Health care costs are a mystery

Gary Kruskall, Las Vegas

Sunday, Sept. 16, 2012 | 2:01 a.m.

With no end in sight to health care costs rising every year, many employers have switched to lower-cost, high-deductible, consumer-driven health plans.

These insurance policies supposedly give consumers more control of how much they spend on medical care by lowering monthly insurance premiums, but raising the deductible that must be met before paying benefits. This allows consumers to make informed decisions about whether to visit a doctor by weighing benefits versus cost.

In reality, however, obtaining the information to make this decision is virtually impossible. For example, consider my health plan from the Public Employees Benefit Program (PEBP). There are three entities involved in paying a claim for a simple office visit: the physician, PEBP and a third-party administrator called HealthScope. As a patient trying to decide whether to visit a doctor, I should be able to call any of these entities and determine exactly what it would cost to visit the doctor. As it turns out, I called all three and still have no idea how much it will cost. The doctor won’t reveal the charge for an office visit, PEBP says only that it will pay 75 percent of an allowable cost, and HealthScope states that it will only process claims that are at or below the allowable cost.

How can we expect patients to be responsible consumers when we get such incomplete information?