January 11, 2016

Talk to Your Doctor About...

Doctors need to openly communicate with their patients about financing their health care

Like many UChicago students, I rely on Student Health Services for my health care. I’ve found Student Health to be a convenient resource that, while not perfect, seems to do the job for what I needed. My attitude changed, however, after a recent procedure that made me dissatisfied with how Student Health, and by extension UChicago Medicine, communicates the costs of its healthcare to its students and community.

Last quarter, I decided to get an intrauterine device (IUD) and made a consultation appointment at Student Health. After chatting for a couple minutes with my general practitioner, she made me a mandatory referral appointment in the gynecology department at the hospital where I could further discuss with a specialist. Having done some preliminary research, I knew that the University Student Health Insurance Plan (U-SHIP) would cover all expenses of getting the IUD, so I didn’t hesitate to see the gynecologist. Two appointments later, I had my IUD.

I then got a bill for $370 from University of Chicago Medicine. Not for the IUD—that, as I had verified, was fully covered by my insurance. This bill was for “Evaluation and Management.” I had no idea what that meant, so I called the insurance company. I was told it was an administrative issue and that I should actually call UChicago Medicine to fix the problem. But after calling the hospital, I was told that the bill was for a “clinic charge” that I had no choice but to pay out of pocket.

When it comes to finance, there is a fundamental problem with the way doctors employed by UChicago Medicine communicate with their patients. Nobody told me that I would be charged or what I would be charged for. What exactly is a “clinic charge?" Why wasn’t this covered by my insurance? I tried to argue with the hospital representative that I had no knowledge of this charge; no one at Student Health had told me that making an appointment with a specialist at this particular clinic would come with a fee. Annoyed, she responded that the information regarding hospital fees had been sent to me, and thus that I should have known about the charge. Fuming, I paid the bill.

When I got home for vacation, I asked my mother about this insurance “information” that supposedly was sent to us. She had no idea about it either. As I reflected on the incident, it felt more and more unfair. First, paying the bill depleted my personal savings. Second, how was I supposed to know that I would have to pay a nearly $400 fee for making a 15-minute-long appointment?

I tried to dispute the bill again, but both my insurance company and the hospital said that it was impossible to get a refund. It turned out that the bill was a hospital facilities charge; in other words, an appointment in the hospital will require me to pay a fee for using the facility. According to the insurance company, my Student Health doctor would have known about this fee, but the hospital representative I later spoke with said that it was “unethical” for doctors to discuss finances with their patients. Indeed, when I’ve asked Student Health doctors about coverage in the past, they said that they had no knowledge of my insurance policy and that I would have to find out myself.

What I think is unethical is that my doctor didn’t tell me about the facilities fee that she knew would result from the referral appointment that she, herself, recommended. Why shouldn’t finances be talked about in the open, when healthcare is already so expensive? Since most students who go to Student Health are enrolled in the same University insurance plan, doesn't it make sense for doctors to be licensed, if not encouraged, to discuss hospital charges and U-SHIP’s coverage with their patients? Furthermore, it’s unrealistic to expect that undergraduates fully grasp the ins and outs of health insurance. In a clinic serving a population that is still learning how the world works, doctors should be informed and transparent about the applicable insurance policies so that they can provide guidance to their patients.

It is infuriating that a fundamental resource on which my family spends so much money is not one I can fully trust. UChicago Medicine—and the medical world as a whole—needs to rethink its “ethical” policy of discouraging doctors from discussing insurance coverage so that patients can make more informed and cost-effective decisions regarding their own health. In a time of prohibitively expensive health care, physicians at academic medical centers and teaching hospitals like UChicago should take the lead in informing patients of the costs of their care and the options that they have.

Giuliana Vaccarino Gearty is a fourth-year in the College majoring in art history.

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