Why Medical Bills Are So Hard to Understand–Even for Healthcare Insiders
You might assume that the complex rules of healthcare billing are only confusing to patients, but we recently conducted a quiz that revealed a surprising truth: even the people who work within the healthcare system are confused by basic costs.
The quiz, administered to a group of healthcare insiders, showed significant numbers weren’t able to navigate common healthcare options in a way that could minimize their own out-of-pocket expenses.
The Top 3 Sources of Cost Confusion (Even for Insiders)
1. The Market Power Trap: Why Bigger Isn’t Cheaper (45% Incorrect)
The question most frequently missed revealed a fundamental flaw in how many people think about medical pricing: they assume “larger” means better value.
In healthcare, the opposite is often true.
The Question: Imagine you have a high-deductible health plan. At which type of practice would you be likely to pay more for a regular checkup?
A. A large primary care practice, B. A small primary care practice
- The Correct Answer: A large primary care practice.
- The Trap: Here, larger doesn’t mean a better service; it’s about business leverage. Larger physician groups and those owned by major health systems have significantly more market power.
A 2017 study in Health Affairs showed that this market dominance allows these practices to negotiate much higher prices from insurance companies for the exact same basic services.
How CareHive Helps: Don’t let your members choose a doctor based on brand recognition. CareHive can help members find quality, independent doctors in their network who charge lower negotiated rates.
2. Urgent Care’s Hidden Hospital Sticker Price (40% Incorrect)
When members need care fast, they head to an urgent care clinic, expecting they will save money by not visiting a traditional ER.
Unfortunately, that isn’t always the case.
The Question: You went to an urgent care for a quick strep test. Which of these could make your bill higher than you expect?
A. Testing for strep throat is quite complex, B. A strep test uses advanced medical equipment, C. The urgent care you chose is part of a hospital, D. You need the result quickly
- The Correct Answer: The urgent care you chose is part of a hospital.
- The Trap: Just like primary care, many urgent care centers look like ordinary clinics, but if they are associated with a larger hospital they may include a costly facility fee.
Facilities fees are separate charges billed by hospitals, or hospital-owned centers, intended to cover the operational costs of the building and administration.
These fees are applied in addition to the doctor’s professional fee, turning a quick visit into a larger than expected bill.
How CareHive Helps: CareHive can help members find the best price for urgent care, allowing them to avoid facilities that will add facility fees to their bill.
3. The Preventative vs. Diagnostic Coding Split (35% Incorrect)
This may be one of the most frustrating causes of surprise billing because it happens during what members–and, our survey showed, healthcare insiders—might think will be a “free” visit.
The Question: You go to the doctor for an annual physical, expecting it to be fully covered. Which of these could cause you to have out-of-pocket costs?
A. Your doctor ordered lab work to monitor your high cholesterol, B. You got a flu vaccine, C. You were due for a routine pap test, D. You have diabetes
- The Correct Answer: Your doctor ordered lab work to monitor your high cholesterol.
- The Trap: The Affordable Care Act requires annual physicals (a preventative service) to be covered at 100% with no cost-sharing.
However, as soon as the provider addresses a pre-existing or chronic condition (e.g., ordering lab work for diabetes or high cholesterol management) during the same visit, the billing code can change.
The visit may shift from being coded as 100% covered preventative care to diagnostic care, making members responsible for a copay, deductible, or coinsurance.
Members Don’t Have to Navigate the Confusion Alone
Though our survey was small, one thing came through clearly: Even healthcare insiders clearly are struggling with how exactly to minimize costs–which is a clear sign that consumers still need help navigating the system.
At CareHive, we believe members shouldn’t need a manual to understand their costs.
Our person-specific Smart RecommendationsSM help people know exactly how to save, with the care they need and benefits they have.
No need for a manual. No confusion. No surprise bills.
Let us show you how CareHive makes it easy for your members to get the best care at the best price.
