I recently went to my local ophthalmologist in order to obtain a new eye glasses and contact lens prescription. Even though I’ve had Coke-bottle glasses since I was 9 years old, I have no other health complications. I never imagined that my plain vanilla eye exam would rack up a $600 bill for a procedure that I should have opted for at Costco costing around $100.
What I thought of as a routine eye exam brought me face to face with the inefficiencies of the health care market that we as patients with insurance are often blind to. However, with the rise of high deductible plans that put more of the burden of health care costs on individuals, we’re going to have to start acting more like consumers.
A few weeks after my visit, I received the bill for the eye exam. I have a high deductible plan so my insurance only paid about a third of my bill — leaving me with a hefty balance of $400. I called my insurance company to find out what accounted for this.
They informed me that the doctor categorized the eye exam as a medical procedure — diagnosis: myopia and dry eye. “Dry eye?” I asked, “I don’t remember coming in for dry eye.” I scanned my memory and then it came to me. The doctor after examining my eyes told me that they looked a “little dry” and every once in a while, I could put a hot wet towel over them. That was it. Those remarks justified the billing as a medical procedure.
The office also added an extra $45 because I was considered a new patient even though I had already been there two times. Evidently, every two years at this office, they act like they’ve never seen you before.
Needless to say, I was incensed.
Here’s what I think happened:
Seeing that I had private insurance, the medical billers probably assumed that my insurance would pay the whole bill, no matter what they coded. So they were incentivized to lay it on thick. They probably didn’t count on the fact that I had a high deductible plan and that the rest of the balance would be kicked back to me.
But to be honest with you, I can’t blame my ophthalmologists’ office. The circumstances that led to my $600 bill for a routine eye exam is a systemic problem, not one that has to do with my doctors in particular. I think that because of the low reimbursement for Medicaid and Medicare patients, coupled with the high cost of malpractice insurance in this country and the high overhead costs for hospitals and clinics, providers have to game the medical billing system in order to stay in business.
We as patients have to learn to be smarter. For the first time there are new tools available that can actually help us actually shop around. Can you imagine going to a car dealership and purchasing a car without looking at the sticker price? No. And now these companies can help you do the same with health care.
What these companies promise, that has never before been available in the health care market, is price transparency. We have yet to see if this new marketplace can substantially lower health care costs overall. But as more and more patients like me are left “holding the bill,” I can’t help but imagine that it will.