What Is The Actual Cost Of An Employee’s Doctor Visit?

cost1111There is a lot of discussion about the costs of healthcare, both for users and their employers if the employer is providing insurance.

Side Note: We have seen claim experience that document average cost of a doctor visit is $700. Yes, that’s correct, $700. This includes doctor charges, lab test, radiology, prescription drug/s. Consumers, shielded by low co-pays don’t see this, nor do they care. Four office visits in a year could eat up the premiums paid toward coverage. This is not insurance………….

What is the actual cost of an employee’s doctor visit?

By Tim Cummings

Published January 12 2017, 1:26pm EST

Do you ever get one of those social media posts with the math equation to solve? Something like 7 + 7 / 7 + 7 x 7 – 7 = ? Usually, the answers submitted by posters vary widely. Usually, the wrong answers come from seeing the equation, but mentally “understanding” it differently than as it is written.

Trying to identify the actual cost of a team member’s doctor visit is a lot like solving those math equations. We have to break apart each component and make sure the pieces add up properly.

There is a lot of discussion about the costs of healthcare, both for users and their employers if the employer is providing insurance. Before investigating the costs, let’s have an understanding. Medical insurance is, in most cases, a misnomer. Only the high-deductible stop-loss policies are truly insurance. These policies are invoked after medical expenditures on the part of the policy holder have exceeded a pre-established level, relieving the policy holder of any further liability.

Also see: “Benefit pros on the move.”

The health insurance we normally discuss is more appropriately considered as pre-negotiated access to healthcare at set pricing levels. This gives us a base to begin the cost calculations, but it is only a single component of a complex equation. So, what does it cost when an employer’s team member needs to visit the doctor? And for a second question, who does it cost?

The simple answer is that it costs the team member their co-pay and the employer some additional amount to the doctor for the balance of the cost of the visit. For the sake of this blog, I am going to set some rates for the purpose of a fair analysis. You may feel the figures are too high or too low when considering the plan(s) to which you have been associated. At least work through the analysis and feel free to change the dollars to whatever you are currently experiencing.

When a team member decided that he or she must see a doctor, the scenario goes something like this:

  • Calls the doctor’s office for an appointment time or plans to attend a “sick call” session.
  • Notifies work that he/she needs to take a half day/full day off.
  • Travels to the doctor’s office
  • Checks in and pays $30-$35 co-pay (or more)
  • Waits to be seen; is finally directed to an examining room
  • Has 30-45 minutes of interaction with staff while waiting for the doctor
  • Is finally seen by the doctor — average time 4-7 minutes for the consult
  • Waits for staff to follow up and check him or her out
  • Travels home or on to work

Considering the obvious costs, this bill may run $100-$150 dollars for a general practitioner visit.

True costs
The cost may be higher if the team member goes to an urgent care or emergency room because the physician cannot see him/her for several days.

But, there are other costs to be considered. Let’s consider costs on the team member’s side of the ledger. This visit costs the employee in lost wages or lost vacation or sick time. With a half day taken, this is 10% of the weekly salary. Then there are transportation costs to travel to the doctor’s office, perhaps parking fees, and there could even be extra fees for dealing with extra childcare if the visit requires an interruption to the regular schedule for family childcare. This might mean a spouse has to take time off work to manage the childcare. All of these additional expenses, while rarely stated, weigh heavily on the decision to visit a doctor, in office. The net result of these costs tends to cause the team member to delay the doctor visit, ultimately increasing the cost of care.

An effective healthcare strategy for any employer should include an understanding of these costs and develop a strategy which permits the team member to speak with a doctor from the work place as an entry level to treatment. Such a strategy would reduce these additional costs experienced by the team member and could encourage them to seek treatment earlier, thereby reducing the actual time and cost to treat illnesses. A private ‘video visit’ with a doctor from the work place, that can be immediate or conveniently scheduled, with the preferred doctor or specialist of choice, can be the lower cost first option choice for both the team member and employer. The result can lead to a culture of more preventative care and better healthcare choices.

Tim Cummings

Cummings, PE, is CTO of Universal Health Advisors.

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