John Hunt, MD
Chief Medical Officer, National Coalition of Healthcare Sharing Ministries
As members of the Liberty HealthShare community, each of us has the responsibility to steward the resources of the entire membership. In order for healthcare sharing to function the way it should, we are duty-bound to try and save money whenever we access the health system. And let’s not be naïve: the health system is out to take all the money it can.
As a Liberty HealthShare member, you should know that determining the price of your health care – in advance of purchasing it – is essential. Unfortunately, our country’s dysfunctional healthcare system rarely makes it simple to find price information for medical care.
In most any health care facility, the front desk staff will not be able to tell you what a visit costs. The doctor cannot tell you either. The office’s billing personnel can tell you what they charge for a visit, but only after the visit is over! We are stuck in a system in which price signals don’t exist, and therefore all prices rise. It’s a salesman’s dream – to sell a product the customer has to buy and to never have to tell the customer the cost.
So how can we untangle this insane system of price ignorance in order to effectively steward our membership resources? I’ll teach you an essential trick right now:
Doctors use something called a Current Procedural Terminology (CPT) code to classify the complexity of, and therefore the charge for, an office visit. They actually select a CPT code for your visit immediately after stepping out of the exam room.
CPT codes range from level 1 to level 5, for both initial and follow up appointments. Most doctors select a CPT code every time you visit. A level 1 visit corresponds with low complexity, such as looking in an ear and doing little else. Level 5 signifies very high complexity, such as multiple organ system disease that is addressed in a single visit. Most visits are coded as level 2, 3, or 4. Doctors generally don’t know what is charged for each level of visit. It is nearly pointless to ask them. But what doctors do know is that the higher the level they code on your bill, the more money you will be charged for the visit.
The income of doctors is increased by coding higher and decreased by coding lower. If doctors are under pressure to generate revenue, they can do so either by seeing more patients or by coding each visit higher (called “up-coding”). Most doctors are under financial pressure from administrative bosses, and because the CPT coding process is flexible, their unadmitted natural tendency is to up-code. They justify this in part because they think some distant, faceless insurance company—that they despise—is going to be paying the bill anyway.
But you don’t have insurance. And your doctor not only needs to know that but also needs to hear that information at just the right time. There is a very reasonable chance you can influence your doctor to “down-code” your office visit CPT code if you let them know about your particular situation. Keep in mind, the difference in billed charges between even a level 3 and a level 2 visit can be substantial. Many doctors are kind enough to automatically down-code your visit, simply in response to you telling them you are a self-pay patient who cares about costs. It’s the one easy way they can help you save money, and good doctors care about saving you money.
So it is absolutely essential that you TELL THE DOCTOR (or nurse practitioner or physician assistant) that you are a self-pay patient. Don’t just tell the front desk or billing staff and expect it to be communicated. It is the doctor who, right after your visit concludes, will choose a CPT code. The CPT code they choose, with hardly a thought, is the critical determining factor in the size of your bill. It will affect how much you pay or how much you will ask the Liberty HealthShare community to share in.
Doctors have a lot on their minds, so you need to tell them, right there during the clinic visit, each time you visit, that you do not have insurance, that you are a self-pay patient, and that you are a member of a healthcare sharing ministry in which the community shares with each other. Tell the doctor that you care very much about how much your care is going to cost and what your bill will be. If you tell your doctor this—during your visit—not only will you prevent them from up-coding the bill, but you will also greatly increase the chance that they will down-code your bill. Either is a big win.
Your involvement in this process is essential. It may be the single most effective way you can help to steward our community’s resources. All you have to do to accomplish these cost savings is to simply tell your doctor that you are very concerned about the cost. They won’t know unless you speak up. You have to tell them.