Having worked in the drug store business for some 20 years before retiring, this reporter (Wayne Howard, Lincoln Herald) has long said that one of the problems with our healtcare system is that not everybody pays the same price for the same medication or service. The same prescription medicines may cost different prices in different stores. Even more important, because of agreements with suppliers, the total cost (co-pay and billed to insurance) may be very different even in the same store.
It has been common knowledge that hospitals also charge different amounts from other hospitals, but the author of a Letter to the Editor we received recently says that the same hospital group makes different charges for the same procedure at different locations. Here's the letter:
I was recently informed that I need to have inguinal hernia surgery. I met with the surgeon who was recommended by my primary care physician and chose one of the two locations he works from to have the surgery performed (I chose the Lincolnton hospital; the other option was the East Lincoln Primary Care facility in Denver). According to the surgeon, the only difference in the two locations is the availability of appointments (I would be seen faster in the Lincolnton location).
After scheduling the surgery, I began investigating the expected cost as I am covered by a Blue Cross/Blue Shield high deductible insurance plan and thus expected to pay a large portion of the bill. Fortunately, the provider network- Atrium Healthcare, has a cost estimator on its website to help with such research. According to its website, the estimated cost is approximately $8,800 to have the surgery at the Lincolnton hospital location. However, after additional research, I noted the cost is approximately $5,000 less for the same surgery provided by the same network but at a different location approximately 40 miles away (hospital to hospital). When I inquired with Atrium, I confirmed this to be true. Many phone calls later, I was equally surprised to learn this does not appear to be a well-known practice – even amongst the staff that work in the Lincolnton hospital.
After cancelling my scheduled surgery, I again began the painful process of finding another surgeon. After just a short while, I quickly understood the issues facing our healthcare system today. Procedures are extremely expensive, yet there is no transparency in the costs of services provided. Even though there may be a difference of 40 miles (again, hospital to hospital), there is a significant difference in cost. Yet it is nearly impossible to obtain price comparisons due to unnecessarily complex pricing structures that exist. Instead, consumers are left to rely on their primary care physicians for a referral, hoping the referral is the answer to their prayers. Yet too often, especially in Lincoln County, the referral is an almost instant ticket to financial ruin.
It is well known that the healthcare system is broken. Yet, our elected officials have yet to provide us help or hope that things will change. The only way change will occur is through the voice and actions of the people. Thus, I am writing this letter as a plea to those of us who use Lincoln County healthcare facilities. When you visit your doctor, ask questions about costs. If you receive a referral, ask if there are options. If you need a surgery performed, ask if it can be performed cheaper outside Lincoln County. While your doctor may be acting on your behalf as it pertains to medicine, far too often they have no idea about the bill you will receive after the procedures are performed. Medical bills appear to be one of the only major purchases people make without having any idea how much they will pay, and whether it was a fair price. Please, do your research. As I have learned, you do have options… and typically the cheaper option is not in Lincoln County.
After receiving this letter, the Lincoln Herald contacted Atrium Healthcare's headquarters in Charlotte and asked several questions. While some of our questions were not definitively answered, we are publishing their response in a separate article.