Why I Despise my HSA – Part Three
Posted by eemilla on January 30, 2011
My second rude awakening came when I changed providers from an obstetrician to a midwife. The OB had the ultrasound equipment in their office so I didn’t even think of going anywhere else to obtain my twenty week ultrasound, but the midwife contracts with a different OB to perform ultrasounds and to be the back-up if the delivery becomes high-risk so I had the option of using their OB’s office or Mission Hospitals Radiology. Knowing that I would have to pay for this out of pocket, I decided to call the insurance company to find out the cost as the midwife’s office only knew the uninsured price ($300). In my naivete, I called the insurance company expecting a simple answer; but I failed to remember what I was dealing with. After navigating their automated service, the human operator needed the CPT code; I explained I didn’t know it or even what it was, and I asked if he could look it up by the name of the treatment. He declined so I called the midwife’s office to obtain the requisite information, and if I had been smart, I would have put him on hold while I did so. I obtained the CPT code along with the diagnosis code, and I called the health care company back to price shop my twenty week ultrasound. My second health insurance employee took the CPT code after reading through her script then informed me the price isn’t guaranteed and is only an estimate. I asked if there was anyway to obtain the actual cost to which she replied once the service had been billed, the claims department would know the actual cost of the service. I then asked if I could speak with the claims department or if she could request the price from the claims department? She explained that even if she could transfer me or contact the claims department, they would not know the exact cost because the doctor’s office might not use the CPT code or diagnosis code they provided me. With a rising temper, I asked why I needed the CPT code, which I assumed would allow the operator to pull the contracted price from my specified provider, if there was no way to know how much any procedure would cost until it was billed? She advised that without the CPT code the estimate range would be even greater like those provided on the health insurance company’s treatment cost estimator website. As the point of the call was to compare between the midwife’s OB office and Mission Radiology ultrasound, I asked her to provide the cost for Mission. However, she was not able to even provide an estimate as facilities don’t always publish their prices. After this answer, I was incensed so I retorted how ridiculous this whole situation was; if the whole point of an HSA is to encourage patients/insureds/consumers to price shop why is it impossible to obtain a price for a basic service that is performed on virtually every single pregnant woman in the US, and not wanting to hear her script I hung up after thanking her for being completely unhelpful and wasting my time. On another note, I was never able to speak with anyone at Mission Radiology to find if they could provide the cost of the twenty week ultrasound on a first pregnancy.
The cost for the ultrasound in my first OB’s office was $120 (per the billing plan provided by the obstetrician’s insurance liaison), which is the same cost the health insurance company estimated for the midwife’s OB’s office. The actual amount billed by the midwife’s OB is $225 less a $104.35 discount for having health insurance so $120.65 is what we’ll pay. There again, the uninsured pay $300 while the insured pay $120 for the exact same service.
To be Continued.