My doctor — general practitioner — recently did a routine referral, sending me to a cardiologist for a stress test, because, well, I’ve reached the advanced age of 53 and haven’t had one, and I have a family history of heart problems. Results first, lest anyone be alarmed: everything is fine, and they have a baseline for future testing if it’s needed.
Specifically, I had a stress echocardiogram. A sonographer attached about a dozen electrocardiogram leads to my chest to monitor my heart, then took very cool pictures of my heart at rest, using ultrasound imaging. The focus, here, was on the blood flow to the heart muscle. The cardiologist came in, and they put me on a treadmill, monitoring all the while. Every three minutes, the treadmill sped up and increased its
steepness. They’re looking for me to get to my
target heart rate and stay there or above for bit.
The target heart rate is a strange thing, by the way, as it’s rather arbitrary. You figure your
maximum heart rate by subtracting your age from 220, as though 220 were a magic number, and magic things happened to you at each birthday. Anyway, that puts my
maximum at 167. The target rate is then 85% of that, 142 for me.
After 10 minutes or so on the treadmill, they turned it off and had me lie back on the table as quickly as I could, so the sonographer could repeat the ultrasound pictures with my heart working hard. They can then compare the
after pictures to see if there are problems with the blood flow under stress. As I said above, there weren’t.
As you might imagine, given that I’m occupying a sonographer for some 45 minutes and a cardiologist for 15 or 20 minutes, and using an exam room, an ultrasound imager, a treadmill, a heart monitor, and so on... it’s not an inexpensive test. I got my insurance information, the
explanation of benefits, the other day.
The cardiologist billed $1750 for the whole procedure. But here’s the interesting part: the insurance company discounted that by about $1240. That’s the amount that the doctor agrees to
eat, as a cost of participating in this insurance plan, and that brings the amount that he actually gets for the procedure to about $510.
Let’s go over that again: he bills $1750, but accepts just $510, by agreement with the insurance company.
And that brings up a question: Who pays
retail? That is, who, if anyone, actually winds up paying $1750 for that procedure?
If everyone with insurance pays a discounted fee, then it would have to be the uninsured people who pay the full one. But that doesn’t make sense: the uninsured are generally the ones least able to afford the full fee. And I’m told that doctors will routinely negotiate discounted fees for people without insurance.
What I get from this is that the
full fee is actually an inflated one that’s designed to draw a higher discounted amount from the insurance company. Something like,
Ask for $1500, hope for $1000, be happy with $500. Most of us have seen that sort of thing in other contexts.
But what does it say about
managed care? Is it really keeping costs down, or are doctors just compensating by pushing their asking price up, requiring more pre- and post-procedure consultations — bringing in hundreds of dollars for spending ten minutes with the patient to
explain the procedure, something that could be done with a leaflet the vast majority of the time — and using other techniques to keep the money coming in, in the face of more scrutiny by the insurance companies?
It seems to me that, in the end, the consumer isn’t winning here.