Patients are paying more out-of-pocket, which means they scrutinize their medical bills more as well. There are some newly-insured patients who may be surprised by their legitimate medical bills, but there are also seasoned veterans who have higher deductibles now that are receiving medical bills and challenging them.
A recent story published in the New York Times about a man who underwent spine surgery and then received bills from his hospital, anesthesiologist and orthopedist. None of those bills were surprising, as the patient had done research beforehand, but then he received an $117,000 bill from an assistant surgeon who he never recalled meeting before.
While it's fairly common for medical experts to assist or consult with each other, billing for those contributions could surprise and anger patients who are paying for their care instead of insurance companies familiar with the service. In this patient's case, the assistant was out-of-network. Simply discussing these potential charges, and using in-network physicians, could avoid issues and make sure patients are expecting all the bills that come to them.
According to an America's Health Insurance Plans: Healthcare Bluebook report — as reported in the NY Times article — out-of-network bills for spinal fusion could reach $115,625. In-network physician bills are usually around $5,893. This is a significant amount of money to spring on a patient.
Patients may also be surprised with lab test bills they didn't know about. If extra tests are taken, their bills could add up. Surprised bills not only make the patient dissatisfied with their care, but they cause headaches for the physician's office when the patient calls in to discuss the bill.
Only around 24 percent of orthopedic surgeons regularly discuss costs with patients, according to a Medscape Orthopedist Compensation Report. Another 59 percent will discuss costs, but only if the patient brings up the subject.
There are some surgeons who aren't aware of the costs, or aren't comfortable quoting costs upfront due to potential changes. However, some orthopedic and spine surgeons are beginning to develop bundled pricing for their procedures, offering a single bill for the entire episode of care. This is sometimes in partnership with the payer, or could be used to attract self-funded employers. They may also publish their packaged price online to attract medical tourism patients.
More surgeons are also working with patients to develop payment plans if they have high deductible health plans or paying out-of-pocket. Finally, surgeons are looking for ways to lower the overall episode of care cost. Some strategies they use include:
• Price comparing same-quality implants
• Eliminating waste in the operating room
• Using less invasive techniques for shorter hospital stays, less blood loss
• Performing cases in the outpatient surgery center, which is less expensive than a hospital
• Not ordering more tests than necessary to provide care
Capital Wired also released a report about patient dissatisfaction with unexpected medical bills, which could have dire consequences. The bills could put patients in debt or cause other financial hardship and significantly bruise their credit. Then the patient may be reticent to seek healthcare they need in the future — especially if they're still struggling to pay off past bills.