Note: this is a special op-ed penned by Urgent 9 founder and physician, Dr. Manuel Momjian. The article also appears in the Quarterly Mailer.
Doctors have spent the last half century distancing themselves from conversations regarding cost, because for most insured patients cost was simply not an issue. Traditionally, a doctor would order testing or treatments, and insurance companies would pay the whole bill. To most millennials this might seem incredible, but health insurance companies used to be pretty good at paying the bills. The insurance industry of yesteryear was comprised of some of the most respected institutions in this country, and created the foundation for our traditional high standard of living. These companies were so good that doctors ‘unlearned’ how to talk to patients about the costs of care. Some even chose to deny care to patients without insurance, because conversations were too complex. Uninsured patients instead were directed to many of our safety net hospitals or government subsidized programs. So, doctors had it easy: they would happily see insured patients, and anyone else would be referred out of their office.
Now, the healthcare landscape has changed substantially — and doctors are struggling to find a way to discuss an even more complex and expensive system than the one they inherited. Unfortunately, today’s health insurance industry does not pay patients’ entire bills; sometimes refusing to pay anything until high deductibles are met. Also, the number of patients receiving government subsidized care has reached unbelievably high levels, making these services essentially useless… or dangerously slow. So now, doctors have to learn how to talk to patients regarding cost again.
Can doctors answer cost questions in the exam room? The simple answer is that most doctors have little knowledge regarding the everyday prices of the services they recommend to their patients. Most of the time, services are performed outside a doctor’s office and the charges are only known to obscure billing departments. Also, details about your specific insurance contract are so incredibly complicated that doctors will have no idea what is covered by your insurance company. To figure out a patient’s responsibility usually requires a phone call to the insurance company, with hold times that can last 30-45 minutes. Doctors are paid so little by insurance companies that a long drawn out conversation regarding cost is simply impossible.
So what is someone to do in this situation? Do patients simply suck it up and blindly go into medical debt in order to rule out a possible medical problem? Unfortunately, this might be the only option for someone that refuses to go outside the constraints of his or her medical insurance. Believe it or not, most laboratory testing and diagnostic imaging are really not all that expensive if you pay cash for these tests. Once insurance companies are brought into the equation, the bills become unrealistically bloated.
This is exactly why I have founded Urgent 9, Urgent Care Center. Urgent 9 is one of the most comprehensive urgent care facilities in Southern California with its own imaging center and in-house laboratory. At Urgent 9, all of our prices are transparent and affordable. For example, at Urgent 9 patients can pay $299 for a basic CT scan. A similar study billed to the insurance company by your local hospital system could cost you as much as $6,000.
Doctors need to not only talk to patients regarding costs; they need to constructively offer solutions locally to battle rising prices of healthcare. The future of our healthcare depends on it.