Friday I went to my annual physical exam and was asked to pay a copay for the visit. I am a non-confrontational person, but for once I spoke out. I took a deep breath and asked, “So when do I get my free ‘routine physical exam’ as promised through the Affordable Care Act preventive and wellness legislation?” The staff person’s response? “Does your plan include a free wellness exam?”
Since I do know health insurance programs pretty well and understand the differences between grandfathered, grand-mothered and compliant benefits it was easy to explain that yes, indeed, I did have a plan that fell into the “free” spectrum of fees. But how about the next person checking in? Had I not known and naively paid my copay would I have gotten that money back after the visit had been filed with the insurance company? I leave you to guess at that answer.
We need to be aware that front desk personnel may not ask about our coverage, but simply make some defensive assumptions. It is imperative that if they don’t ask we need to tell them what we know.
At the front desk I had noted that there was signage announcing a $10 fee if I had failed to bring my insurance card or if the office had to check benefits for me. Wow. I guess it is time for all of us to become much more conversant on our health insurance benefits than at any time in the past. And yet, who can get a straight answer when we ask about what is covered and what our costs will be?
We can call the insurance carrier and ask if something is a covered charge and, of course, they cannot answer because they do not know what will actually be done. Well, since the procedure has not yet been completed we can go to the provider and ask what services will be included so that we can determine how much to budget, and guess what. They can’t tell us either since the procedure is not yet completed and there are many unknown services that could be included. No easy way to make financial decisions.
Earlier this same week my husband decided to go to an urgent-care center since he could not get an appointment with his physician. Imagine his surprise when he was charged five times what it said on his card. He went into the facility with symptoms of dizziness. He came out with symptoms of incredulity and rage. Is that really the desired result when we access medical care?
So we ask, is the office visit copay we pay just the entry fee? Lab work and x-rays are now routinely unbundled and applied to our deductibles separately from the copay we paid to get in the door. Can we really get an MRI for $150 when elsewhere we are quoted $12,000 for what is supposed to be the same procedure?
There is much discussion about transparency in costs, but how is that possible when each scheduled procedure can prompt the need for additional services. In many cases we do not understand why we are being put through medical procedures and we certainly do not know the cost. Just as medical providers take defensive positions on benefits billing, I believe that we need to ask questions and practice some self-defense to protect our wallets.