Wednesday, March 23, 2011

The Problem with Healthcare

My daughter needs eye surgery. Nothing major, she was born with a tear duct issue that causes teary eyes. Because she was born with 2 other health issues, the eyes fell to the bottom of the priority list. Now we are ready to deal with it and have been to 3 surgeons to determine the best approach and hospital. The first stop we made was to Boston Children’s who recommended an outpatient procedure. Being self-employed, we do not have great health insurance coverage so we knew we would likely be out-of-pocket for the majority of the cost. So we asked if we could get an all-in cost estimate (the surgeon, the anesthesiologist, the OR, – the total expected cost of the surgery) and were told no: they couldn’t provide it because they didn’t know how to create an estimate.

The third opinion was at Dartmouth Medical Center where we received a similar diagnosis and recommended out-patient procedure, so again we asked for a cost estimate. This time, they were able to give us an estimate (it took almost a month to get it) – are you ready? We were quoted $30,000 to $35,000. I was stunned when I heard the amount. I called the surgical coordinator back to get a breakdown and try and understand how a 10-minute outpatient procedure could possibly cost so much. After leaving 2 messages for her, another 3 weeks later I still did not have an answer. I kept thinking that if I were calling a car dealership about purchasing a $35,000 Lexus I would have a call back the same day.

So I called the surgeon directly and told her my story. She said she had no idea how much even her own fees were and when I told her the quoted amount of $30,000 to $35,000 she herself gasped. She said she had no idea how much it cost to have any of the procedures she performed. Despite follow up, it has been almost 2 months since our original appointment and no one can give us the breakdown of the estimated costs for her procedure.


The providers don’t even know how much they are charging. The healthcare system doesn’t know how to accurately create an estimate for services. The patients aren’t asking for cost information. What other industry can get away with this? I can’t imagine my clients asking about my fee structure and me saying, “I have no idea”.

My daughter needs this surgery but also feel that I have a responsibility to manage how much I will pay and how much my insurance company will pay for a routine procedure. If you are a patient and haven’t been asking about the costs of your healthcare, start asking. If you are a provider and don’t know your own fee structure, start learning. We all need to take a role in assessing reasonableness in cost of care. This is ridiculous.

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