By using this site, you agree to the Privacy Policy and Terms of Use.
Accept
Health Works CollectiveHealth Works Collective
  • Health
    • Mental Health
    Health
    Healthcare organizations are operating on slimmer profit margins than ever. One report in August showed that they are even lower than the beginning of the…
    Show More
    Top News
    health benefits of taking a vacation to reduce stress
    Relaxing European Destinations to Reduce Stress Risks to Health
    October 11, 2021
    pain management tips
    Managing Pain Differently: Alternative Pain Management Techniques
    January 12, 2022
    5 Ways to Promote Wellness in Your Home
    April 12, 2022
    Latest News
    What To Expect On A Meditation Retreat In Miami
    February 6, 2023
    Botanical Extracts That Should be on Your Health Radar
    February 5, 2023
    Navigating Medical Care as a Wheelchair User
    February 4, 2023
    4 Common Myths and Misunderstandings About Brain Injuries
    February 5, 2023
  • Policy and Law
    • Global Healthcare
    • Medical Ethics
    Policy and Law
    Get the latest updates about Insurance policies and Laws in the Healthcare industry for different geographical locations.
    Show More
    Top News
    Kratom – a Solution for Opioid Addiction?
    February 5, 2021
    English: U.S. President delivers the while sta...
    Obama to Congress: Quality, not Quantity of Care
    February 13, 2013
    Is The Future Of Injectable Drug Delivery In Needle-Free Devices?
    February 16, 2021
    Latest News
    Why Is a Referenced Based Pricing Tool Necessary?
    February 3, 2023
    Simplifying the Genetic Testing Process: How At-Home Kits are Changing the Game
    January 25, 2023
    9 Hospitals That Have Introduced Green Initiatives
    February 1, 2023
    Why a Health Retreat Can Be the Best Medicine
    January 12, 2023
  • Medical Innovations
  • News
  • Wellness
  • Tech
Search
© 2023 HealthWorks Collective. All Rights Reserved.
Reading: Still Missing: Price Transparency in Healthcare
Share
Sign In
Notification Show More
Latest News
meditation retreat
What To Expect On A Meditation Retreat In Miami
Health
Guide To Pursuing a Career in Nursing as a Foreigner in the USA
Guide To Pursuing a Career in Nursing as a Foreigner in the USA
Career
Botanical Extracts
Botanical Extracts That Should be on Your Health Radar
Health
Navigating Medical Care as a Wheelchair User
Navigating Medical Care as a Wheelchair User
Health
common misconseptions about brain injuries
4 Common Myths and Misunderstandings About Brain Injuries
Health
Aa
Health Works CollectiveHealth Works Collective
Aa
Search
Have an existing account? Sign In
Follow US
  • About
  • Contact
  • Privacy
© 2023 HealthWorks Collective. All Rights Reserved.
Health Works Collective > Business > Finance > Still Missing: Price Transparency in Healthcare
BusinessFinanceHospital AdministrationPublic HealthWellness

Still Missing: Price Transparency in Healthcare

Bill Crounse
Last updated: 2014/03/06 at 9:00 AM
Bill Crounse
Share
6 Min Read
SHARE

image

A few weeks ago, I saw my primary care provider for a scheduled physical exam or what the health ins

image

A few weeks ago, I saw my primary care provider for a scheduled physical exam or what the health insurance industry now likes to call a “wellness checkup.” If you recall, a major selling point of the Affordable Care Act (Obamacare) is that we are moving from a fee-for-service world to a place where value takes precedence over volume. Physicians will be rewarded for keeping people well. That is why most heath insurance plans, even those with high deductibles, now cover scheduled, annual wellness exams at 100 percent.

So imagine my shock and surprise when I received the explanation of benefits (EOB) summary from my insurance company for my wellness checkup. The first shock was seeing the total amount that had been billed to my insurance plan–more than $880. The second surprise came when I saw what my physician, or more likely his coders, had charged for my visit.

Actually, I had been charged for two visits on the same day. There was one charge for $300. That was for my wellness checkup. There was a second charge of $225 for an office visit. The remainder of the total charges were a vaccine administration fee of $36, and a charge of more than $300 for the shingles vaccine. The good news was that my insurance company would pay for all but $126 of the total charges. None-the-less, I decided to investigate a little to find out why my “wellness checkup” was costing both my insurance plan and me a whole lot more than I would have anticipated.

