Health Care System Fail : It’s Your Money and your Health at Stake
As your stereotypical male, I don’t go to the doctor often. I believe that if given ample opportunity the amazing human body can usually heal itself. I don’t go for an office visit unless something has been nagging me for weeks, or a body part has ceased to function. My lack of enthusiasm is reinforced by the fact that almost every time I do decide to make a venture into getting some medical treatment I’m reminded of just how messed up our health care system is.
Take my most recent experience as an example.
While I may be reluctant to go to the doctor when ill, I do place a high value on my annual preventative exam. While making the appointment, I was told I should come in and have blood drawn a few days before the physical so the doctor could go over the results with me. I asked if a Prostate-Specific Antigen (PSA) test would be done as part of my blood work. The person I spoke to indicated they would have to check on that, and get back to me.
When a nurse called back, she said that they did not do the PSA as the standard blood work for two reasons:
- It was likely not covered by insurance
- The doctor favors a physical examination of the prostate
Healthcare System Fail #1
First, my health insurance DOES cover the PSA test under preventative care. Which leaves the second reason as really the only reason they don’t do the test. I’ve had this conversation with my doctor before. There is no normal level of PSA in a male human, therefore by itself is not a good screen for prostate cancer. My doctor doesn’t like to order unnecessary tests.
However, I know a little about PSA tests because my father was diagnosed with prostate cancer. His doctor also favored a physical exam, and was told everything was OK. My mother insisted upon a PSA test as part of his blood work, and they found that it was elevated compared to a baseline test done a few years earlier. That prompted more testing, and cancer was found.
By itself, a single PSA Test is not very useful. But a baseline test along with a series of yearly results would help signal a problem if the results changed significantly. According to my father’s surgeon who removed his prostrate (highly regarded as one of the best in his field at the Mayo Clinic) the best way to get an early diagnosis of prostate cancer is to have both a physical examination AND a PSA test done yearly.
One would think that this would trickle down to other physicians in the field. One would think that doctors would at least relay this opinion to their patients as a possible option.
But thanks for trying to save my insurance company some money at the potential expense of my life.
The nurse then told me that I could request to have a PSA test done, and the approximate price would be $199. She emphasized that was the approximate price, and said that if I wanted to add it to the lab work order to just let them know.
Healthcare System Fail #2
I simply cannot believe that the best they could do is give me an approximate price. Why can’t they tell me exactly how much the test is? I understand there are prices charged by the medical facility, and then there are insurance negotiated prices. BUT, they have all my information. They should know what their price would be, and given that they have my insurance information they should know what my insurance coverage’s negotiated price should be.
How can I determine if I can afford the test if they can’t tell me how much it costs?
I decided to have the test done. I have plenty of funds in my health savings account (HSA) to cover the fee.
When dealing with health care, you must assume that the only one that really has your best interests in mind is YOU. Doctors will order or not order tests based upon their own subjective opinion. Hospitals and Clinics will brush you off by giving you approximate costs. Insurance companies will make up reason to not cover your expenses. You have to get second opinions, do research, make phone calls and fight for what you know is best for you.
Ugh, and my wife wonders why it’s so hard to get me to go to the doctor.
Brock is a software engineer by day and personal finance blogger at night. He is a fitness junkie and enjoys grilling and smoking meat. Married with two children, Brock strives to improve his skills as a husband and father, and is always on the lookout to stretch his family’s budget as far as he can.
I find it endlessly frustrating that non one, not the doctor’s office and not the insurance company, seems to be able to determine in advance how much a procedure should cost. Not sure why its so complicated!
My friend was shocked because she didn’t expect her hospital bill exist! She asked her health care insurance about it, but they failed to explain to her briefly.
I view most doctors as I would view an auto mechanic. They are mostly there to crank out charges, not to ensure you get the best care. You are exactly right Brock – you have to be more informed these days and take your health into you own hands. Doctors and the insurance company certainly won’t anymore!!!
That is frustrating, but remember that nurses don’t deal with billing. That’s an entirely different department.
So nurses/doctors can tell you what *most* insurances cover, but they don’t handle the nitty gritty. I’m guessing most companies don’t cover it, leading to them giving you the wrong information.
When asking what things will cost, it’s usually fastest to check with insurance directly. Otherwise, just ask the nurse to transfer you to the billing department if there is one.
Also, I know it’s frustrating when you have to push for the exact level of care you want. But also realize that doctors aren’t concerned about saving the insurance companies money. They’re trying to keep the patient’s bill lower.
If they run a test/procedure considered unnecessary, insurance may not cover it at all or there may be a steep co-pay. And even if the test is covered, a fair number of people — especially as more people find ways to go into business for themselves — have private insurance through the health care exchange. Those tend to have *huge* deductibles.
So running tests that they don’t think will help just means that doctors are (in their eyes) unnecessarily costing patients money.
That said, I’ve had similar situations where I had to push to get what we needed. Once in Seattle, Tim’s MRSA infection was making his forehead swell. It got to be so bad one of his eyes was kind of pushed down.
We went to the ER, and the doctor refused to do anything. He said, “You don’t know how many of these I’ve seen.” Which was hilarious because this was literally the 20-something-th boil we’d had to deal with in the past 18 months.
I had to talk to a supervisor and even so, all they did was a CT. They didn’t find anything, and we were sent home. The next day he got in to see his dermatologist. Some of the pus (sorry, gross I know) had hardened, so the site wasn’t draining. Hence the swelling. The dermatologist was shocked that the doctors had missed it/refused to lance it.
Grrrr and double grrrr.
@Ali – I know……I think it’s more of a “I don’t want to take the time to figure it out for you.” Which is SAD.
@Clarisse – In those situations, I would keep calling and keep demanding answers until they answered my questions to my satisfaction!
@Derek – And it’s sad that it’s come to that. I had a physical TODAY, and I kept on watching what I said because I didn’t want my physical to turn into an office visit. It’s stupid that should have to be the case….
@Abigail – Sometimes I end up talking to Billing at my health provider AND calling insurance. You’d be surprised at how often the disagree on how much something will cost. 🙁 Thanks for sharing your experience…..another example of how hard it is to navigate the medical care system!