{"id":17154,"date":"2015-03-27T14:01:30","date_gmt":"2015-03-27T18:01:30","guid":{"rendered":"http:\/\/pmedicine.org\/epatients\/?p=17154"},"modified":"2015-03-27T15:05:02","modified_gmt":"2015-03-27T19:05:02","slug":"cyndy-nayer-transparency","status":"publish","type":"post","link":"https:\/\/participatorymedicine.org\/epatients\/2015\/03\/cyndy-nayer-transparency.html","title":{"rendered":"Accountable Care: Transparency of Fees Is Mandatory"},"content":{"rendered":"

Participatory medicine and healthcare system transparency warrior Cyndy Nayer put this up on her blog this week<\/strong><\/a>, and we’re re-posting it here because it’s a message that’s got to spread.<\/em><\/p>\n

A personal account of a transaction that went very badly, and rules of Health Reform were not followed<\/h4>\n

In my surveys and seminars, physicians\u00a0tell me they want responsible, accountable patients.\u00a0 I\u2019m calm, I\u2019m rational, I\u2019m doing my best to be proactive and ensure they get their money.\u00a0 But I can\u2019t promise an open-ended checkbook.<\/p>\n

Accountable Care and associated transparency have not made it to Florida, at least not in this physician\u2019s office.<\/p>\n

I made an appt with an ENT (ear nose and throat doctor) for ear wax. \u00a0When I get there, I need to fill out 5 papers (EMR<\/acronym>anyone??), and I\u2019m told there is a $35.00 copay, which she says I can pay on my way out.<\/p>\n

The 5 page HIPAA form says they can share my info with other providers<\/acronym> who are trying to collect fees. But you only learn this, among other clauses, if you read the form that is tacked on the wall\u2013it\u2019s not in the form the patient signs.<\/p>\n

<\/p>\n

\"image<\/a><\/p>\n

A Shortened Synopsis of The Patient Attempting to Be Responsible for Her Fees<\/h3>\n

I asked the receptionist how much the office visit is, and she said, \u201cOn your insurance there\u2019s a $35.00 copay.\u201d Yes, but is there an additional fee for removal of ear wax? How much? \u201cWe can\u2019t tell you that until after the doctor sees you and marks what is done. And besides, we don\u2019t know if you have satisfied your deductible.\u201d I tell her I have not, but because I have to guarantee payment if the insurance company denies anything, I\u2019d like an estimate of charges. She repeats the deductible statement and I say yes, I understand, but that\u2019s a problem, as I haven\u2019t satisfied my deductible so I need to know how much this will be. She tells me she will get the Office Manager (OM).<\/p>\n

The Office Mgr (who is disguised in a clinical suit) tells me, \u201cYou have to sign this financial form before the doctor sees you because after, you will have received the services so you or the insurance company owe the money.\u201d No problem say I, but I need an estimate, and I can\u2019t sign a financial responsibility form that allows you to bill me if my insurance company doesn\u2019t pay you in 45 days AND that tacks on a 30% interest fee, when I don\u2019t know if I can afford it.<\/p>\n

Two visits into the doctor\u2019s lair, she comes out and says, \u201cDr M is more than willing to provide the services you need but he cannot be interrupted to tell you the costs of the services.\u201d BOOM.<\/p>\n

In my surveys and seminars, physicians tell me they want responsible, accountable patients. I\u2019m calm, I\u2019m rational, I\u2019m doing my best to be proactive and ensure they get their money. But I can\u2019t promise an open-ended checkbook, and I\u2019m not on Medicare (which, if you read the financial form attached, seems the gateway to payment nirvana). I\u2019m a firm believer in people being paid according to contracts and promptly upon receipt of services. But OM keeps telling me that they just don\u2019t know what all this will cost.<\/p>\n

So, I say, \u201cHow about if, when I get into the exam room, the doctor and I chat and then he tells me, before he does anything, what estimated costs will be billed?\u201d Note, I\u2019m not asking negotiated fees, even, just retail pricing.<\/p>\n

If you know me, you know I tried every which way to get some inkling of an estimate, including sharing my dermatologist\u2019s willingness to tell me the price of the lab review for a specimen.<\/p>\n

OM goes back once more and comes out with this: \u201cDr M will gladly provide you the services you need but he is not responsible for knowing the prices of the services so he cannot provide those, and he doesn\u2019t want to be interrupted with a patient.\u201d<\/p>\n

I left. What would you have done?? BTW, I\u2019ve attached the financial guarantee with my name blacked out so you can see what I was I told to sign.<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

Participatory medicine and healthcare system transparency warrior Cyndy Nayer put this up on her blog this week, and we’re re-posting it here because it’s a message that’s got to spread. 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