Medical Costs and Billing Needs to be More Transparent

I have my fair share of doctor appointments. In fact, I've probably had more than my share over the past 11 years since my migraines went chronic. Over the years I've grown increasingly bothered by the way billing is handled. 

We make an appointment and we check to make sure the doctor is covered by our insurance. Then before we can see the doctor we have to sign a paper giving permission to be treated, to have our insurance billed for the treatment and vowing to be financially responsible for anything that isn't covered.

I get why we have to sign this paper. The doctors and practices need to protect themselves BUT there are no financial protections in place for us as patients.

Let me explain. 

1. We never see an itemized bill. The insurance company gets a bill and they make adjustments and payments based on that bill. Then, when applicable, we receive a bill for whatever portion we are responsible for. We never have an opportunity to verify anything in that bill. 

Call me crazy but doesn't that open this entire system up to fraud and mistakes? How much money is being wasted because there is zero transparency for and accountability to patients for the billing process. 

2. Nobody can help us figure out what something is going to cost in advance. Considering the high cost of every single medical encounter, I find it outrageous that pricing isn't readily available and disclosed to every patient, every time. 

For example: I went to see a physical therapist several years ago. We started our sessions at the end of one year and it continued into the beginning of the following year. I never saw a bill early on because I had met my out-of-pocket maximum. It wasn't until the new year that I saw what was being charged. To my horror, I discovered that I was being charged more for appointments when I asked questions than when I didn't. 

The physical therapist I was stuck with was super obnoxious and she felt the need to drone on and on about her farm and her horses and other shit I just didn't care to hear about, so often I would try to redirect the conversation by asking about my progress and getting ideas from her about things I could do better. Turns out, every time I did that I, she charged more for the appointment. So me and my insurance both paid her more money simply because I didn't have the energy to try to pretend to care about her personal life. I had nothing in common with this woman and I don't think it's right for her to fill silence during our appointment with personal stories. If we had to talk I wanted it to be about something germane to my appointment. 

I wish I had been told in advance that my appointment would be more expensive if I asked questions. Let's not gloss over the fact that asking questions during a pt session SHOULD NEVER COST MORE. 

Cost needs to be transparent and formally discussed at every stage along the way. Basic costs should be discussed before every appointment of every kind. Then if the doc needs to do more that should be discussed at the time. Then before leaving both parties should sign off on all of the expenses that were incurred.