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At DocSpot, our mission is to connect people with the right health care by helping them navigate publicly available information. We believe the first step of that mission is to help connect people with an appropriate medical provider, and we look forward to helping people navigate other aspects of their care as the opportunities arise. We are just at the start of that mission, so we hope you will come back often to see how things are developing.

An underlying philosophy of our work is that right care means different things to different people. We also recognize that doctors are multidimensional people. So, instead of trying to determine which doctors are "better" than others, we offer a variety of filter options that individuals can apply to more quickly discover providers that fit their needs.

Billing nuances

by jerry on June 05, 2022

Kaiser Health News published a piece on how a slight difference in how a procedure was billed made a significant financial difference for the patient. As background, the Affordable Care Act mandated that certain preventative care procedures (e.g. routine check-ups) would not cost insured patients anything out-of-pocket with the hope that more people would undergo preventative care and avoid more costly care. A screening colonoscopy is an example of such preventative care procedures. However, diagnostic colonoscopies -- which might be prescribed to determine if a patient has colon cancer -- can still be billed as non-preventative care, thereby costing some patients. Presumably, healthcare providers get paid much more for diagnostic colonoscopies than they do for screening colonoscopies, tempting many to bill for the more profitable procedure. In turn, Medicare has clarified that the removal of a polyp (relevant to the patient's colonoscopy described in the article) does not warrant changing a screening colonoscopy to a diagnostic one. However, it seems like some providers persist in the more lucrative billing. In this particular piece, the patient expected her colonoscopy to be a screening procedure and therefore not to cost her anything. She was billed over $2,000, and the provider persisted in billing her procedure as diagnostic rather than as screening (even when a representative from the insurance company was present). After being contacted by Kaiser Health News, the provider admitted making a mistake and re-submitted the procedure as a screening colonoscopy.

Kaiser Health News published a piece on how a slight difference in how a procedure was billed made a significant financial difference for the patient. As background, the Affordable Care Act mandated that certain preventative care procedures (e.g. routine check-ups) would not cost insured patients anything out-of-pocket with the hope that more people would undergo preventative care and avoid more costly care. A screening colonoscopy is an example of such preventative care procedures. However, diagnostic colonoscopies -- which might be prescribed to determine if a patient has colon cancer -- can still be billed as non-preventative care, thereby costing some patients. Presumably, healthcare providers get paid much more for diagnostic colonoscopies than they do for screening colonoscopies, tempting many to bill for the more profitable procedure. In turn, Medicare has clarified that the removal of a polyp (relevant to the patient's colonoscopy described in the article) does not warrant changing a screening colonoscopy to a diagnostic one. However, it seems like some providers persist in the more lucrative billing. In this particular piece, the patient expected her colonoscopy to be a screening procedure and therefore not to cost her anything. She was billed over $2,000, and the provider persisted in billing her procedure as diagnostic rather than as screening (even when a representative from the insurance company was present). After being contacted by Kaiser Health News, the provider admitted making a mistake and re-submitted the procedure as a screening colonoscopy.

While this case was resolved in favor of the patient, it is unfortunate that the provider admitted to making a mistake only after media's involvement. There must be many, many other cases in which media does not get involved, and patients might have little practical recourse when providers insist they are correct.

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Concerns about afforability of insurance plans

by jerry on May 30, 2022

Kaiser Health News published a piece about the upcoming potential decrease in affordability of health insurance plans. Last year, Congress passed the American Rescue Plan Act, which subsidized health insurance premiums for plans offered through insurance exchanges set up by the Affordable Care Act, reducing those premiums on average by about 23%. Perhaps unsurprisingly, enrollment in such plans increased. Congress has not yet renewed the subsidies, and the current governor of California has proposed using some of its surplus to offset the loss of subsidies for Californians if Congress does not act.

Kaiser Health News published a piece about the upcoming potential decrease in affordability of health insurance plans. Last year, Congress passed the American Rescue Plan Act, which subsidized health insurance premiums for plans offered through insurance exchanges set up by the Affordable Care Act, reducing those premiums on average by about 23%. Perhaps unsurprisingly, enrollment in such plans increased. Congress has not yet renewed the subsidies, and the current governor of California has proposed using some of its surplus to offset the loss of subsidies for Californians if Congress does not act.

After a cursory reading, one might think this article is about the importance of government subsidies to boost enrollment. However, such efforts seem to ignore the underlying cause of the rising premiums. That is, governments might be willing to spend millions and billions on subsidizing insurance premiums, perhaps without spending corresponding amounts on slowing the rise in healthcare costs. Both efforts might be needed: subsidies for short-term relief and cost management for help ensure that governments (and patients) do not simply keep paying higher and higher amounts that might have been avoided through a more systems-oriented solution.

