocation, she never had time to visit all her doctors and get copies of her records. Every once in a while she remembers those files hundreds of miles away and worries that she'll have to repeat many of the same procedures again with new doctors. Another friend actually did send all her doctors the request for files to be transferred to a new doctor, but found out the hard way several years later that the files never showed up. She’s lost about 10 years of her medical history.
One study by a think tank estimated that $81 billion could be saved annually by computerizing patient records. Both the Bush and Obama administrations have pushed for the creation of a system for local hospitals and physicians to electronically share medical records, because it could save lives and money. So why hasn't it happened? True, there are upfront costs. But other perceived barriers, like concerns about privacy, shouldn't really be barriers at all. The banking industry has overcome them, which is why we can use ATMs anywhere. I can e-file my taxes and check my financial history online at a credit agency, so we know issues such as privacy, security, misplaced competition and compatibility across technology can be addressed.
A computerized system would mean doctors could immediately see lab results and read specialists' comments on their patients. It would mean that if you show up in the emergency room, your medical history is already there — your allergies, previous blood work, past Xrays and more. That sounds like a win-win for everybody, doesn't it?
What do you think? Share your ideas at our Facebook page.
— Susan with Regence
Friday, August 28, 2009
Health reform takes attitude
Thinking back on that last post, about how it takes all of us to curb medical spending, reminded me of my personal attitude adjustment on this issue.
My health plan puts claims online so I can track them, and also shows what I paid and what the plan paid. That was an eye-opener. I thought I was pretty low-maintenance, not a drain on the plan. But my two little meds for a skin condition really add up: between co-pay and insurance coverage, they cost $200 a month, more than my premium share.
Working for a health plan has made me conscious of medical costs. So I researched my options at RegenceRx.com. I found that hydrocortisone cream controls the same symptoms as the prescription I used, for only $5 a tube (less for store-brand). After awhile, I didn’t even need it every day, just every few weeks.
Unfortunately, they don’t make a hydrocortisone shampoo (unless you’re a dog). But I got a valuable clue from RegenceRx.com: both my meds were considered “anti-fungal” (ew!). A Google search showed vinegar has anti-fungal properties. I left some vinegar on my scalp for several minutes before shampooing and voila--that works too!
It was fun to find such easy and cheap solutions, but how come I had to find them myself? No doctor in 15 years of taking those meds offered any alternatives. But then, no vinegar salesmen go to my doctor’s office and buy her staff pizza so she will recommend it.
For about $35 a year, I took myself off two meds and saved $450 in co-pays and $1900 for the health plan -- Unbelievable!! I told my doctor to note I was no longer taking those meds, and that she should pass the word to other patients so they could try it. She just looked kind of bemused. “But those meds are covered,” she said.
“Covered” doesn’t mean “free” – somebody still pays. In fact, everybody pays. That’s why reform can’t stop with health insurance. It will take an attitude adjustment.
My little DIY solution cut almost $10,000 in spending by my health plan – that is, me and my co-workers – in just four years. This didn’t take months of research, settling for less or changing my lifestyle. It just took changing my attitude.
If you’ve had one of those attitude adjustments, maybe you could share it at our Facebook page.
My health plan puts claims online so I can track them, and also shows what I paid and what the plan paid. That was an eye-opener. I thought I was pretty low-maintenance, not a drain on the plan. But my two little meds for a skin condition really add up: between co-pay and insurance coverage, they cost $200 a month, more than my premium share.
Working for a health plan has made me conscious of medical costs. So I researched my options at RegenceRx.com. I found that hydrocortisone cream controls the same symptoms as the prescription I used, for only $5 a tube (less for store-brand). After awhile, I didn’t even need it every day, just every few weeks.
Unfortunately, they don’t make a hydrocortisone shampoo (unless you’re a dog). But I got a valuable clue from RegenceRx.com: both my meds were considered “anti-fungal” (ew!). A Google search showed vinegar has anti-fungal properties. I left some vinegar on my scalp for several minutes before shampooing and voila--that works too!
