The Nearly Impossible Task of Being a Smart Shopper of Healthcare

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This is the result of an 18 month investigation to determine if it is actually poss bile for consumers to be smart shoppers of health care.

This story shares the herculean effort it took with the CEO and CFO of our large health care provider to get them to reluctantly match pricing of local competitors on a simple colonscopy. It also shares the struggle it took to have our insurance company refund the reduced pricing that we, not them, negotiated. During the eighteen months of this investigation, we were continually ignored from the highest levels of a large healthcare organization.

We discovered that it is virtually impossible for consumers to be smart shoppers of healthcare because the system is designed to work against you and throw up road blocks every step of the way.

BACKGROUND
Have you ever heard an employer, a newscaster or government official say that we all need to be smart shoppers of health care?

As an employee of two large global Fortune 150 companies I wondered what that meant. And I was a senior officer of one of them.

Now as entrepreneurs with a costly and high deductible policy where we are responsible for the first $7,500 in medical expenses (and prescriptions), we have an increased interest in getting the best value, high quality health care.

My wife and I are consumer advocates, having authored Negotiate Anything! Secrets to Make Businesses Treat You Fairly. We wondered if it were possible to be a smart shopper of health care. We began our 18 month investigation to see if it were possible to comparison shop for something as straight forward as a colonscopy and negotiate better pricing.

THE PROCESS
We began by utilizing a third party resource provided by our insurance company that comparison shops for procedures. We requested that they shop three quality healthcare providers in our area and obtain the cost of the doctor, the facility and quality statistics. It is not easy to get this type of information because it requires many phone calls, not a simple Google search.

As mentioned, they also gathered quality statistics on each doctor including the years experience and number of procedures performed weekly.

Healthcare providers are not accustomed to having people ask for pricing information. Most medical professionals have no idea what their services cost. One time, when asking a provider about pricing, we were told not to worry about it because insurance will cover it.

COMPARISON SHOPPING AMONG HEALTH CARE PROVIDERS
When the comparisons were tallied, we discovered that our health care provider’s charges were 60% higher than the other two and their quality metrics weren’t superior to either of them.

In the interest of being a smart shopper, we wrote to the CEO of our provider and asked if he would meet his local competitors pricing. We also requested that they post prices of the most common procedures on the internet to make comparison shopping easier for consumers. He ignored us for fours months, but finally relented after we made continued contacts. Ultimately, he had his CFO contact us. He never acknowledged us.

The CFO questioned the validity and accuracy of our data because he said that the pricing we sent him certainly wasn’t representative. He wanted to know where we got it from. We provided him with the dates, times and names of who provided the data from his organization. We also offered to send him a recording of each of the conversations.

After several additional contacts with him, he ultimately relented and agreed to match his competitors pricing. He asked that I contact him when my appointment was set and he would take care of everything. I contacted him prior to the procedure but he never responded or acknowledged my contact.

The procedure was performed in December 2010. I received the billing in January which reflected the original higher cost.

Over several months I attempted to make contact with the CFO, but he ignored me. I sent at least 4 mails, 4 phone calls and a letter. He too, like the CEO finally relented. He had his Assistant call me. She was initially indignant, asking me if the price of an oil change were more at one place compared with another, would I contact the President of the company. I told I was just trying to be a smart shopper of health care and that the first $7,500 of expenses was out of our own pockets… not some faceless insurance company.

The CFO’s assistant said they would issue a refund, but that it would need to be mailed to the insurance company, since the insurance company originally issued the check.

We contacted our insurance company and they were confused and wanted to know when ‘they’ requested a refund’. After several explanations and background documentation of the situation, they agreed to issue a refund.

As promised, they issued a refund…. but they sent it to our healthcare provider instead of us so we had to go full circle — back to dealing with our health care provider.

The Assistant to the CFO told us they could not refund the amount to us directly because providing a refund to us would not be in compliance with their contract with our health care provider and would raise red flags with their external auditors. She put the insurance company and their auditors ahead of providing customer service.

She said that their billing office was now working with our insurance company to rebill them for the $2500, the base cost of my procedure, plus any additional procedures that were performed. She said that they would again send a refund to my health care provider, and that I could negotiate with them for the refund.

We contacted our insurance company two times, but have not heard anything back. To date (June 2011), we have been working on this investigation for 18 months.

This exhaustive investigation has made it clear to us that it is virtually impossible for consumers to become smart shoppers of health care. The amount of time, effort and aggravation are simply not worth it. Employees in the health care system, even at the highest levels don’t embrace a free market system. They are at best, ambivalent about customer service.

Once we reach a final outcome, we will begin a media blitz to bring this to the forefront of the national health care discussion as it clearly shines a light on one aspect of a broken system.

I would be curious if anyone else has any ‘case studies’ on their attempt at shopping for health care procedures.

Tom Wilson
Tom Wilson, former global Sector President at Kimberly-Clark Corporation spent 30 years in consumer products, started up two companies, one manufacturing underground coal mining equipment (Wilson Manufacturing Company, Inc.) and in 2004, The Caregiver Partnership, a national direct to consumer retailer of home medical supplies to the more than 66 million caregivers in the U.S. He is also co-author of Negotiate Anything!, a 30-year longitudinal study of customer service in the U.S., the first of its kind.

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