Don’t Get Lost in the Confusion: Exercise Your Power of Choice

3:45 PM, Apr 17, 2019
12:54 PM, May 30, 2019

Remember when you went to see your physician and he or she decided you needed a diagnostic test? The office set up an appointment and your employer-paid insurance took care of most of the bill. Those were the good ol’ days! Well, maybe not so good if you’re at the doctor’s, but at least the financial aspect of your health wasn’t at the forefront of your mind.

How did this all get so complicated? For starters, doctor’s offices and hospitals are burdened with the laborious process of pre-certifying diagnostic tests through the insurance company to merely get permission to perform the test. A pre-certification is not a guarantee of payment, just a green light to move forward. Often, physicians ordering tests have no idea of their cost. After the test is performed, it is coded by a crazily complicated system, submitted, reviewed by the insurance company – which then rejects it at least once for resubmission – and at last an explanation of benefits (EOB) is issued to you, the policy holder, and some partial-to-no payment is sent to the medical provider. Any balance due is up to you to pay.

Another thing to be aware of is you can choose where to go for your diagnostic tests. In some cases, patients feel “bullied” into using the services preferred by their physicians. This could be because of the physician’s comfort or convenience or corporate pressure to meet a quota. Sometimes, it makes sense to stay with a physician’s recommended provider or within the same corporate entity, depending on the procedure and the involvement the physician may have in treating any results from the test(s). For example, most obstetricians have an in-office ultrasound. Since the obstetrician will be monitoring the entire pregnancy, it makes sense to have ultrasounds performed there rather than elsewhere. But it’s not always necessary to undergo diagnostic tests at a recommended partner hospital or hospital-owned facility. Typically, tests at these places have higher fees than independently owned offices. It’s understandable these facilities charge higher rates, with their 24/7 overheads costs, numerous no-pay patients and extremely expensive emergency treatment costs. But unless you need to have tests done at such places, why should you be burdened with paying a higher cost?

Here’s the good news: There is a way to navigate this system by exercising your power of choice in your healthcare providers. This is especially easy to do with diagnostic tests. Whether you have insurance or not (although everyone should have at least a catastrophic insurance plan), you need to price check. Often outpatient diagnostic tests can be performed at a much lower cost with the same quality and expertise. Educating patients about how much power of choice they actually have has been our greatest obstacle at Patient Choice Ultrasound & Thermography (PCU). Ultimately it’s every patient’s choice because at the end of the day, it’s the patient who is responsible for the bill.

Having been in the mobile ultrasound business since 1982, I saw more and more physician clients either retire or become absorbed into a corporation. I became frustrated with doing business as usual and being unable to answer the question, “Will my insurance pay for this?” So this past January, I opened up a “storefront” diagnostic ultrasound office that is “cash based.” By eliminating the dependency on insurance reimbursement, we are able to reduce the price of all of our diagnostic testing to a fraction of the cost. Many people have very high deductibles, which means they pay out of pocket for almost everything until that deductible is met. In most cases, the deductible isn’t met without a catastrophic event or serious illness. Our prices are affordable, transparent and all-inclusive, including the interpretation fee. PCU provides a receipt that may be used towards a patient’s deductible.

At PCU, we believe in empowering the patient. Somewhere along the line, the patient has gotten lost in the system. Our practice is designed for everyone, regardless of their insurance carrier, but especially for those with no insurance or those with high deductibles that make it a burden to go the traditional route. At PCU, we feel your only concern should be your health, not whether you should choose between your health and finances.

When scheduling, we have a moral obligation based on the company’s philosophy to inquire about your deductible. If you are close to meeting your deductible or anticipating an upcoming surgery, etc., we recommend you continue to shop around to do what is best for you in each particular circumstance. And whenever a patient chooses a different route, we appreciate any feedback so we can continually assess how to improve the care we are capable of providing.

We are currently open Monday through Friday with weekend appointments available. We accept Medicare as our only insurance. This decision was made solely to provide for the entire family. Health savings and Flex accounts are also welcome.

About the Author
With 40 years in the field of ultrasound, Kim Davis, RDMS, RDCS, RVS, is the founder and CEO of Patient Choice Ultrasound at 152 W. Tiverton Way in Lexington. PCU can be reached at (859) 554-7360 or by visiting its Web site at www.
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Patient Choice Ultrasound

152 W Tiverton Way
Lexington, KY 40503

Monday – Thursday, 8 a.m. – 7 p.m.
Friday, 8 a.m. – 5 p.m.
Saturday appointments always available


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