Friday, June 21, 2013

The End of the $10 Co-Pay Bubble

A conversation somewhere in a doctor's office near you:

"I'm sorry the I chose to be a Blue Cross / Blue Shield provider, Mr. Smith, but I need to determine the money I need to earn, not an insurance company."

 "How could you do such a thing? You have an obligation to continue our therapy! I've been seeing you for years! What you're doing amounts to nothing less that patient abandonment!"

"Mr. Smith, I am not abandoning you. I am only saying that under my new construct, I am not willing to take the negotiated price the insurance company wants me to accept. As we have discussed, I am willing to negotiate a reduced rate for you given our history, but I am not willing to see you for less than $100/session."

"You're so damn greedy.  How could you do such a thing?"

"Did you really think that I would be willing to continue to see you for only $10 a session? This expectation has created a cost of care bubble expectation that is incredibly destructive to the realities of health care costs today.  I would suggest that if you feel this reduced rate of $100/session is not fair that you consider seeing another psychologist. I'll keep your appointment on the books for next week at your regular time. I suggest you think about it, and if you decide to cancel, let me know."

With that, he left in a huff. Forty-eight hours later he called, asking that his appointment be cancelled. She complied and booked another new patient in his place.

* * *

Weeks passed.  Then a phone message appeared amongst her many telephone messages:

"Doctor, would it be possible to see you next week at the reduced rate we discussed?"

* * *


Anonymous said...

"Cost of care bubble expectation"?

That's not the bubble I was thinking of.

It's ironic that the same people who hid pricing data from patients for decades, and continue to do so, are complaining that patients don't know how much things cost.

Insurance does hide the real cost from patients with the $10 co-pay. Insurance also protects patients from unreasonable billed amounts.

At one time, Providers billed a rate that was based in reality. Since insurance hides the cost from patients, Providers were able to increase the billed rate over and over again in a game of brinkmanship with insurance companies.

Now we have original bills have been inflated so much that they are far removed from reality. - an amount billed bubble -

The only thing that pops that bubble right now is the negotiated rate.

Removing the insurance company as a middle man between the provider and the patient will fix the 'amount billed' bubble that makes patients terrified to enter the health care system without an insurance company on their side.

A clearly posted price list for standard services would do the same thing (examples include anything from the CVS Minute Clinic to the Surgery Center of OK).

Insurance companies love to play billing games, but so far Docs have been more than happy to play along.

Patients have been stuck in the middle.

Anonymous said...

I understand there are some Docs who have decided to stop accepting ALL forms of insurance and were able to reduce their rates 50% or more. This sounds good to me, since these Docs won't have to wait for permission from some agency to treat their own patients. It seems to me the rise of the cost of healthcare began when government started meddling in the 1960's. It's no wonder so many people can not go to a doctor. Same thing happened when they meddled with education and formed that giant department of education in the 1970's; when that didn't work for them, they proceeded to double the size of it! The price of education is sky high now, and it hasn't solved the problem it was formed to do, instead created more problems. Most people have to borrow to get a college education now. Sheesh.

DrWes said...

Anony 12:53:

Precisely. But this issue is even more complicated than doctors, insurers and "providers" (like employers or hospital systems) hiding costs.

Patients, too, are complicit in their approval of the current system. Some are in denial - that nothing needs or should change - and another larger portion of them have a growing dependent/entitled attitude (as the patient in the present post appears) that doctors HAVE to be willing to play along because, well they shouldn't have to bear the brunt of costs (and who can blame them given how our system has been constructed?)

How this will this all play out? We can only guess. But I would agree with you that the more transparent and honest we are about prices, the better everyone will be in the long run.

Anonymous said...

Anon 12:53 here.

You're right about the entitlement mentality - it's real and growing from what I can tell. Actual quote from a pharmacy - "Why do I have to pay $2. I only pay $1. I can't afford $2. Can you ring up these
chips too?"

A bit of pessimism - My read of the ACA is that it will reduce price transparency and make current problems worse. Many people still believe it will make health care 'free' starting in 2014. What rock they've been hiding under - I don't know....

A couple of points that might give some hope:

(1) Many people would move to a more price transparent system in a heartbeat but can't because of what's offered by their employer. My large private employer (over 200K employees) strongly subsidizes the current system and offers no option for those who want an opportunity to try something else (high deductible, pay out of the insurance system for routine care and small emergencies). Frustrating.... but when the dam breaks I think there will be a stampede away from the current setup.

(2) The entitled patients are probably overrepresented at any health care practice vs general pop. They can be both frequent fliers and frequent complainers. The general population is both more understanding and more supportive than you might expect based on daily encounters at work.

Anyway, I appreciate both your insights and your willingness to let others share some thoughts.