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The Importance of Understanding the US Healthcare System
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Our healthcare system is the worst in the developed world, but you can’t opt out of it. Because it affects us all, we’ll discuss the importance of understanding the US healthcare system.
Our guest today is here to explain how consumers can take back some control of healthcare costs. David Vivero is co-founder and CEO at Amino a healthcare transparency company working to connect everyone to better, more affordable care.
Transparent as Molasses
The last word most of us would use to describe health care costs in the US is transparent. Healthcare is the only thing you buy without first knowing the price. Because there is no way to find out the price. And this is a big part of what drives the obscene cost of health care;
What patients really need is timely, actionable and personalized information so they can shop for an MRI scan in the same way they would shop for a new car – by factoring in quality, cost and accessibility. Their informed choices would create a culture of competition across the diverse landscape of health-care providers, be they physicians, hospitals or pharmacies.
Amino gives consumers the information that has been withheld from them. Amino compiles data that helps people estimate their healthcare costs and book appointments with experienced doctors. Amino’s data comes from nine billion insurance claims from nearly one million providers.
Not only can consumers get pricing, but they can also get information on providers and facilities like how often they do a procedure and what their rate of post-op sepsis is. It also shows the standard range for this ratings and tells you if your doctor or facility are above or below the range.
I made an account to try Amino out. You enter the procedure you need a price for, your location, and type of insurance. I got 126 matches in my area that do MRI’s. You can filter by distance, insurance, facility type, and hours. An abdominal MRI in my search ranges from $369-665.
You can enter details about your insurance coverage, and Amino will give you an out of pocket estimate. You can also follow the Yelp link to see reviews of providers and facilities.
Trillions with a T
Americans spend $3.4 trillion a year on healthcare. Medical debt is the leading cause of bankruptcy in the US. So healthcare is absolutely a personal finance issue. For 20% of us, it’s our number one financial concern. You could do everything right, go to college, get a good job, have an emergency fund, pay your credit cards every month, even have health insurance and still be wiped out financially with one trip to the emergency room.
You Better Shop Around
Some of us compare prices on toilet paper so when it comes to something as expensive as healthcare, why do we just blindly accept the price we’re given? I’ll speak for myself and say that I had no idea shopping around was even an option.
Now we know about Amino, so we don’t have that excuse. For some of us, it’s probably just laziness. I hate even calling to make a medical appointment so I’m not going to bother calling around to compare prices if I could even get the information by doing so.
Part of it is fear and intimidation. If you need a medical procedure, it’s not because you feel great and everything is fine. It’s because something is wrong. It could be a little something like a stress fracture in your shin, or it could be a big something like a lump in a place there shouldn’t be one. You’re scared, and money is not the first thing on your mind.
Dealing with the folks in the white coats can be intimidating even if your doctor is the most helpful, kindest person on earth. Being a doctor bestows prestige on a person, and they are using words you don’t understand. They know best, certainly better than you so when they tell you to go downstairs to the imaging center for an MRI, you don’t argue, you just go. You don’t tell them you need to price compare first.
There is no need to feel helpless when it comes to saving money on healthcare. There are several ways to get the care you need without having to declare bankruptcy.
Read the Fine Print
Insurance policies can be like credit cards; there are a lot of perks you don’t know about and aren’t using. Read your benefits policy. Many companies cover some things like yearly physicals and pap smears which are considered preventative care at no cost to you.
Skip the Ambulance
Unless you have a gunshot wound, do not go to the emergency room. There is nothing so miserable as waiting around in an ER for hours with a minor ailment or injury. If you’re sitting there with a broken wrist, there are going to be a lot of people coming in considered a higher priority than you, and when you get the bill, it’s going to be steep.
Instead, go to an urgent care clinic. You’ll be seen much faster, and the cost will be lower. Most urgent cares aren’t open 24 hours, but they are open earlier and later than a doctor’s office and are open on weekends and holidays too.
If it is midnight and you broke your wrist, unless the bone is poking out of your skin, put an Ace bandage on it and wait until morning when the urgent care opens. Seriously. I spent four miserable hours from midnight to four am in a NYC ER a few years ago when the ex broke his wrist, and there was nothing fun about it.
Stay in Network
Make sure every person who is doing anything related to your care is in network. You might go to an in-network hospital to an in-network doctor for an MRI, but when you get the bill, you find out the doctor who read, not ordered, your MRI is not in network. And going out of network is going to cost you more.
Get it in Writing
Get an itemized bill for all medical appointments and procedures, especially if you were in the hospital. Men have been hospitalized for heart surgery and been billed for pap smears. Billing mistakes happen.
Take a Trip
Make it a vacation. A gastric band in Mexico averages $3,000-6,500. In the US, the average ranges from $8,700-29,000. There are companies dedicated to this kind of “health tourism.” They arrange everything from picking you up at the airport to tending to you until you’re well enough to travel back home. You could fly first class, stay at a five-star resort and have your procedure for a fraction of the cost to have it done in the US.
Use an HSA
An HSA is a tax-advantaged saving account for those with high deductible plans from which you can pay medical expenses. The money you contribute is not taxed, and the balance in the account rolls over from year to year if you don’t spend all of it.
We did a deep dive on HSA’s.
Health and Youth are Fleeting Things
If you’re young and in good health, it can be tempting to blow off things like getting health insurance and seeing the doctor for physicals. But the cliche is true, an ounce of prevention is worth a pound of cure.
The only thing worse than neglecting your fiances is neglecting your health. No one likes going to the doctor, and it can seem like a waste of time and money to see a doctor when nothing is wrong with you. But something might very well be wrong with you, but you don’t think there is because some conditions are asymptomatic. One in four people who are Type 2 diabetic, 7.2 million people, didn’t know they had it.
Left untreated, Type 2 diabetes has terrible consequences, heart disease and heart attack, vision problems including blindness, kidney failure requiring dialysis, amputation, and even death. Ages 45-64 are the most common ages to be diagnosed with Type 2, but in 2014, there were 20,000 people in America under age twenty diagnosed.
Don’t neglect your health. Get a physical with blood work every year. Find a doctor you like, preferably a young one because you want to build a long-term relationship with your general practitioner. Educate yourself, so you know good advice from bad advice. Just because someone is a doctor doesn’t mean they are up to date on new scientific information. How many doctors are still pushing low fat, high carb and a side of statins?
Take Some Control
I know our healthcare system sucks. In a past life, I worked for doctors, so I know how frustrating healthcare in America is from both sides. But there are some things you can do to take control of health care costs. Sign up for Amino; it’s free. We met them at FinCon and were excited by what they are doing. It’s long overdue that as consumers we have some transparency in healthcare pricing.
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