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Why Can My Mechanic Give Me an Estimate But Not the Laboratory?

Posted Mar 31 2011 11:42am
Here's a riddle for you.  Why is it that everywhere else in life BUT health care, you can get a complete estimate of services before you agree to the service - but with health care, nobody seems to understand how to grant that request, never mind how to do it?

I'm not talking about the times when people are rushed to the emergency room with a life-threatening condition. Nobody is expecting the hospital staff to stop cardiac resuscitation, flip open the laptop, print a complete estimate of services and get a family member to sign off on it while Grandpa is code blue.

I'm talking about simple things, routine things. Like going for an annual physical.

Now most people have insurance of some kind, right? And with your insurance program, it's usually spelled out pretty clearly how much the doctor's visit will cost you. There's either a flat dollar amount called a co-pay or a percentage, but it's usually spelled out right there in your paperwork.  And the nice lady or man at the front desk of the office can usually rattle of what you owe before you so much as catch sight of your doctor.

But not so with laboratory work.

Someone of my acquaintance was ill this past year.  She had unexplained fatigue and a few fainting spells.  Normally she's one of those robust, climb every mountain, healthy other medical conditions...just a crushing tiredness without explanation.  So she went to her doctor.

During the routine visit (co pay $30) he drew three vials of blood and said he was going to run a CBC (complete blood count), test her thyroid, and run a "few other tests."  She has insurance.  It didn't even occur to her that the tests wouldn't be covered.

Imagine her shock when several weeks later - and still without a diagnosis - she started getting bills. Lots of bills.

First, there were bills from the doctor's office for drawing the blood. They charge extra? she wondered. Why?

Next, there were bills for each test. Only she couldn't figure out what she was being billed for. Each test just said "laboratory" on the bill. There were bills from hospitals 50 miles away and one from a lab in Minnesota.

"Jeanne," she said, "You need a freakin degree in medicine just to unravel your bills!"

Despite having "good" insurance, she ended up paying over $2,000 for all the tests....and she's still not sure exactly what she paid for.

Here's my question.  My friend did not have a life-threatening condition.  She was sitting there chatting with her doctor. He used a laptop to order the tests. He typed them into an internet portal.

Why can't the internet portal be synced with her insurance information to provide an estimate? Why can't the office say to her, "Margaret, these tests will be about $2,000."  Now if that is a problem for Margaret, she should know right then and there so she can talk to her doctor about her options.  Margaret did go back to her doctor and talk to him. Apparently, one of those very expensive tests was "just in case" and could have been avoided.

Why are we at the mercy of the mysterious insurance companies and laboratories? Why can't they provide us with clear estimates of services? Why does this have to be so hard? Why do doctors have to do tests "just in case" - are they so fearful (or hounded) by litigation that they have to cover their bases every time they practice medicine? If so, that is just plain awful for everyone but those making money off of lawsuits. 

If I bring my car into my mechanic, he gives me a written or verbal estimate over the phone. There are no mystery bills and if there were, I would refuse to pay them.

Even my dentist provided me with a written estimate when I experienced some bad dental problems years ago!  He examined my teeth and told me his findings. He sat down in the exam room and went over why I needed the work done, what his opinion was, and then told me his staff would develop an estimate. I could choose to do nothing (and possible lose my teeth), do some of the work (he prioritized it for me) or do it all and make payments. Clear, simple, no surprises.  I had dental insurance too, by the way - and his staff made sure they ran the estimate through the insurance company's website calculator before handing me the written estimate.

Why is this so hard to do with medical insurance?  Why can't patients be armed with costs for voluntary services (not emergency services) before making the decision to go through with them?

I can't find the answer to this question anywhere. I've begun looking at the whole health care debacle through a new lens after talking to my friend Margaret. I looked at the research into efficacy, I started reading - really reading - the statistics. 

I'd love to hear your thoughts on this, especially if you work in the medical profession. 

I think the answer to the health care debate lies not with the politicians but with you and me, the people, demanding more transparency and cost containment. 
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