Do you know what your chargemaster says?
Health Care. Do you know what your chargemaster says?
Healthcare is making quite the headlines in preliminary debates. I will be the first to agree that there is a significant disconnect between consumers and our healthcare system. My objective today is not to steer you into believing medicare for all or continued allowance is right or wrong. My objective today is to create a discussion about consumer education.
I recently finally decided to address some home repairs that have been long lingering since I bought house bac, in 2015. To shorten the story, I have 6 CFL 4 pin lights in my kitchen. I also have 25+ recessed canned lights throughout my entire hours. The other remaining 19 are LED standard screw in light bulbs. Clearly, I am not an avid home depot goer as it has taken me almost 5 years to address dead bulbs in my house. Regardless, I have started the journey to replace them. I submitted two requests 1) Yelp & 2) Home Advisor. Within minutes of my submissions I have 10+ offers in varying degrees to assist with my project. Electrician #1 offers me a quote based on pictures submitted. Electrician #2 offers to look at my lights and do a physical exam before offering a quote. At the conclusion, I have two almost identical quotes that are line itemed out by cost of labor and cost of materials. Both Electricians go one step further and also outline the exact steps that need to occur in order to replace my CFL 4 pin light bulbs with standard LED screw in bulbs. In total, I knowing was advised I should plan for $45 per hour + $300 in materials. (Yes, there is a large asterisk that explains differences given any unforeseen challenges.) I tell you this story because it is a service provider and as a consumer I am notified in advance of the costs for services rendered. Why should healthcare be any different?
I also recently had a rash. I went to my Primary Care Physician (PCP) and was advised I would be charged an office visit (full total cost based on my plan enrollment). This turned out to be $175.00. During my office visit I was prescribed a prescription based on my diagnosis, well, I should clarify, first diagnosis. In addition to the script (total cost at time of fill was $7.89, total cost of drug) I was advised to check back in after 7 days if there was no progress. There was not. I then returned to the doctors, again I was charged an office visit and again, this was NOT disclosed at the time of visit but billed after the fact. My PCP offered an alternative prescription; sadly he didn’t even look at the rash the second visit. He suggested, if I do not see progress within 7 days, I should explore seeing a dermatologist. Again no changes. I then found a dermatologist. I was charged an office visit and offered a different prescription. This doctor said regardless of progress, I should return in 14 days. So I did and again I was charged an office visit (unknowingly at the time which was $250.00 per visit). No changes. Then, I was offered a coupon and a fourth prescription.
To recap, I have been prescribed three different medications to date 1) $7.89 topical cream 2) $20.00 topical cream 3) $25.00 topical cream. Assuming the fourth would be approximately the same price I headed to the pharmacy. At the checkout, I see a grand total of $1259.00. Yes, that is one thousand, two hundred fifty-nine dollars. My stunned look must have shocked the pharmacist. She then proceeded to offer me a coupon with the statement “this only charge you X and your insurance will get billed for the rest, use this.” While I am paraphrasing, the message was as such. This is probably to most consumers a reasonable offering however as the plan administrator I was flabbergasted. I left no prescription in hand and called my doctor. I requested an alternative prescription. Then she offered me a door-to-door delivery (again with coupon) so I could afford the prescription. This offering allowed me to collect my prescription at a discount of $600.00.
Again, no change. I went back to the dermatologist 2 weeks later per her request. I was offered a biopsy given nothing topical was working. I inquired at the cost and was provided a generic “not much, insurance usually covers it if its to assist with a diagnosis”. Reluctantly, I proceeded. We are now 8 weeks in and I am no closer to a diagnosis. Let’s also add up what I have spent.
Office Visit Costs
PCP $175.00 x 2
Dermatologist $250.00 x 3
Prescriptions
Topical Cream #1 $7.89
Topical Cream #2 $20.00
Topical Cream #3 $25.00
Topical Cream #4 $600.00
Labs
Biopsy $150.00
Supplies $175.00 (not itemized)
Grant Total $2077.89
I am unaware of all of the charges until about 4-5 months later when I start to receive bills from each provider. The only exception is the costs for the prescriptions. I will have spent $1425.00 without a single doctor knowing what they charge for services rendered. I lied. The best part is after all this I never received a diagnosis. I am not claiming malpractice or making a claim that the specific doctors I spoke with are not fit to assist patients. My claim is that there is a huge disconnect between how consumers spend their money in healthcare costs and how educated service providers are. I never received an exact number or even a rough estimate. After awhile it became very clear to me that the reason I couldn’t get an answer is because 1) they charge different insurance providers different rates 2) they don’t know the costs of services 2) based on your providers you may be offered additional disconnects or rates.
Hospitals are required to publish their rates however what is published doesn’t have to be digestible for consumers ie: rates are often published by service code. For me to use the information accessible to the public, I would have to request from each doctor the service code that will be tied to the service provided. Often these charges are broken into three parts 1) Procedures 2) Pharmacy 3) Supplies. For 1 Acetaminophen w/ Codeine Tab 300-30 MG (this would be equivalent to 3 Tylenol) they will charge $21.00. Your approximately retail cost for a 30-day supply at Ralphs or CVS would range from $7.34 to $9.27. Some hospitals will publish insurance rates vs. cash rates so make sure you look closely.
Below I have included the direct link to the chargemaster for three major hospitals in Southern California (Hoag, MemorialCare and St. Josephs).