By Becky Wiese
The mindset of patient as “consumer” presents a relatively new perspective in healthcare. For many years, patients were bound by the constraints of their employers’ benefits packages, especially regarding healthcare. Once insurance became so costly to provide, companies started narrowing the possibilities as far as eligible physicians (only if the physician was in your company’s insurance network, for example), specialists, and hospitals.
Networks and HMOs morphed into Preferred Providers and various other iterations of providing healthcare coverage. Under most of these types of packages, the patient still didn’t know or need to make decisions regarding certain aspects of their health coverage — they simply went with whatever hospital, doctor, or specialist was in their plan.
Now, under the ACA guidelines, which require all US citizens to have healthcare coverage (whether it’s provided by an employer or not), in addition to the changes companies have made to their health benefits due to increasing costs, the patient as consumer now stands front and center to face the costs of healthcare, especially in regard to some tests and diagnostic procedures.
According to John Hesse, Vice President of Business Development at Advocate BroMenn Hospital, although the patient may have more freedom to choose where they go and whom they see, they may also bear a larger portion of the cost, as deductibles and co-pays have increased to shift more of the burden squarely on the patient’s shoulders, or checkbook, to be more accurate.
Thus, patients need to be aware of the fact they may literally save money by shopping around to get certain tests and procedures done — things like MRIs, CT scans, or mammograms. Thinking and planning in advance is highly beneficial — largely because you don’t care so much if you’re in an acute situation; you just want to get the information you need so that the physician can diagnose and prescribe a plan for returning to health.
Sitting in your doctor’s exam room during an annual physical or when bothersome issues are getting more irksome but not yet critical would be a good time and place to start asking questions.
However, patients need to realize that their primary care physician likely does not know the ins and outs of financial costs for all the tests and procedures they recommend. The doc is a great place to start, but patients should also talk with someone in the finance area of the office regarding payment options and insurance benefits as well as be willing to do some research on their own.
In addition, patients should have an idea of what their own insurance policy covers. This will be helpful as they do their research to find out the costs and other considerations of different types of tests and diagnostic procedures in order to make an informed decision.
Some questions and issues to consider include the following:
- What is the cost of the procedure or test I need? Does this cost include a physician’s interpretation of the results?
- Is the equipment the latest technology (does it need to be)? What is the accreditation of the office staff?
- How easy is it to get an appointment? How soon will I get feedback?
- Where is the office located? Is it easy to get in and out the door? Is it comfortable and inviting?
- Will I talk with a local person in the office when I call with questions or will I talk with a centralized call center?
- Do you accept my insurance?
- Do I have to pay a copay? Do I pay all of the costs up front and get reimbursed, or do you submit to my insurance and I pay the difference?
- Do I need a referral (either due to insurance requirements or testing center requirements)?
It may take a few years, but eventually, patient-consumers will become accustomed to doing a little research prior to undergoing various tests, procedures, and even elective surgeries. The notion of “getting more bang for your buck” will apply.