Friday, May 25, 2012

Hidden costs are bad for business

Since we live in an old house, I've hired a lot of contractors in my time. The first step, of course, is getting an estimate for the work; the second step (after I recover from sticker shock) is discussing what to add or drop from the estimate to meet my needs and my budget. I would never hire a contractor and say "just bill me when it's done." I need to know how much it will cost me, and the estimate needs to be correct.

Alas, this is not the model that some doctors follow. I was reminded of this recently when my daughter had a minor medical problem. I asked my pediatrician to take a look, but her office referred me to a specialist instead. At the first visit with the specialist, he wrote a prescription for a medication that cost $200 (I found out later at the pharmacy), then went on to bill us $191 (after insurance kicked in) for the visit. When I called his office requesting a cheaper medication option, he recommended using a $20 over-the-counter treatment off-label.

At the follow-up visit, the receptionist asked me whether I'd like to pay the bill for the first visit. No I would not, I said, because we had just received the bill a few days earlier and had not yet sat down to pay our bills for the month. If my ire was apparent, at least my daughter learned a valuable lesson: how to say no.

During the five-minute follow-up visit, I told the specialist that I was not comfortable using a treatment off-label, ignoring the bold warnings on the box. I stopped the treatment. He insisted that the off-label treatment he recommended was safe, then billed us another $191 for his time.

The saga ended at last when we saw my daughter's pediatrician for a yearly checkup a few weeks later. She recommended an alternative, $15 on-label over-the-counter treatment, which worked like a charm. 

Ultimately, we were out $400 - more than we budget for out-of-pocket health care costs each month -  to treat a problem that could be cured for $15. Had I known what it would cost at the outset, I would have held out for a (much cheaper) appointment with my pediatrician, or gone online to the fabulous Mayo Clinic Health Information site to diagnose and treat it myself.

Health care is a business, and we are the customers. Yet it doesn't always feel that way. The specialist never told me what the medication or the visits might cost me, or asked whether I was willing to use a treatment off-label, or asked my daughter how she felt about the treatment.

He made good money off of my family. But, like any business that doesn't put customers first, he lost any potential long-term revenue from us. We won't be back.