e-Patient Dave

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Search Results for: cost-cutting edition

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Let Patients Help, Cost-Cutting Edition: “Chaos behind a veil of secrecy”

One blog I read regularly is “Not Running A Hospital” by Paul Levy, formerly CEO of my hospital, Beth Israel Deaconess. Today’s post is A Tale of Two Blues, in which an MIT professor colleague recounts the insane, infuriating situation with his insurance company. His tale:

The last couple of months have been very heavy duty bad medical stuff for me.  Horrendous. So, I’ve been able to see the dysfunctional medical insurance system in action.   Do you understand how Blue Cross/Blue Shield actually works?  Out of, oh, maybe 80 transactions over 2 months — they managed to get one, as in the number 1, correct.  The rest are mistakes, mis-billings, computer errors, everything one can imagine.  And the only reason I can ever figure it out is because I am dogged and know something.  I can’t even begin to imagine the bone-head database that lurks behind all of it, along with inept programming, but whatever it is, the people running the place (sorry if I tread on toes) — up to and including all the executives, are simply, sorry to say, totally bonkers.  And they are just middlemen. They aren’t providing services, just managing to extract rents. Badly.

P.S. BTW, my running statistics on them, is that out of 540 transactions with them over the past 1.8 years, they have gotten two, as in the number 2, correct.   Not a good batting average. Why are they so inept?

As regular readers know, this general subject (not BC/BS of MA) has been one of my pet peeves lately, especially since I so often hear “Our costs are high because patients are irresponsible lazy slugs.” I summarized the past year’s posts in a comment there; I’m pasting it in here:

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A quick preliminary response, Paul:

As I think you know, Paul, this is something I’ve been blogging about for the past year. [Read more…]

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Let Patients Help, Cost-Cutting Edition, Part 3: Shopping for my next CT scan

Since November  I’ve been blogging about what happens when a patient tries to help control costs, in my cost cutting edition posts. Most recently I noted that this stuff takes time, especially since our glorious American healthcare system seems to be set up to block our access to what things actually cost … or at very best, we have no channels and pathways to let us find the information.

Well, ladies and gents, I’m fed up.  I have to get on with life.  I’ve been trying to be a responsible, engaged patient, and if the established channels won’t make it easy for me to find out what I need to protect myself, I will blow the whistle, announce what I’ve found so far, and move on. And we’ll take it from there.

I’m leaving tomorrow for 11 days of work in more sane countries – Switzerland and Holland – so I’m going to report the status here.

A caution and apology at the outset: I expect this will be read by some of the people I’ve spoken to at these companies. A lot of the frustrations I express here are because we couldn’t connect. I am grateful for your effort; you’re just too hard to reach, which is a problem if you’re the only one at your company who can help with this kind of work. I will appreciate your continued effort as we work through this change in American healthcare.:)

Later I’ll blog about the results of my research into my basal cell carcinoma. But for today, let’s just look at the simple (you would think) matter of getting an important CT scan.

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Let Patients Help, Cost-Cutting Edition, part 2: Shingles vaccine

Corrections added Jan 10 as noted. See sections marked “Update 1/10”. See also my comment tonight on today’s disgusting experience of trying to sort this out, and our ultimate rescue.

Two months ago I posted Let Patients Help, Cost-Cutting Edition, part 1: a bill:

I often hear about how patients are a major part of the cost problem – their “non-compliance,” their wanting everything they can get, wanting it for free, etc.  So, let’s see what happens when a patient who wants to help cut costs gives it a try. …

In that case I tried to fathom a so-called “Explanation” of Benefits, which was in fact unfathomable. (The FTC forced cigarette makers to be truthful in labeling; can’t they force insurers to stop using “explanation” on something nobody understands?)

This time my wife and I are shopping for vaccines. Specifically, shingles. And trying to be a responsible consumer turned out not to be easy.

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Let Patients Help, Cost-Cutting Edition, part 1: a bill.

I often hear about how patients are a major part of the cost problem – their “non-compliance,” their wanting everything they can get, wanting it for free, etc.  So, let’s see what happens when a patient who wants to help cut costs gives it a try.

So-called "explanation" of benefits for 10-3-2011
Click to enlarge

I was recently scheduled for a semi-annual test, four years after my treatment ended. I thought, “Hm, could I save costs by getting it somewhere else? Perhaps even find a place with higher quality? Get more for less? That’s what consumers like to do.” It turns out that information isn’t readily available. Next time I’ll hunt, but this was in the middle of my busy travel season.

Anyway, the bill just showed up. Actually it’s not a bill (“THIS IS NOT A BILL”), it’s an “explanation” of benefits. But take a good look at it, folks, and see if this “explanation” helps you answer any of these questions:

  • What was done to me?
  • Which line items were mistakenly overcharged, if any?
  • Which items were listed (and billed) without having actually been done? (That would be insurance fraud.)  The insurance company wasn’t there, so I’m in a much better position to audit.
  • All in all, did I get a good deal, for my $1,736 out-of-pocket co-pay?  And did my insurance company get a good deal?  Because when my $10,000 deductible is used up this year, they start paying.