It was fun to find such easy and cheap solutions, but how come I had to find them myself? No doctor in 15 years of taking those meds offered any alternatives. But then, no vinegar salesmen go to my doctor’s office and buy her staff pizza so she will recommend it.
For about $35 a year, I took myself off two meds and saved $450 in co-pays and $1900 for the health plan -- Unbelievable!! I told my doctor to note I was no longer taking those meds, and that she should pass the word to other patients so they could try it. She just looked kind of bemused. “But those meds are covered,” she said.
“Covered” doesn’t mean “free” – somebody still pays. In fact, everybody pays. That’s why reform can’t stop with health insurance. It will take an attitude adjustment.
My little DIY solution cut almost $10,000 in spending by my health plan – that is, me and my co-workers – in just four years. This didn’t take months of research, settling for less or changing my lifestyle. It just took changing my attitude.
If you’ve had one of those attitude adjustments, maybe you could share it at our Facebook page.
Wednesday, August 19, 2009
One word makes a big difference
Have you noticed the change? I'm talking about the change in the debate over health care reform. Lots of Washington politicians, now on their August break, have started focusing on health insurance reform rather than health care system reform. It might look like just a little shift in wording, but there's a big difference. What should the debate be focused on?
The whole point of reform is to control the costs that have sharply increased over the last decade. Can we really resolve this problem by looking only at insurance?
It would be great if that was the case. And focusing just on health insurance reform might be tempting, because that's the bill we get in the mail, so we're super-aware of it. Actually, health insurance reform will be the easiest thing we could do this year, since all the insurers have already agreed on key reforms that everyone wants.
But health insurance doesn't come close to reflecting the total cost of health care.
Unfortunately, there is no one cause for the skyrocketing costs. Rather, several issues have caused our health care system to become overly expensive. It's true that insurers have played their part. But they have plenty of company! Focusing only on health insurance reform won't get the job done.
Drug companies, the government, doctors, hospitals, and even all of us as consumers have also had a hand in creating this situation. Drug companies charge a lot for certain medicines. Politicians make rules about things like Medicare reimbursements. Hospitals and doctors know they'll earn more money by doing costly interventions, while we as patients have almost no control over the amounts that hospitals and doctors charge.
I know it's a big job, but all of these factors need to be addressed -- and that includes each one of us! We can all make an effort to adopt healthier lifestyles. We can research health issues and treatment options on the internet. We can talk to our doctors about the least expensive yet most effective care. We've got to see ourselves as the central actor in our own health care story. And we can economize on medical care the way that we do with our other expenses.
We're all in this together. Keep checking back here for ideas about how to reform the whole health care system.
-- Susan with Regence
The whole point of reform is to control the costs that have sharply increased over the last decade. Can we really resolve this problem by looking only at insurance?
It would be great if that was the case. And focusing just on health insurance reform might be tempting, because that's the bill we get in the mail, so we're super-aware of it. Actually, health insurance reform will be the easiest thing we could do this year, since all the insurers have already agreed on key reforms that everyone wants.
But health insurance doesn't come close to reflecting the total cost of health care.
Unfortunately, there is no one cause for the skyrocketing costs. Rather, several issues have caused our health care system to become overly expensive. It's true that insurers have played their part. But they have plenty of company! Focusing only on health insurance reform won't get the job done.
Drug companies, the government, doctors, hospitals, and even all of us as consumers have also had a hand in creating this situation. Drug companies charge a lot for certain medicines. Politicians make rules about things like Medicare reimbursements. Hospitals and doctors know they'll earn more money by doing costly interventions, while we as patients have almost no control over the amounts that hospitals and doctors charge.
I know it's a big job, but all of these factors need to be addressed -- and that includes each one of us! We can all make an effort to adopt healthier lifestyles. We can research health issues and treatment options on the internet. We can talk to our doctors about the least expensive yet most effective care. We've got to see ourselves as the central actor in our own health care story. And we can economize on medical care the way that we do with our other expenses.
