Patient Describes Experience At Methodist – San Antonio

The following email was sent to us by a San Antonio client whose self-funded health plan of 400 employee lives has been on a Reference Based Pricing model for over ten years. If more consumers like this one would ask what medical services costs beforehand and “vote with their feet” then health care costs will drastically reduce and employee wages would go up.

How many times have you asked what something costs and the answer is “Don’t worry about it, your insurance will pay for this.”

Bill,

Just FYI, I had to get an Echocardiogram last week.  My cardiologist (owned by the Methodist system) wanted to do it “first available”, so they scheduled me at Texsan.  

When I got there, I spent about 45 minutes while they checked with my insurance.  I was given their print out that showed I had an individual deductible of $4,000 (which is not correct – mine is $2,000), and that my OOP was going to be $561.00.  

When I asked what the total billed charge for the procedure was going to be, that completely flummoxed them.  It took another 20 minutes for them to figure that out, coming back and finally telling me (there were two people from the billing department who came out in the WR to talk to me at this point) that the charge was a nice round $6,169.87.  No telling where that came from.

As politely as I could, I told them that I was self insured, and that I thought that charge was obscene.  An Echo is a 30 minute procedure.  

They apologized, but I said I was going to go somewhere else.  I expressed that they should tell their CFO that I thought that charge was outrageous.

I knew our insurance would reduce it down to something more reasonable, but they just pissed me off with that BC.  

I got the procedure done the next day at my Cardiologist’s office for a BC of about $560.00 (which Our insurance will also probably reduce).  So, same procedure; same company – one in a hospital and one in a drs office with a differential of about 11 times the fee.  How absurd is that?

The Echo was normal after all.

I don’t need/want you to do anything about it.  I just wanted to let you know that I expressed/protested in the best way I could: I voted with my feet

WRITE RISKMANAGER@RISKMANAGERS.US

FROM INSURANCE CONSULTANT

Great story and so enlightening…I took a quick look at bundled (professional and technical) Echocardiagram (CPT 93306) for Medicare in San Antonio ($202.50), Dallas ($214.69), Austin ($216.78) and Houston ($215.79).

Billed charge from Methodist is crazy, and the “experts” at Lockton are supposedly building a narrow network using Methodist.

FROM ERISA ATTORNEY

The Revolution is here…

FROM IN-HOUSE PLAN SPONSOR ATTORNEY

Bill, I hope all is well.  That is amazing.  It’s good you didn’t have the echo done there after all because it probably would have been way high after hearing their price!

FROM HR DIRECTOR

I like this story!  Thanks for sharing.

FROM TPA SALES REP.

That’s what it’s all about.