Sorry Captain, there's no transparency in medical pricing

Just what the doctor ordered
Just what the doctor ordered

In the 1990s I used to go to a decent family seafood restaurant in the Coolidge Corner area of Brookline: Captain’s Wharf. The restaurant was pretty successful and underwent a nice renovation. Soon after it closed, which was a surprise, but the building was soon put to a better and higher use:  Coolidge Corner Imaging — an outpatient MRI/CT center.

I thought of Captain’s Wharf recently when I read a Kaiser Health News story about a consumer who did his darndest to find a good deal on a CT scan, finally settling on the $475.53 price at Coolidge Corner Imaging.

But the bill he got later was for $1,273.02 — more than twice as much — from a hospital he had no idea was connected to the imaging center.

“I was shocked,” said White, a doctor of physical therapy who thought he knew his way around the medical system. “If I get tripped up, the average consumer doesn’t have the slightest chance of effectively managing their health expenses.”

The patient wasted tons of time and effort trying to get the problem cleared up. He cared since he had a high deductible plan.

In my view, high deductible plans are a pretty crude instrument to encourage cost consciousness and price transparency. I switched to a high-deductible plan recently because the premium was so much lower –as a business owner I pay the whole premium in any case. It has no real impact on the way our family uses the insurance. The main impact is that I struggle more to understand the medical bills and EOBs that arrive. In particular, once one dependent met his deductible I kept getting confused by new bills that arrived asking for the out-of-pocket payment.

Were these expenses not subject to the deductible? Was the date of service before the deductible was met? It was hard to know and I’m still unclear. What is clear is that my administrative cost is higher from trying to deal with the nonsense.

Meanwhile, on the lower end of the income spectrum are people with high deductible plans who are afraid to use their benefits for fear of the deductible. That’s an indirect subsidy to folks like me, because when people hold back on running up a bill it holds down overall expenses.

High deductible plans are pretty lame. Transparency isn’t here yet and even then it will only be part of the answer. Can’t we do better?

Image courtesy of stockimages at

By healthcare business consultant David E. Williams, president of Health Business Group.


June 1, 2015

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