Cost of care is just as important as quality care

I didn't land a news reporter job right away when I first graduated from college with a journalism degree. So I took the first job offered to me as a customer service representative for a major health insurer. Basically I was yelled at eight hours a day by people upset that their doctor visits, hospital stays or prescription drugs weren't covered for one reason or another.

My job was explaining to customers why their policy didn't cover a particular procedure or office visit or helping them appeal claims denied in error. But the hardest calls were the ones where there was no recourse because the customers had allowed their coverage to lapse for even one day and now had a 180-day waiting period before coverage would take effect. Those one-day lapses occurred frequently and, sure enough, that 24-hour period was when the uninsured customer became gravely ill or was in an accident and landed in the emergency room.

I empathized with them but could offer little more than a sympathetic ear. Those calls remain etched in my memory and are likely the reason I am so careful to make sure my family has necessary insurance coverage--even when it meant paying astronomical monthly COBRA premiums after my husband was laid off from work. When he even suggested that we allow our coverage to lapse because the odds were in our favor that we'd remain healthy, I launched into a mini-tirade, telling him all the horror stories from my customer service days and warning him those monthly premium payments would pale in comparison to the bills we'd incur if one of us did become ill or hospitalized.

So I was fascinated this week to read Andrew Gray's first-hand account of what it was like to be an uninsured healthcare provider facing an emergency appendectomy. Gray, a physician assistant at a Beverly Hills HIV clinic, was fairly new to the job and only recently became eligible for health insurance. But because he neglected to fill out the necessary insurance paperwork, he now faced an operation and God knows how much in out-of-pocket costs for the surgery and related care. The attending physician, surgeon and nurse weren't concerned about the cost of his care--only that he received appropriate care.

And those caregivers were right--Gray's care should have been their top concern. But Gray also had a legitimate concern. He had a right to know how much the appendectomy was going to cost him, particularly when he asked doctors to consider the results of a Swedish study that successfully treated appendicitis with antibiotics. All patients--whether insured or uninsured--should have pricing information for common procedures. Cost is an important factor and if there are less expensive alternatives available, patients have a right to know what they are and have a say in their course of treatment.

Insurance isn't necessarily the determining factor either. Despite the relief of knowing I have insurance, there have been times when I've debated whether to seek care at the emergency room, which will result in a bigger copayment, or wait a few hours until my doctor's office opened to make an appointment and save unnecessary out-of-pocket expenses. And though a doctor's visit may sometimes be the better, more economical choice, it isn't always the best one.

After his experience, Gray wrote that he is more sensitive when patients at his facility question the cost of services and treatment options. If he doesn't have the information at his fingertips, he makes an effort to find out. More hospitals and health systems should follow Gray's lead. Pricing transparency does matter--patients demand it... and they deserve it. - Ilene (@FierceHealth)

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