As a parent of four kids, I know where to get a good deal. I can tell you which store is offering the best deal on kids clothes with long lasting quality; I know where to get the best price on cereal, produce and meat; and I know how to make snacks stretch. I have researched which cleaning products work the best to get slime out of carpet, and how to get spaghetti sauce out of a white shirt. You know what...every single one of those tasks took time to research and figure out the best option. I do it because it matters to the overall well being of our family. As parents, we are naturally inclined to do our research on things that affect our kids daily lives and especially things that hit our wallets.

It seems so strange then that literally one of the most expensive things a parent could have to spend on their children is generally unknown until the bill comes. I am talking about the healthcare bills that arrive after your child needs an urgent care visit, an x-ray, or a trip to the emergency room.

We have all been there (or if you are one of the lucky ones that hasn’t yet...trust me you will) where you hear the blood curdling scream, a sibling comes running up the stairs and says “Mom come quick!” You find yourself racing downstairs to find one of your kids bleeding from their head. Heads bleed a lot! Your first instinct is to determine where the bleeding is coming from, and then just how bad is this emergency! Once you figure out the injury is more than you can handle yourself, the next step is to figure out how quickly you can get help.

Depending on the time of day, the answer may be a drive to the pediatrician, a trip to urgent care, or perhaps the emergency room. In those moments of crisis, nowhere in my thought process have I paused to ask myself, “Which physician or healthcare facility has the lowest negotiated rate with my insurance plan?” or “Where can I go and get the best deal on head staples?” I just need to “fix things” and ease the pain and fear for my child. This need overpowers any other instinct I may have in the moment.

I am lucky enough to have good healthcare facilities within a reasonable distance (which I am quite aware is not always the case for so many people in this country), so this incident at most will last a few hours. I will come home with a sheet of instructions of what to expect the next few days, warning signs to look for, perhaps a medication, and if any follow-up is needed. Kids are miraculous at bouncing back and after some relatively short period of time, life returns to normal.

Then the bad news comes in the mail, in the form of an Explanation of Benefits (EOB) from my insurance company. The EOB is then followed by bills from the facility and/or the doctor. This is even more devastating if you are uninsured (recently so many more families are facing this reality). With our high deductible insurance plan, the out-of-pocket costs for these bills can be thousands of dollars for something as relatively straightforward as a visit to the Emergency Room for head staples. As with most insurance companies, our insurance separately negotiates rates with each provider as to what they are going to cover for each service, including facility fees, physician fees, diagnostic tests, prescriptions, etc.

Only once the facility and doctors know what procedures were performed do they have any clue what it is going to cost. Nevertheless, while I sit there in the exam room, they ask me to sign away permission to bill my insurance, and yet I have no idea if this may very well bankrupt me in the future. I sign the permission form anyway because what choice do I have - I can’t very well put in staples in myself and going somewhere else seems ridiculous. This is just a basic example. What is it like for more complicated health care issues and long-lasting diseases or disorders? The answer is that it can be devastating for a family.

We are the consumers of healthcare and the healthcare system cannot thrive without us. This has been made abundantly clear during the past eight months of the COVID-19 pandemic. Ironically, the pandemic literally brought the healthcare industry to a screeching halt. Delayed elective procedures, physician office visits cancelled, and people even avoiding emergency rooms.

In April of 2020, Kaufman Hall reported U.S. hospitals had their worst financial performance in history. In fact, most of the healthcare systems across the country needed government aid to keep from crumbling financially, and they still had around 29% operating losses even with the aid.

This fact showed me that the healthcare industry needs us just as much as we need them. As healthcare consumers have more control than we ever thought possible. We can take back control and demand the transparency of healthcare prices.

We should have a much better understanding of how much health care services will cost us before we arrive at the provider facility. If we had price transparency, we could do our research, make an informed decision on where to go, and have a plan in place for when life throws us a curveball. We could feel armed with knowledge to make the best possible choices for our families.

I am not naïve to the fact that the current healthcare pricing is complicated and highly ingrained in the healthcare system / insurance company culture….but that doesn’t mean it can’t be changed. It starts with you and me - asking the right questions and deciding that just because something has always been done this way doesn’t mean it has to stay this way.

The future is bright,

Amy