“I haven’t met my deductible. How much will this cost?”
Donna was a 44-year-old woman with hypertension, diabetes and, now, chest pain. Arriving in my emergency department a few hours earlier, she had described a few days of intermittent pressure in her left chest. Her initial evaluation revealed no indication for an emergency procedure, but I recommend observation overnight for continued evaluation. Despite the good news, Donna looked at me with apprehension. Money was tight, and her expenses would be paid out of pocket since her family had a high-deductible plan. If she truly needed care, she would find a way to pay for it, but these expenses would make it difficult to pay rent, purchase medications, or care for her children. Did she really need further testing?
Her question seemed simple. What would she be charged for a night of observation and, possibly, a stress test? But that information isn’t simple to get. Moreover, her real question – whether the recommended care was worth the price – is far more complicated. Without information on costs, risks, benefits, and alternatives, how could anyone be expected to make a reasonable decision?
Having “skin in the game” is meant to make patients more sensitive to cost. Now Donna and 17 million other Americans with high-deductible plans have skin in the game – and a set of information needs we’ve never faced before.