What your copay was hiding all those years…

A public rant began on an large, campus-wide email alias at work today.  Those are just too fun not to jump right in the middle of!

Apparently, a coworker wore a contact with a tear in it, and it majorly irritated his eye.  It was bad enough for him to feel like he needed to go to his eyecare professional to have his eye examined.  His rant was that they charged him for a full office visit.  It ended up costing him $80 to sit in the chair for 15 minutes while the doctor looked into his eye and determined that there was nothing wrong.

He finished his rant with the question: “Is this normal [the charge associated with the office visit] and I’m overreacting?”

My short answer to him:

Yes, it’s normal and yes you’re overreacting.

But there was a long answer as well…

Here is some background, for those who don’t know the situation.

Last year, our company made some radical changes to its health insurance offerings.  Up until now, we have only had traditional In Network/Out of Network coverage offered, with the standard premiums and co-pays.  Last year, though, a “Health Savings Plus” plan was introduced.  It featured a low premium, high deductible ($3000) insurance policy coupled with a tax-free Health Savings Account (HSA).  The company seeded the HSA with $750 as well as offered health incentives for employees to earn up to $1200 more for the account.  This plan saves the company a lot of money by shifting the first $3000 of health care expense to the employee and banking on their laziness to not accomplish the health incentives.  The company really pushed this plan to the employees, though they continued to offer the traditional plans at a higher cost.  Of course, many employees jumped at the lower cost plan.

My coworker was clearly one of these guys who got onto HSP+ without understanding how it was going to work.  He balked at playing an $80 bill for an office visit to an optometrist!  That’s usually where you START for a doctor’s office visit.  That doesn’t include any labs or imaging you might have done, which can eclipse the doctor’s office visits in costs.

Really, this just goes to show that the beloved copay has been obfuscating the cost of health care to the general public.  This guy was outraged that he was “charged that much because that’s the most that UHC will allow them to charge for such a procedure, otherwise they would charge even more (that’s what they told me to try to make me feel better about this charge.)”  He was too used to going in and paying $10 or $20 out of his pocket for an office visit, a charge he felt was reasonable for the 15 minutes he sat in the chair.  What he never bothered to find out was that his insurance company was paying 3x that price to cover the rest of the office visit.  (Also, in what universe do you think you’re going to get an office visit for just $15… especially when you’re seeing an array of nurses and doctors using expensive equipment to diagnose and treat you… but this guy’s ignorance notwithstanding…)

My advice to him, if you can’t bear to see the cost of your health care, go back to the old PPO/EPO plans.

With copays, we never saw the expenses the insurance companies were shelling out.  We never saw a true cost of health care consumption.  This is (my theory) one of the major contributors to the run-up in health care costs in America.  No one is looking at their bills, and even after they do, no one is getting upset at these industries for charging so much because their insurance is covering it.  Insurance has significantly enabled the run up of health care costs in America.  There is no downward pressure being put on prices because of the wonky payer system we have now.

Even though I think this guy is being a pansy, I kind of like how upset he’s gotten.  Should you have to go see an eye specialist every time you just want them to make sure nothing’s stuck in your eye?  Perhaps not.  Perhaps the market could come up with a lower cost way for him to get the care he needs.

To do so, though, a lot more people are going to have to get angry at the current fee-for-service policy.

For the record, here was my long answer to the whole alias (who, in proper North Texas fashion, had already blamed the whole thing on Obama).

To answer your original question, yes – it is customary for an optometrist or ophthalmologist to charge you for a full office visit as you’ve described your last visit. You had a problem with your eye. They brought you back, sat you down in the chair and examined it and determined there was no immediate health issue (that the eye was recovering from a previous trauma). It is “reasonable and customary” (an important phrase in medical billing) for this Dr to charge you, even if he didn’t prescribe any medication or pull any contact fragment from your eye.

If you didn’t like the Doctor’s bedside manner, or the way in which he told you there wasn’t a problem, I would suggest you get a new doctor. Sure, he might have given you some ideas of drops that might have relieved the discomfort in the meantime. But you can’t fault him for charging for an office visit, though, just because there didn’t end up being anything wrong with your eye.

Really (and I hear you here) it just stings more because we’re paying 100% up to the high deductible. (If you’re on the Health Savings Plus plan, that is.)

As for the politics, this is the way it’s been since Medicare was instituted (the 1960’s), which created the fee-for-service health care system we enjoy now. This is not a direct result of the recently passed health care legislation, though you could argue (and I would) that Cisco’s recent cutbacks in subsidy to our health plans are a result of the failure of industry AND government (the recent legislation) to reign in the out-of-control rise in health care costs we’re experiencing. Everyone talks about bending the cost curve down, but no one knows how to actually do it. Insurers, medical supply companies, drug companies, and the like are riding as high on the hog as they possibly can for as long as we’ll tolerate at the expense of the taxpayer and insurance policy holder.

I actually think the HSP+ plan is pretty good. Now that some of the cost they’ve been hiding for years behind “copays” is being passed on to people like us, perhaps the market will change and offer different solutions.