Medical Costs: Still a Guessing Game?

The same drug, the same procedure, the same test but prices can vary greatly depending on who provides the service. Patients have a RIGHT to know the price so they can make smart choices or set up a payment plan.

Any consumer knows that the secret to staying on a budget is comparing prices when you shop.  In today’s world, the internet gives us excellent resources to do this easily. We search for the best price. That’s easier said than done in America’s Health Care System, where the prices for doctor visits, diagnostic tests and surgical treatments can be hard to find out in advance. 

Only 14 of 50 states in America have laws that call for “Price Transparency” – knowing the cost of care before it’s done. 

Now President Trump has proposed “Price Transparency” for all healthcare providers.  The goal is to help patients shop around for a CT scan, MRI scan, or even a hip replacement; the same way they shop for food, clothing, and shelter. 

Ohio politicians also dipped their toes in the “Price Transparency” swamp.  The Ohio House of Representatives and Senate unanimously passed the Healthcare Transparency Law in June 2015.  Gov. Kasich promptly signed the bill shortly thereafter. 

But the Ohio Hospital Association (OHA), joined by the Ohio State Medical Association (OSMA), had a judge issue an order preventing the law from going into effect on January 1, 2017-an astounding 18 months after it was enacted. In 18 months, these groups could not establish regulations that insurers agreed upon. Everyone is looking out for themselves regardless of what is best for the patient.

All parties involved have given lip service to this Healthcare Transparency Law yet it has been legally blocked from taking effect. They claim the problem is lack of  available information because of too many contracts with different prices.  It’s hard to believe that Big Hospitals do not know the upfront costs of their own CT scans, cardiac stress tests or hip replacements.  It just does not ring true.

Smaller practices typically use the same 25 medical codes, so they should be able to easily create a cost estimator for those top codes. The patient will need to understand that this is simply an estimate. Once the claim is filed the insurance carrier could leave more or less responsibility to the patient.  A reasonable percentage of variance should be easy to establish. Typically an estimate is just that – it could vary 5% more or 5% less.

There’s just no need to keep healthcare prices a guessing game.  Our Governor, The Honorable John Kasich, needs to hear from you.

Governor Kasich can be reached at 614-466-3555. Call him or his staff and tell them how you feel about this issue. Your voice really does matter. 

And don’t just stop there.  Next time you are at a doctor’s office or getting a CT scan or having surgery, ask what your out-of-pocket cost will be.  You do have time to shop around.  Medical costs should not be a guessing game any longer. 

I know what I am talking about.  First Dayton Cancer Care has been providing upfront, out-of-pocket cost for patients since opening in 2003.  It is just the right thing to do. 

If you have any questions about your cancer, its diagnosis or its treatment, call me, Dr. Edward Hughes, at 855-DAYTON1.