The Covid-19 pandemic brought most of us face-to-face with the mysteries of our healthcare system. Despite the CARES Act, which was intended to make Covid-testing accessible and affordable for all, many people received extraordinarily high bills from testing centers, myself included. I went to an urgent care center to test for antibodies. The test was performed in my car, by a nurse, and the entire process took no more than 15 minutes. I was told not to worry about paying because I am a doctor... a week later I received a bill for $2750.
At BreatheMD, our patients file their own claims for Covid-testing. With the CARES act requiring insurance companies to cover all Covid-related costs, we felt confident our patients would get reimbursed. Instead, the insurance companies created roadblocks by changing the ICD-10 and CPT codes (at least 5 times since the pandemic started) and rejecting claims based on ‘incorrect codes.’
The absence of price transparency in our healthcare system plus having large institutions - hospitals and insurance companies - holding the monetary power, eliminates any chance of fair treatment for healthcare consumers. President Trump recognized this problem, and by law, hospitals are now required to list prices on their website in a consumer-friendly format. And while this is a step in the right direction, people with urgent medical problems don’t have the luxury of comparison shopping.
A small but growing movement has started amongst physicians and disillusioned insurance brokers to help healthcare consumers find affordable, quality care for non-urgent medical problems. While insurance companies and hospitals are essential for catastrophic care, chronic and less severe health problems are better served by a system where everyone knows exactly how much their care will cost before they receive it.
If you are interested in shopping for healthcare, I encourage you to look at sites such as ZocDoc, UberDoc, Sesame, BabylonHealth and FMMA (Free Market Medical Association.) Google “Direct Primary Care near me” and you will find physicians who charge cash but at fair prices.
Direct Specialty Care is for specialists like myself who don’t accept insurance but believe in fair, transparent pricing. This is particularly important for surgery, since the surgery center, surgeon and anesthesiologist all contribute to the total cost. I am one of the few ENTs in the country who lists surgery prices on my website (www.breathemd.org) with all those costs accounted for - no surprises. Eventually this will become the norm, but until then, don’t let the system take advantage of you.
Demand to know the full cost before you receive treatment!