Counting the Cost of Healthcare

My niece went to the dentist the other day. She's new to this adult thing, and like many of us (even those much older!), trusts healthcare providers to help her make good decisions. They told her they needed to take x-rays because it had been a while since she had them taken. She agreed....they are the experts and they said it was necessary. Later on, after the x-rays had been taken, the dentist told her that her insurance "probably" wouldn't cover the additional panoramic x-rays they had taken. They never told her what it would cost her, never explained in advance they weren't covered by her insurance, and never talked to her about why they found them necessary until after they were taken.

I was a bit frustrated when I heard her accounting of it. Knowing insurance as I do, I know that panoramic x-rays are covered....if necessary and usually on a schedule that is consistent with (or more generous than) the guidelines established by the American Dental Association. Essentially they were telling her they couldn't make a case for the coverage of it with her insurance company...but they assumed that she (a college student) would just pay for it. Without knowing the cost beforehand. Without consideration of her having a voice in the decision at all.

I had a situation that was somewhat related a couple of years ago when I was in the process of deciding what kind of braces I was going to get....either traditional wire or Invisalign. I had been told the result would be a bit better with traditional, but I would need to see an oral surgeon before I did that because I would need teeth pulled. I made an appointment for a consultation with the oral surgeon.

I admit I am a bit of  pain-in-the-rear patient for a provider who does not like an involved patient. I see myself as an integral part of any decision that concerns my health....so ask a lot of questions and want to, as much as I am able, understand what is going on with my body and exactly what is expected from my treatment. Luckily I have found providers who respect my questions and don't make me feel like a weirdo for asking them. Well OK, sometimes they think I am a weirdo, but they humor me!

Having been in the insurance industry in some capacity for over 30 years, I also see myself as a consumer of healthcare. Yep, I often ask how much things cost. Before they deliver the service. I also try to determine if I think the service is necessary. Yes, I trust my providers, but I also know I look at life differently than a lot of people. What they may see as necessary, I may feel is not. There are risks with most procedures.....do I want to take that risk? I want veto power over everything, and also the ultimate responsibility for what is done to me. I believe if I am passive, not only can my care possibly not meet my needs, but I know healthcare can become more expensive for all of us. I am passive too often (it's exhausting)....so I apologize for those times I don't question things....not for the times I do.

Anyway, my oral surgeon visit....I was there on time, a copy of my panoramic x-ray in hand. No one was in the waiting room, but it took a very long time for them to call me back. In fact, I thought perhaps I was in a ghost town. When they finally did call me (and no other patient seemed to be in the office at the time), the oral surgeon seemed to only see my mouth. He didn't introduce himself or talk directly to me. He ordered his assistant to take another panoramic and quickly left the room. Not a word said to me. I was stunned.

The assistant appeared shocked herself when I said "Did he said he wanted another panoramic? I just had one. No....I don't want another one. My insurance won't cover it and I don't want the extra exposure to radiation." She told me I would have to talk to him about it. Thirty minutes later he came back into the room. He acted like I was being unreasonable. Maybe I was....I didn't care. I believe in myself when it comes to this stuff. He finally said he would do the panoramic without charge. I said "Can you also do it without radiation?" He got angry. I knew by then he was not a doctor I could respect....so I just left as quickly as possible. Livid that I felt that he disrespected me and probably many other patients. I went for the Invisalign braces and never regretted that decision.

I once went to visit an allergist and was charged for an "intermediate" office visit. I didn't even sit down in his office. What would have been a "short" office visit with that guy? He didn't examine me at all. I went in, he asked what my problem was, I said I was having severe headaches, he said allergies don't cause headaches, and wrote me a referral to neurologist. (I never did see that neurologist. It turned out the sweetener in some sugar-free mints was causing the headaches and I figured that out myself. Isn't that an allergy of sorts? I never saw that allergist again. I am allergic to grass, I mow grass, and get headaches. Don't tell me they are not related.)

When diagnosed with restless legs syndrome I was given a new medication that was also used for multiple sclerosis. It was very expensive and very strong. I knew day one it was not good for my body. The doctor told me to stay on it for a month. I lasted two weeks....maybe. I decided the treatment was worse than the condition. It was a couple of years later that my regular nurse practitioner (who was out of the country at the time I got the other medication) prescribed another medication for me.....it costs me less than $3 a month. It changed my life. (I began to sleep again!) Why wasn't that drug the first one that was offered?

We've become a nation that will drive across town to save a quarter on a gallon of milk, but we don't ask what our MRI costs before we get it. We don't ask the cost of a prescription. We don't seek the least costly treatments first. We don't know what the cost of an office visit with our doctor is compared to the doctor next door. Many of our doctors often don't know the cost of our office visit or the medication they prescribe either (trust me....I have asked.) I understand it is complicated....the charge depends on whether you have insurance or not and which insurance you have. Oh....and the cost is not your copay. What is important is the total charge. I guarantee if you ask, you will be surprised at how much some things and how little is paid for others.

I see both the good and the bad of our healthcare system, and have no brilliant solutions for how we can make things work perfectly, but one thing we can each do....we can become better consumers. We can ask what things cost. We can ask why we need particular services. We can question ourselves as to whether we think that the benefits are worth the cost of the treatment. We can be our own advocates, and trust that we are an expert on ourselves.  And we can challenge our providers, as very busy and stressed as they are, to know the cost of the care they give and the drugs they prescribe.

I believe my niece is going to be a great healthcare consumer. She is listening and learning with each encounter. Her dad is asking her a lot of tough questions that are not allowing her to look at it all passively, that are requiring that she question the system. I know she hates it. I still do, too. But it is important. Not just to her pocketbook, but to the pocketbook of us all. It's important to the quality of care she will receive. Positive change doesn't usually happen when we are passive, but when we get up on our high-horse a bit and require that it happen. Our healthcare system can use quite a bit of positive change. Let's make it better.