An Explanation of Benefits (EOB) came in the U.S. mail yesterday. A plain piece of white 8.5″ x 11″ printed in tiny font with black ink, the logo of my health insurance company in the upper left of the form, and several lines of words and numbers showing me names of providers and facilities, dollar amounts billed, dollar amounts discounted, dollar amounts paid to the providers, and dollar amounts that were the patient’s responsibility — that would be me.
The procedure was for a colonoscopy, for preventive screening and base lining for future reference. The good news: my colon looks just fine, and I’ll be reminded to re-do the procedure in 5 years. The bad news, ex post facto: the physician charge listed on the EOB was for $800, the discount to the fee was $0, the reimbursed amount by the health plan was $0, and the patient’s responsibility? 100%: that is, $800 out-of-my-pocket.
Sticker shock ensued: is this any way to encourage health citizens to undergo preventive screenings?
What can a person living in a U.S. metropolitan area buy for $800? Let’s estimate: 20 tanks of gas for her car (based on January 2011 petrol prices); several weeks of food for her family’s dinner table; and, a huge chunk of her monthly house payment. For members of my community with more gas-efficient cars, $800 would buy even more petrol, more food for the more organized couponing grocery shoppers among us, and a month’s rent for others.
Health Populi’s Hot Points: Had I known about the $800 out-of-pocket fee in advance of the colonoscopy procedure, would I have opted to undergo the test? Everyone knows a colonoscopy is invasive, dissuading many people from even making the appointment to schedule the exam. For others, taking the time to prep the day and night before, and its humbling effects, is another dissuader. An $800 would certainly be a postponing or preventive factor for other people who need to gas their cars to get to work, put food on the table for families, and pay the rent when money is increasingly tight. The chart shows data from Kaiser Family Foundation’s Health Tracking Poll from December 2010 indicating that 25% of U.S. adults skipped a recommended medical test due to cost in the past year — such as a colonoscopy.
The New York Times Well Blog covers the colonoscopy fear angle in a post titled, Why People Aren’t Screened for Colon Cancer, on January 20, 2011.
A footnote: in following up with my insurance company, it appears that the EOB’s information was mistaken: that the physician fee will be mostly covered based on my health plan. But in the moment of truth when faced with a purchase price of $800 for a physician fee, I was taken aback. The visceral experience of even considering, in a personal scenario, of saving the $800 by not undergoing a preventive test — even knowing the real value of that test — took me aback.
As some members of Congress seek to chip away at health reform provisions (which cover preventive care for all Americans), the value of preventive care priced at or near “zero” to the health citizen should continue to be a foundational building block of the U.S. health system.