The $511 Annual Checkup – or – How To Spend $11.36 Per Minute on Well-Person Health Care

Is this for real?  The EOB from RMHP shows that I’ve been charged $511 for what I thought was an annual physical at Primary Care Partners. It was a pleasant 45 minutes spent with someone that I hoped would become my primary care physician – someone who might come to know my health history and help me make informed decisions regarding my health.

I contacted my PC Provider, and PCP billing to let them know that I’d been double charged – $291 for “initial comprehensive preventative medicine E&M of new patient” and $207 for “E&M of new patient which requires 3 key components, typically 30 minutes”.  The $291 will come out of my $482 monthly insurance premium, but the bill from PCP for $207 arrived promptly on the heels of the EOB. The PCP Billing department’s questions: “well, did you get a prescription written? and statements: “that’s the way that we bill” are not promising a satisfactory outcome.  We will see how this goes.

I have several concerns:

1. How can a 45 minute office visit possibly cost $511?  I’m pretty sure that the care I received (although it was satisfactory) didn’t approach that value.

2. How could I have known what the charges would be?  I asked for an “annual physical” which I knew to be an essential benefit, covered under the insurance premium, but I was charged for things that I didn’t know existed, and couldn’t have predicted from any information available on the website, or provided to me prior to my visit.

3. I left the care of a popular local doctor who last year decided to quit working with insurance companies.  His annual “all the primary care you can use” charge of about $1000 per year could have been half paid for in this single 45 minute visit. His ‘membership’ model looks like a pretty good value compared to PCP, right now.

4. I decided to look to Primary Care Partners for a new PCP because I have been favorably impressed by Dr. Michael Pramenko’s vocal advocacy of innovative methods of providing health care (and, I thought, of keeping health care costs within reason). Yet here is an absolutely egregious example of “fee for service” abuse. Can’t PCP practice what they preach?

5.  See the previous post.  In 2016, I anticipate that the least expensive health insurance policy available in Grand Junction will include a PPO with Primary Care Partners at the center. I am very afraid that the $5000+ annual deductible will be quickly claimed by the physicians and hospitals in the “Monument Health” network should I make contact with them for any reason.

“Even in Grand Junction, Michael Pramenko told me, “some of the doctors are beginning to complain about ‘leaving money on the table.’ ”  Atul Gawande, The Cost Conundrum, The New Yorker, June 1, 2009.

Later…..

Update:  Spoke with the billing coder.  She tells me that they use “Private AMA guidelines” to bill which say that anytime an acute or chronic condition is discussed, it’s billed in addition to the physical.  In my case, I think it was my “chronic” high blood pressure which required sending a prescription to the local City Market. She said however, that the claim was incorrectly processed and that the ‘corrected’ bill will be for $143 rather than the $207 originally billed.

Further – if meds are discussed in an office visit (next year, possibly?) then the bill might fall within a range of $122 (99213), and $244 (99215), with a mid range of approximately $181.

OK – so it wasn’t $11.36 per minute.  It’s going to be closer to $10 per minute.  But still…..

Grand Junction Colorado – Hospital-Led Provider Networks

A letter in this morning’s Grand Junction Daily Sentinel highlighted one of the reasons we are seeing a 34% increase in health insurance costs in 2016 in the Grand Valley. See Dr. Gregory Reicks letter at: http://www.gjsentinel.com/opinion/articles/hospitalled-provider-networks-are-not-good-for-mes

Dr. Reicks writes “Now St. Mary’s Hospital is forming its own provider network (Monument Health) to attract business to their facility and providers .. patients will be channeled to St. Mary’s to receive expensive services that could be provided elsewhere for lower cost.”

I see that RMHO’s DORA Filing for 2016 insurance rates (LEIF130052948)  lists a PPO option called “Rocky Mountain Monument”, a “tiered network” with an in-network deductible of $5650 and an additional $950 for using services from the next tier.

Other RMHO DORA filings may shed light on how this is going to work.

The Cost Conundrum 2016

In the June 1, 2009 issue of the New Yorker, Atul Gawande looked at the disparate costs for  providing health care to Medicare beneficiaries around the country. In his article, he called out Grand Junction. Colorado as having one of the lowest average cost-per-beneficiary medicare costs in the country.

So in 2011, I was looking forward to living in an area with low health care costs due to local innovation in health care delivery processes and procedures, but I was surprised and disappointed to find that that the cost of the Rocky Mountain Health Plans (RMHP) employer-provided plan that I had access to was higher than the per-beneficiary cost to treat medicare patients.  If you could provide cost-effective healthcare for medicare recipients who are all over 65, I figured it could be done for folks in their 50s.

I suppose that was a naive conclusion. I subsequently applied to RMHP’s individual market to try lowering my insurance costs. The roughly $250 per month 2012 online quote for a plan with a $3500 deductible became an actual offer of $356, followed in 2013 by a 37% increase to $487.

In 2014, the first year of ‘Obamacare’, the cost actually dropped 6% to $459, although the deductible nearly doubled to $6300.  In 2015 the cost rose to 2013 levels ($481) for the same $6300 deductible.

Now, documents filed with the Colorado Insurance Commissioner show a proposed increase of 46% to $702/month for a deductible of $6850.

So, here in GJ where the cost to treat medicare patients was less than $7000 per year per beneficiary in 2012, a 57-year-old will face a cost of $84-8500 per year for insurance, if willing to consider a $6850 deductible.

If I were to include the cost for my spouse (his employer currently pays 75% of his $1222 monthly insurance tab), our 2016 household health insurance cost would soar to $18,858, and it would come with a household deductible of $13,700.

A couple of questions come to mind:  1. why, in an area that received national recognition in 2009 for innovation leading to low health care costs, can the cost of health insurance for two healthy individuals reach nearly $19,000 (especially when it comes with a nearly $14,000 deductible)?  and 2: Why does anyone think that someone could afford this?