You’d think they’d want to be auditing this stuff. I’ll call ’em Monday, and see what they have to say. (I wonder if they have the information on which providers have the best costs and quality. That would help both of us.)

The accuracy question isn’t just academic; in 2009 I blogged at some length about significant errors in my billing records, such as conditions I never had. I’ll be glad to help reduce costs, and clean up my medical record, if the information is taken out from under the blankets.

Any more of you lazy consumers out there wanna sign a pledge to do the same?

New Orleans investigative reporters expose health cost craziness, with ClearHealthCosts

Click to see the Times-Picayune article
Click to see the Times-Picayune article

Video of the first episode is below.

Last updated April 10, 9:30 pm ET.

Regular readers know that among my various causes – patient-centered care, patient access to our medical records, etc – is the importance and challenge of managing our health costs. For years I’ve blogged about my own experience – see the list of posts below. Occasionally I’ve blogged about my friends at ClearHealthCosts, who have been busting their butts to … well, make health costs clear. And for years I’ve wished we had more public attention on this crazy situation. Because when costs are chaotic, it can be hard to get the care your family needs without getting hurt in the process. How ironic is that?

So I’m thrilled to say that WVUE in New Orleans (“Fox 8 NOLA”) started a new series April 5, “Cracking the Code: The Real Cost of Health Care,” followed immediately by a print series by the Times-Picayune‘s Jed Lipinski.  From what I’ve seen so far, each is spot-on. ClearHealthCosts is a big part of the project.

To my surprise a simple Skype interview that I did was used in the first TV episode. I can’t wait to see more.

It’s all new so for the moment I’m quickly adding this page to my site … I’ll update it when I can. For now, here’s video of the first episode, and below are my past posts on health costs. I hope it helps.

FOX 8 WVUE New Orleans News, Weather, Sports, Social

My past posts on figuring out health costs

You can also browse my entire cost-cutting category.

4/12/16: The difficulty of shopping when they hide the facts: that skin cancer RFP in the NY Times

9/11/15: Article in USA Today soon with my opinion on costs, and online advice

3/11/14: How much should/could this pathology cost? (Skin cancer biopsies)

2/7/14: A new era: the “consumer-patient,” via Inquire Healthcare

6/5/13: “Chaos, behind a veil of secrecy”: Show me the cash flow

4/25/13: The reality of shopping for health insurance (pre-Obamacare)

3/25/13: An encounter with the Swiss medical system

3/11/13: The Big Ugly continues: “Hospital charges bring a backlash”

3/4/13: Let Patients Help, Cost-Cutting Edition: “Chaos behind a veil of secrecy”

1/6/13: Pricing visibility – video interview with HealthWorks Collective

12/11/12: Reprise: The healthcare waste pit is BIGGER than the fiscal cliff.

11/11/12: Great Robert Wood Johnson video “This Cost How Much?”

10/1/12: Perceptions creating reality: the scapegoat dynamic and the role of the patient

6/16/12: A dermatologist responds: “Who the heck is charging $3000 for Mohs first stage?”

5/21/12: Raw numbers for treating my basal cell carcinoma at three hospitals

5/10/12: Decision: Just scrape it off. (“ED&C”)

3/25/12: Let Patients Help, Cost-Cutting Edition, Part 3: Shopping for my next CT scan

2/20/12: It turns out being an engaged patient/consumer takes time.

2/11/12: I’ve started an RFP for my skin cancer

2/9/12: Time to practice what I preach: I have skin cancer again.

1/9/12: Let Patients Help, Cost-Cutting Edition, part 2: Shingles vaccine

11/5/11: Let Patients Help, Cost-Cutting Edition, part 1: a bill.

 

 

 

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Article in USA Today soon with my opinion on costs, and online advice

Photo of e-Patient Dave
Photo by Zack DeClerck for USA Today. (Click to link to article)

I was interviewed recently by USA Today reporter Laura Ungar of the Louisville Courier-Journal. The story ran Monday 9/14 in that paper and will be in the national USA Today soon. (I expected it on Tuesday 9/15 but it’s not there.)

The subject is summed up perfectly by the headline: Wildly varied health costs a national mystery.

Regular readers of this blog are familiar with my years-long series of posts Let Patients Help: Cost-Cutting Edition, especially my efforts to shop responsibly to get a skin cancer treated. If you’re not familiar with it, and you have the stomach for it, sit back with a cup of your favorite beverage and start digging.  (For a shorter version, read the final post, which is pretty unsettling.)

Why do I ask you to read it? Because I believe this is important to the future of health(care) in America. We must put an end to this crap. Providers, give us the facts! Tell us what things will cost, so we can decide what’s important to us!

Good providers who are trying to do a good job at a good price simply cannot win our business in an environment that, 9 years after the original article in Health Affairs, is still best described as that article’s title did: “Chaos behind a veil of secrecy.”

Can you believe that this situation is tolerated and nobody is getting busted? As I told Laura in the interview:

There can be no explanation other than some secret malarkey going on. …

I feel disempowered and disrespected, because aside from the incredible cost crunch we’re all experiencing, it’s a downright sin that my family can’t readily find out what the options are and what the costs are.

Remedy: information!

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