Have you ever bought a durable medical device? If so, did you get a good deal on it, or are you like most people – insurance paid, and you have no idea about its cost?
Sleep apnea may be one of those over-diagnosed conditions. My dad “snored.” I have “sleep apnea.” My guess is that he and I shared the same likelihood of a heart attack or stroke from snoring, and in fact, he did have a stroke – at 85. I am fairly sure it was not from snoring – er, sleep apnea.
Regardless, my doctor prescribed a CPAP. Unlike many that find the CPAP mask claustrophobic, I did not. From the beginning I slept better and felt more rested. My wife, by the way, also slept better as a result of the quiet whoosh of my CPAP instead of thunderous, room-shaking snoring.
Two years ago I had to replace my CPAP. Clutching tightly to my Health Savings Account (HSA) card, and carrying the knowledge of my $5,960 deductible health plan, I went prepared. Allina’s staffer showed me this slick, small unit. The H2O chamber and the blower were built into one device, easily separated for maintenance and carrying.
“Looks good to me,” I said. “How much does it cost?”
You would have thought I asked “When was the last time you went to Mars?”
“I don’t know,” she said.
When I pressed her for the price she became defensive. I reminded her that in Minnesota the law requires Allina (all medical providers) to give me a price for medical services and products prior to my receiving or purchasing them. “The law requires you to give me a good faith estimate,” I said. I believe for a moment she thought I had her confused with an auto mechanic.
“Well, I don’t know,” she said, protesting, defensively, and revealing her ignorance. “You should call our business office.”
The business office manager knew the law and answered immediately. “$200 a month for a 10-month lease,” he said.
“But I don’t want to lease it,” I answered. “I want to buy it. How much does it cost?”
Hold on to your seat now. The answer is astonishing, especially considering that perhaps 1 out of 1,000 bother to ask the question. “$1,395,” he said. I bought it.
Just in the first 10 months I would have spent $2,000, and Allina would still own it. I never asked how much a new lease would be, or whether they had a “used CPAP lot” to which they sent suckers – er, I mean insured people – when the lease expires.
I saved at least $1,005 the first year. The second year, at least $2,400. But none of this would have happened if, 1) I had a standard PPO health plan with a low co-pay, 2) would not have asked “How much does this cost?” 3) owned a Consumer-Directed Health Plan with an HSA.
My purchase represents billions of wasted healthcare spending each month, and tens of billions wasted each year. And the motivation for me started and ended with the financial transaction, with me acting as a purchasing consumer.
Today, Allina calls to tell me I need new hoses, masks, filters, pads, and so forth because “your insurance covers it.” Could be, but I’m paying it, and my mask is just fine.
Dave:
ReplyDeleteKeep blogging! I learned to do this many years ago when I opened a Consumer Health Resource Center with some colleagues in Illinois. One of the other founding Directors owned a medical equipment company and supplied oxygen/respiratory equipment to patients. At the time I was receiving TENS therapy for back pain management and biofeedback. I learned from him that I could purchase a unit for under $200; whereas, the treatment provided at a physical therapy provider cost upwards of $150 a visit. Needless to say, I also purchased the equipment. The biofeedback machine was under $200 as well. Patients who need equipment should ALWAYS ask about purchase and then contact their insurance company to see if they will cover the purchase in lieu of rental.
We also discovered that as a private pay patient you can obtain braces for a fraction of what the insurance company pays. You can then submit the itemized bill for reimbursement from the carrier. Again, this all goes back to "claims are paid out of your premium", or better known as YOUR MONEY.
How about exporting this concept to physicians charges? And what are they based upon? Perceived value? $$ brought intomhospital (proceduralists)? I believe the big white elephant in the living room are physician charges, and by extension, physician salary discrepency. I personally see hand surgeons command close to $1,000,000/ yr in a hospital employed environment while the the family practitioners and peds docs are lucky to squeeze out of the hospital a salary of $165000! in my view, this is crazy, significant over valuing and undervaluing of physician services. I think an entire restructuring of physician salaries along a value based paradigm would go a long way to aligning incentives throughout the healthcare delivery m. (FYI, I have no bone to pick in this fight as I am one of the more highly paid specialties out there)
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