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.

4 Comments on How health price sticker shock can prevent preventive care – the case of my colonoscopy

10 Reasons Why ObamaCare is Good for US | Health Populi said : Guest Report 9 years ago

[...] have been dis-empowered through the lack of pricing knowledge. Instead, health consumers have been sticker-shocked at the point-of-care in doctors’ offices and hospitals, and in pharmacies at the [...]

lesliebarretta said : Guest Report 12 years ago

what happened to you is a typical insurance problem - they send you a statement that is inaccurate; not timely; and causes you undue "pain" because you have to deal with something that is a waste of your time and theirs. much savings could be realized if insurance companies wait until the EOB is fully accurate and realized before they send it to you.

Tweets that mention How health price sticker shock can prevent preventive care – the case of my colonoscopy | Health Populi -- said : Guest Report 12 years ago

[...] This post was mentioned on Twitter by healthythinker, Jennifer Jarratt, Fred Goldstein, Yves Hanoulle, Kathi Apostolidis and others. Kathi Apostolidis said: RT @healthythinker: How health care price sticker shock can prevent preventive care: the case of my colonoscopy | ... [...]

@kgapo said : Guest Report 12 years ago

Don't worry Jane, in a few years Europeans will join you in the aha! moment reading news from health insurance. There are clear marks that show politicians in Europe want to reverse the healthcare systems and go into the anglo-saxon model: you have money to pay for it, you get healthcare. You don't have money, we are sorry no heatlhcare for you. Unfolrtunately, European populations do not clearly see yet into all the health economics jargon preached and do grasp what the changes talked about will mean for the individual European citizen: something like you experienced....

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