Opaque Answers

Sept. 1, 2006

Last year, my doctor ordered two blood tests, simple ones but tests that would have to be repeated several months apart. For the first set, I hand-carried his written orders downstairs to the medical lab associated with the practice, where a tech drew blood and bid me farewell. Two weeks later, I received a bill for $15, my cost-sharing portion of the event.

Last year, my doctor ordered two blood tests, simple ones but tests that would have to be repeated several months apart. For the first set, I hand-carried his written orders downstairs to the medical lab associated with the practice, where a tech drew blood and bid me farewell. Two weeks later, I received a bill for $15, my cost-sharing portion of the event.

For the second set of tests, I went to LabCorp at 7 a.m., before heading to work. LabCorp is three miles from my home, not 20 miles from my home and another 15 miles back to my office, the trip entailed by using the internal lab connected with my physician’s practice. But before heading to LabCorp, I spent 45 minutes on the phone one evening with my health plan and two different customer service reps (CSRs).

I had only set out to learn, approximately, what my cost-sharing obligation would be with LabCorp. I knew I faced a $15 charge with my physician’s lab and wanted to comparison shop a little. I didn’t get answers to some of my questions, but my eyes nevertheless were opened to how little I know about health plans’ contracts with providers and how little information is disclosed to patients.

When I had asked the CSR how much LabCorp might charge, she said, “LabCorp can bill whatever they want, but what they will be paid is $9 and $12 respectively, according to our contract” and that my share was a fixed amount of that total fee. In the end, LabCorp did charge for a $9 blood test and a $12 blood test; two weeks later, I received a bill for $4.50 for my share.

The reason I paid $15 to the lab connected with my physician’s practice was because they billed the two lab tests as an office visit—straight from the CSR’s mouth to my ears—and $15 was my office-visit copayment. I couldn’t uncover what the health plan paid for the rest of the blood-drawing “office visit,” but I guesstimate it was in the $40 to $60 vicinity. The difference between a $4.50 copay and a $15 copay isn’t life or death to me, although I like paying less. But the difference between $21 and perhaps $60, for the same procedure, does seem more significant. Doesn’t my health plan like paying less too?

Most of us who work in or around healthcare IT must, at times, step out of our professional roles and become patients. As a patient, I couldn’t get satisfactory answers from my health plan to questions about pricing discrepancies and payment differentials. In spite of all the ballyhoo and grand-standing about the need for transparency of information to transform consumers into informed decision-makers, I came up nearly empty-handed from my telephonic pursuit of info about pricing, charges and policies.

It will require more than transparency for providers, health plans and the government to achieve a fruitful sharing of information with consumers. Why is the lab at my physician’s office allowed to bill for two blood tests as an office visit, and how much does my health plan pay toward that, when LabCorp must settle for a combined $21 in fees? When a relatively educated, relatively informed consumer like me can’t get meaningful answers to simple questions like that, perhaps the road ahead is a tad longer and the incline is a tad steeper than anyone originally envisioned.

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