Why don't we ask our Western doctors how much they charge for their services?
This is a brilliant question.
When people find out what I do and are interested in coming in for a treatment, the first thing they ask is: How much do you charge? I am willingly transparent about how much I charge for what I do. I am very comfortable with the conversation. With the intention of full disclosure and respect for my patients, my prices are listed on my website. Are they listed on your Western doctor's website? Does the hospital have a menu of services and rates? Never. Let's investigate why.
How do we normally operate in the world of commerce and service? We ask the price. Cost helps determine the flight we take, the house we buy, the hotel we choose. Cost is not the only decision-making factor in our lives, of course. Value, preferences, and quality come into play, but we feel very comfortable asking about the cost of things to help us make buying decision. At the retail market we ask: "These raspberries look delicious, how much are they?". "These shoes are dope, what's the price?". And in the land of service we ask: "How much do you charge for a massage?", "What does it cost for a cut and color?". We ask the nanny, the house cleaner, the mechanic. But once we move over an imaginary line into Western medicine, we stop. We don't ask our dentist, our physical therapist, our primary care physician, our surgeon, or the hospital.
In many places we are so interested in the price that we shop around. Like at the mechanic. We are going to get an estimated cost of the repair, and we may get a second or even a third estimate before deciding which shop to give your well-earned dollars to. Construction is the same. We are presently planning a remodel of our basement and kitchen and we are getting bids from a number of contractors. These bids help us make our decision about who to hire. Well, you might say, these are big money things and of course it is important to know how much you are going to pay and be able to shop around. I would ask the same about surgery, or an extended hospital stay. These could run you into the hundreds of thousands of dollars, yet no one asks.
Well, I am done with the silence. I have been thinking about this phenomenon for many years. And yesterday the last straw was added to the camel's back. I received a standard bill from my doctor, who I love and respect, for an annual exam I had a few months ago. According to what I know of my Lifewise Insurance benefits, my annual exams are covered; no co-pay, no co-insurance for this one visit, once a year. The bill I received said I owed 41.14 for the visit. The bill listed two office visit amounts for the same date. One for $175 and another for $75. So I called the billing department and ask why two visit charges for the same date, and stated that my annuals are usually covered in full by my insurance company. The lovely billing lady said that because I had asked about a mole and the doctor discussed possible removal and referral that that created the extra visit charge. This discussion was maybe 2 minutes long, 5 minutes tops. But it is not about deciphering what my doctor's time is worth. Go ahead, charge me what you are worth, but let me know you are going to do it!!!! It is about the unsaid things. What is so wrong about saying "OK, if you want to talk about that mole or any extra detail during your standard annual visit, it is going to cost you another $75". What is so bad about that? Then it is clear and clean. Then the charge is consensual. That is what makes sense and feels professional. That is what is important to me. I am super clear with my patients about cost and what I am going to charge them. I want them to be 'in the know'. I want decisions about cost to be team decisions.
What got my feathers ruffled about this bill, was not the money. Actually, the smallish dollar amount is what makes the point clear: It isn't about the amount, it’s about the lack of clarity. Please, by all means, charge what you are worth. Just let us all know what you are charging.
In reality we cannot change the way other people run their business, what they disclose or don't disclose. I don't see a nationwide revolution in Western medicine where they all start putting illuminated fee schedules up at the front desk, like a menu at McDonald's. So what can we change? Our practices. We can transform our silence into questions. We have every right to know what we will be charged for our doctor's service.
Let's keep in mind that the answers are rarely clear. Actually, many Western doctors don't know how much they charge. They account for their procedures by code, and each code has a dollar amount. And usually the billing department is in charge of this. But the billing department cannot tell you beforehand what codes your doctor is going to bill for. Hmmmmm. This gets us into the messy business insurance companies creating a very inefficient and expensive system. It is this system that has created the silence. People who think that their insurance is going to pay are less likely to ask questions about cost. Medical establishments and individuals who bill insurance companies for your visits are less likely to think that you even care about the price. Dare I say that this has created a system of deception? And because of this, the important empowering piece is that you ask.
Here are a few concrete actions you can take:
Call your insurance company before your visit or use their online services.
Be familiar with your coverage.
Ask the front desk for an estimate before you make your appointment.
Ask your Western doctor during the visit what each procedure is going to cost.
Request that they tell you if a discussion or variance will add cost.
We are trained to not do this. At some level we think it would be rude to ask. But it is not rude. It is an honoring or our right to know, and an assertion of our financial participation in the process. And when you receive a bill and are unclear about the codes, charges and costs, call the billing department and ask!
Here's the full transparency!
Reya