More Read

healthy food delivery service

The Benefits of Using a Healthy Food Delivery Service

Don’t Let These 3 Mistakes Lower Your Immune System
Best Money-Saving Tips for Health Managers
Shed Pounds Quickly – Unearth the 5 Weight Loss Aids
Why Modern Pillows Reduce Back and Neck Problems

imageAfter a call to the billing department at my physician’s office and another call to my insurance plan, here is what I learned. First, how was it that I was being charged for two, separate office visits on the same day? Well, it turns out that I was billed $300 for the wellness checkup, and an additional $225 for an issue that was discussed during my checkup. Now, the issue that was discussed is nothing new. I travel the world on business and I occasionally suffer from insomnia. During my physical exam, I mentioned to my doctor that I was still having problems with sleep. I told my physician that I didn’t like to use the sleeping pills he had prescribed previously because they made me feel groggy in the morning. I asked if he had any other ideas. He mentioned another drug that he often prescribes to help people like me, and I agreed to give it a try. Well, it turns out that that five minute discussion during my wellness checkup about my ongoing problem with insomnia was the reason for the extra $225 charge.

Now, let’s examine this issue. Isn’t the whole purpose of a wellness exam to survey the patient’s current health status, do a physical exam, review any medications the patient is taking, make any needed adjustments to those medications or recommend new treatment options? Well, that’s what I thought but apparently I was mistaken. The billing office told me that the discussion about my sleep problem was apparently outside the limits of my wellness checkup and hence the extra charge. Please! My insurance plan told me pretty much the same thing. I asked if this was a common practice, and here’s what they told me. The Affordable Care Act mandates that insurance companies cover wellness checkups in full. It is also expected that physicians will accept the discounts that insurance companies pay for these services. That being the case, it is now becoming a common practice for physician billing offices to code things in such a way that physicians can charge extra during wellness exams.

And what about that charge of more than $300 for a shingles vaccination? I mentioned to my insurance company that I was a bit on the fence when my doctor asked me if I wanted the vaccine. We discussed the pros and cons and I decided to do it, but we never discussed the cost. I told my insurance plan representative that perhaps my doctor should have mentioned the cost while discussing this optional vaccine with me, especially since it was priced at more than $300. To that she said, “Actually, I doubt that most providers have any idea how much the vaccine costs.” “Well, maybe they should,” I said.

Even though, I too am a physician, I am perplexed by these fees. I do understand that my doctor won’t get anywhere near the full $880 for my “wellness checkup”. It will be discounted by my insurance plan. But I wanted to vent just a little over what continues to be a significant  source of consumer dissatisfaction with our healthcare system—the complete lack of price transparency. Surely we can do better than this. What do you think?

TAGGED: price transparency

Sign Up For Daily Newsletter

Be keep up! Get the latest breaking news delivered straight to your inbox.
By signing up, you agree to our Terms of Use and acknowledge the data practices in our Privacy Policy. You may unsubscribe at any time.
Bill Crounse March 6, 2014
Share this Article
Facebook Twitter Copy Link Print
Share
Previous Article 8 funny icd10 codes his Eight of the Funniest ICD-10 Codes
Next Article Invest to Build a High-Performing Healthcare Marketing Team (Part 4)

Stay Connected

1.5k Followers Like
4.5k Followers Follow
2.8k Followers Pin
136k Subscribers Subscribe

Latest News

meditation retreat
What To Expect On A Meditation Retreat In Miami
Health February 6, 2023
Guide To Pursuing a Career in Nursing as a Foreigner in the USA
Guide To Pursuing a Career in Nursing as a Foreigner in the USA
Career February 5, 2023
Botanical Extracts
Botanical Extracts That Should be on Your Health Radar
Health February 5, 2023
Navigating Medical Care as a Wheelchair User
Navigating Medical Care as a Wheelchair User
Health February 4, 2023

You Might also Like

investing in senior care
Senior Care

5 Reasons Why Investing in Senior Care Is a Wise Choice?

January 30, 2023
Personal Injury Healing Tips and Strategies
Health

Personal Injury Healing Tips and Strategies

January 28, 2023
lifestyleWellness

Small Lifestyle Changes That Can Have A Big Impact On Your Well-Being

January 26, 2023
green hospitals
Hospital Administration

9 Hospitals That Have Introduced Green Initiatives

January 20, 2023
//

We influence million of users and is the most authentic source of information on healthcare business and technology news.

Quick Links

  • About
  • Contact
  • Privacy
Subscribe

Subscribe to our newsletter to get our newest articles instantly!

Follow US

© 2008-2023 HealthWorks Collective. All Rights Reserved.

Removed from reading list

Undo
Welcome Back!

Sign in to your account

Lost your password?