Everyone needs health care at some point in their lives, and wouldn’t it be nice if navigating through the system was as easy as buying a new car? Actually, it should be even easier, right? Because car salespeople aren’t reputed to be the most trustworthy people in the world. Well, when you throw the covers off the American Healthcare System, you reveal a lot of shady individuals all vying for your health care dollars.
Dr. David Wilcox, with three decades of experience in health care, has a sharp warning for you: “Health care is complex, and that is not an accident. It is a strategy on the part of those who benefit from your health care dollars to keep the general public from knowing what is really going on in the healthcare system.”
His eye-opening book – How to Avoid Being a Victim of the American Healthcare System: A Patient’s Handbook for Survival – levels the playing field, enabling consumers of health care to understand how to avoid getting caught in the systemic net. After all, we will all be consumers of health care at some point in our lives.
In his own words, Dr. Wilcox’s book explores “what to do if you have to go to a hospital, how to handle an insurance company’s claim denial, how to find an alternative to high-priced prescriptions, and why the current pay-for-fee system is inadequate. You will also discover the direction the healthcare system needs to move in, to holistically care for you, the patient … information that the health care entities would prefer you didn’t know.”
You can learn more in this interview.
Why does it benefit the healthcare system to be complex?
The healthcare system benefits from complexity as there is little to no price transparency. If the patient has to have a procedure done there is no way to estimate the costs. Even though an executive order went into effect on January 1, 2021, stating that hospitals have to list the cost for many procedures many hospitals are not complying as the fine is a meager $300 dollars a day resulting in penalties of $109,500 a year and has yet to be inforced. Hospitals deal with various insurance companies which makes this more complex. For instance, if you had United Healthcare insurance they will negotiate a different rate than Blue Cross would for the same procedure. If you had your procedure at an ambulatory surgical center as opposed to the hospital the costs will drop significantly. This is information the average American doesn’t know.
Another example is the pharmaceutical companies. I had a dog who had some heart issues. The vet prescribed Viagra for my dog as this medication’s original intent was to reduce pulmonary hypertension. It was only after the side effect of reducing erectile dysfunction was discovered that it shot up in price. When my wife went to the pharmacy to fill the prescription she was told it would cost over $700 for a one month supply. Finding the cost unacceptable my wife searched for the same prescription on the GoodRx app and found it for $63 dollars at another pharmacy. The point is if you can sell the drug for $63 and still make a profit why is it being sold for over $700 just a few blocks away? This lack of price transparency works to the advantage of hospitals, pharmaceutical, and insurance companies to allow them to pull in the greatest profit.
What are some of the ways that patients can be taken advantage of or miss details?
Many patients are hit with surprise billing. In the book How to Avoid Being a Victim of the American Healthcare System: A Patient’s Handbook for Survival, I share the story of a gentleman who needed a double lung transplant. His condition worsened and he was in an Intensive Care Unit (ICU) at his local hospital. When a set of lungs became available that were a perfect match, he had to be transported by helicopter to another hospital in the same state. When he received his bill his surgery cost $40,000 but his transport cost $53,000! That’s because there is a federal law that considers medical air transport as being out of network which means the patient pays more out of pocket. The bill was dismissed after Good Morning America aired the story as media attention to outrageous healthcare expenses usually cause the healthcare entity to settle in the patient's favor. This is another fact that most Americans are unaware of.
Another area that patients are taken advantage of is in their hospital bills. Many times hospitals will charge patients for procedures or medication that they never had. Every patient should review their hospital bill for accuracy.
The problem is in the current Fee-For-Service model doctors and hospitals are incentivized to order more tests as they profit from them. In the book, I discuss Value-Based care which is a model that incentivizes the medical team to keep you healthy and out of the hospital as they receive a certain amount of money to care for you and if the cost of your care exceeds that amount, the healthcare entity has to cover it.
How can patients advocate for themselves so they aren't victims?
Patients have to educate themselves on how to safely navigate the American Healthcare System. This is why I wrote the book, How to Avoid Being a Victim of the American Healthcare System: A Patient’s Handbook for Survival. With medical errors being the third leading cause of death in the United States it is not enough to think when you enter a hospital you will be safe. Patients need to know what medications they are on and why they are on them. Patients need to ask questions when medications are given to them in the hospital. It’s confusing enough that medications have brand names and generic names. Tylenol has three names depending on if it’s a brand, generic or intravenous infusion! Health care is complex, and that is not an accident. It is a strategy on the part of those who benefit from your health care dollars to keep the general public from knowing what is really going on in the healthcare system. No other business is run the same way. There is little to no transparency, about procedures or billing, and the average health care consumer doesn't think about it until they have to access the healthcare system. That is a dangerous mentality, as we all will need health care at some point in our lives. Not being prepared and knowledgeable means you will have little control over the health care you receive. The time is now, while you are still healthy to educate yourself on the American Healthcare System proactively.
Dr. David Wilcox is a health care professional who believes proactive patient education enables those accessing the healthcare system to be better partners in their health care. He also believes that everyone has the right to access the American Healthcare System safely. A Doctorate-prepared nurse who also holds a Master’s in Health Administration and is Board Certified in Nursing Informatics, Dr. Wilcox has nearly three decades of health care experience as a bedside nurse, hospital administrator and in health care information technology, which has helped him to develop his unique perspective on the American Healthcare System.
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