We're all in this together. Keep checking back here for ideas about how to reform the whole health care system.
-- Susan with Regence
Wednesday, August 12, 2009
The power of a question, and the answer
This doctor has a couple of great stories about the “medical industrial complex” and why health care reform is hard-- http://tinyurl.com/THCB-lobster-and-lap-choley
After the lobster-salad analogy, he talks about high-tech driving up medical spending, not always for the better. I could relate to his example: gallbladder surgery. Full disclosure–I have gallstones (maybe TMI).
The pain felt like a sword sticking through me right under the rib cage. My doctor said, “Classic gallstone attack, we’ll get CT scan to be sure.” The scan showed a gallbladder that looked like a bag of marbles. The doctor advised removal of the gallbladder: “With laparoscopic surgery, you hardly even have a scar.”
“Doesn’t the gallbladder have a job to do?” I asked. The doctor agreed it did. “Is it necessary to take it out?” She said no, it wasn’t, but I should avoid fats and eating too close to bed time to avert future attacks.
I also went to a licensed naturopathic doctor and he gave me the same dietary advice, plus a pain remedy: peppermint oil pills.
Apparently, peppermint oil soothes spasms, like when a gallstone blocks the bile duct. The pills were about $17 in the grocery store’s health food section. At my next attack: 2 peppermint oil pills, and 10 minutes later – horrendous pain is gone! After 7 years, I’m only on the second bottle of pills. I raved about the peppermint oil -- it helped my friend’s cramps and my brother-in-law’s lower back pain, too.
Guess I could have had the operation, but just I wanted to stop the pain and keep all my working parts. Did you know that gallbladder removal is one of the most common surgeries in the U.S. and the #1 reason is pain. Wonder how many of those people would choose peppermint oil over surgery?
I asked some questions, checked the Internet, got another opinion and found a treatment that worked for me. More disclosure – yes, I had health insurance at the time; no, I did not work for an insurance company then.
It wasn’t about the money, but now I see how each decision impacts the money. We can all ask "Why?" and "How much?", without an act of Congress. You never know what could happen.
Susan with Regence
After the lobster-salad analogy, he talks about high-tech driving up medical spending, not always for the better. I could relate to his example: gallbladder surgery. Full disclosure–I have gallstones (maybe TMI).
The pain felt like a sword sticking through me right under the rib cage. My doctor said, “Classic gallstone attack, we’ll get CT scan to be sure.” The scan showed a gallbladder that looked like a bag of marbles. The doctor advised removal of the gallbladder: “With laparoscopic surgery, you hardly even have a scar.”
“Doesn’t the gallbladder have a job to do?” I asked. The doctor agreed it did. “Is it necessary to take it out?” She said no, it wasn’t, but I should avoid fats and eating too close to bed time to avert future attacks.
I also went to a licensed naturopathic doctor and he gave me the same dietary advice, plus a pain remedy: peppermint oil pills.
Apparently, peppermint oil soothes spasms, like when a gallstone blocks the bile duct. The pills were about $17 in the grocery store’s health food section. At my next attack: 2 peppermint oil pills, and 10 minutes later – horrendous pain is gone! After 7 years, I’m only on the second bottle of pills. I raved about the peppermint oil -- it helped my friend’s cramps and my brother-in-law’s lower back pain, too.
Guess I could have had the operation, but just I wanted to stop the pain and keep all my working parts. Did you know that gallbladder removal is one of the most common surgeries in the U.S. and the #1 reason is pain. Wonder how many of those people would choose peppermint oil over surgery?
I asked some questions, checked the Internet, got another opinion and found a treatment that worked for me. More disclosure – yes, I had health insurance at the time; no, I did not work for an insurance company then.
It wasn’t about the money, but now I see how each decision impacts the money. We can all ask "Why?" and "How much?", without an act of Congress. You never know what could happen.
Susan with Regence
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