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Hospital ignores its own mistake

by jerry on May 22, 2022

The New York Times published an article about a patient who got surgery and was surprised by how large the bill was: over $200,000 when she was told that it would have been less than $1,400. In this case, the patient relied on the hospital's estimate, and the hospital subsequently stated that it misread her insurance card. The issue is that the services provided were considered out-of-network, meaning that the insurer would not really be involved and the patient would be liable for much more of the bill. Apparently, the hospital believed that the patient should pay the entire bill, even though she relied on information from the hospital. The hospital system went as far as suing her. The Colorado Supreme Court ruled in the patient's favor, about eight years after her surgery.

The New York Times published an article about a patient who got surgery and was surprised by how large the bill was: over $200,000 when she was told that it would have been less than $1,400. In this case, the patient relied on the hospital's estimate, and the hospital subsequently stated that it misread her insurance card. The issue is that the services provided were considered out-of-network, meaning that the insurer would not really be involved and the patient would be liable for much more of the bill. Apparently, the hospital believed that the patient should pay the entire bill, even though she relied on information from the hospital. The hospital system went as far as suing her. The Colorado Supreme Court ruled in the patient's favor, about eight years after her surgery.

The emotional toll and the cost in time and money seem like they would have been overwhelming. In other industries, it seems like service providers tend to bear most of the additional cost if they grossly underestimate a job. It is unclear why the hospital system believed it was entitled to the full amount given its mistake, and strategically, why they thought they would be able to meaningfully recover enough of the charge to make the negative press worthwhile.

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Massachusetts moves to contain healthcare costs

by jerry on May 15, 2022

Kaiser Health News reported on efforts in Massachusetts to block the expansion proposed by the largest healthcare provider in the state. The healthcare provider is a non-profit institution who reported $442 million in operating income last year, and the proposed expansion was found to be expected to nearly double that figure. Growth in the state's healthcare spending exceeded the target set by the state's health policy commission, and prices from the healthcare provider that proposed the expansion "far exceeded those of other hospital systems."

Kaiser Health News reported on efforts in Massachusetts to block the expansion proposed by the largest healthcare provider in the state. The healthcare provider is a non-profit institution who reported $442 million in operating income last year, and the proposed expansion was found to be expected to nearly double that figure. Growth in the state's healthcare spending exceeded the target set by the state's health policy commission, and prices from the healthcare provider that proposed the expansion "far exceeded those of other hospital systems."

The healthcare institution has been able to command such a premium in pricing in part because of its size. The institution was formed as the merger of two prominent Boston hospitals, whose merge likely should have been blocked to prevent consolidation in the market. Now the state seems to be mitigating its earlier permissiveness by blocking further expansion.

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Drug price increase during the year

by jerry on May 09, 2022

Kaiser Health News published an article about a patient whose drug costs changed after selecting a drug plan. Although the article is about a Medicare drug plan, the possibility seems to be relevant to all insurance plans. This dynamic is unfortunate for the patient, who might select a plan during open enrollment because of drug pricing specifically relevant to him or her, only to discover that the prices change before the next opportunity to change insurance plans. Insurers would probably respond that they do not set drug prices, and therefore should not be held responsible for price increases.

Kaiser Health News published an article about a patient whose drug costs changed after selecting a drug plan. Although the article is about a Medicare drug plan, the possibility seems to be relevant to all insurance plans. This dynamic is unfortunate for the patient, who might select a plan during open enrollment because of drug pricing specifically relevant to him or her, only to discover that the prices change before the next opportunity to change insurance plans. Insurers would probably respond that they do not set drug prices, and therefore should not be held responsible for price increases.

Changing drug prices during a year seems to contrast with how insurers negotiate year-long (or multi-year) contracts with healthcare providers. Hence, office visits and procedures seem like they might be more stable in price during a single year. Theoretically, insurers could also negotiate annual terms for drugs, making their pricing stable. In this case, it appears that the insurer in question might have supplied incorrect information to Medicare's Plan Finder. If the insurer supplied incorrect pricing information, then it does seem that they should be held responsible for the price difference since the patient in the article selected the plan based on that information and cannot change plan selection during the year. Another policy change that could be more patient-friendly is to require insurers give 30 days' or 60 days' notice of price changes of relevant drugs and allow patients to change plans in the case of price increases.

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