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Monday, July 27, 2015

Argue your limitations and they are yours

I'm having a [amusing | interesting | disheartening | great ] discussion over on Facebook with two Massachusetts doctors who are telling me how difficult it is to get information about the cost of treatment from payers.

Fortunately for me, unfortunately for them, MA state law effective January 1, 2014 states:
§228(a): Prior to an admission, procedure or service and upon request by a patient or prospective patient, a health care provider shall, within 2 working days, disclose the allowed amount or charge of the admission, procedure or service, including the amount for any facility fees required; provided, however, that if a health care provider is unable to quote a specific amount in advance due to the health care provider’s inability to predict the specific treatment or diagnostic code, the health care provider shall disclose the estimated maximum allowed amount or charge for a proposed admission, procedure or service, including the amount for any facility fees required.
(b) If a patient or prospective patient is covered by a health plan, a health care provider who participates as a network provider shall, upon request of a patient or prospective patient, provide, based on the information available to the provider at the time of the request, sufficient information regarding the proposed admission, procedure or service for the patient or prospective patient to use the applicable toll-free telephone number and website of the health plan established to disclose out-of-pocket costs, under section 23 of chapter 176O. A health care provider may assist a patient or prospective patient in using the health plan’s toll-free number and website.
Unfortunately for me, they probably still don't have a clue how to do this if the discussion I'm hearing is any clue.  This information is "difficult", hard to find, not complete, et cetera.

As my wife likes to tell me routinely, arguing for your limitations simply makes them stick, rather than producing any real change.

When I have a real health concern where this becomes an issue, I think I'll go tilt at that windmill for a while.