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October 2013
Health Care: Consumer Choice and Decision-Making
By John Paul Galles

     I am always pleased to hear from our readers about our content, and especially responses to this column. In a recent communiqué, prompted by our current series on health care reform, a particular writer described how she had been confronted by unaffordably high costs of fairly straightforward services and how she overcame them. I think our readers may benefit from some of her insights, so here is her story in pertinent part.


     “I will begin by saying that I have had no health care coverage for a couple of years now. ‘That’s not how I was raised,’ my parents would say, but it has been an economic reality. Fortunately, I have been pretty healthy. Let’s put it this way—if all of my health care premiums were still in the bank, it’d be a pretty healthy bank account, too. But that’s not how it works.

      “Let me say initially that this ‘self-help’ I describe involves healthy amounts of Internet research.

      “From my general reading, I had decided it would be prudent to embark on hormone replacement therapy (HRT), appropriate for my age to prevent osteoporosis and benefit cardiovascular health. So, for the first time in over 15 years, I decided to go to a doctor.

      “I was very careful to ask in advance about the costs of the consultation and ancillary procedures, as I had to budget for them.

      “I went to my appointment, again confirming the costs with the receptionist before I completed the paperwork. Before they could put me in the system, however, it took them some time to figure out the right ‘code’ for someone who was uninsured.

      “After the visit, I stopped at the payment counter. There they tried to assign dollar amounts for the services rendered. Again, it took them quite some time to locate a fairly beaten up binder of plastic-covered sheets with the rates for services, and an equal amount to match up codes with services that should be charged. Actually, I was at the payment counter longer than the entire appointment had taken. After we got it all straightened out, I wrote my check.

      “The regular exam and five blood tests totaled $1,200-plus. Those blood tests alone had been charged at whopping $800. And that’s with the ‘self pay discount.’

      “No more than a week later, I received a bill from the doctor’s billing service attempting to charge me $70 more. I returned it with an explanation that nothing more would be forthcoming, along with copies of the bill marked Paid in Full and my cancelled check. Then about a month later, I received the same invoice as before, only now ‘60 days late.’

      “This wasn’t long after The Charlotte Observer’s series of articles on hospitals’ aggressive collection tactics, so I wasn’t surprised. I sent back the same information and was prepared to do so each time in the future, but I did not receive any further invoices.

      “As far as the prices for the actual HRT prescription, the lowest price I could find among all area pharmacies including Costco was $115 per month. So after paying that once, I researched whether I could find it cheaper online. As it turns out, there are a number of reputable pharmacies in Canada that anyone can order from for about one-third of the price of the same exact (non-generic) product in the U.S.

      “So I chose one——and emailed them my prescription, and from that time on I have had exemplary service, receiving shipments every three months.

      “As the year passed, I knew that, while I might have to see the doctor annually, there was no reason at my age and given current recommendations of the surgeon general, that I needed an exam every year. So this year when it was time to go, I determined to specify that no exam was necessary, only a consult on blood work with the doctor.

       “Then I did some research online on how to get blood tests done less expensively. First, though, I had to request my records from the doctor to see the particulars of the blood tests that had been done the first time. When I picked up a copy of those records, I was glad I did, because they had a lot of information that should be part of my own personal health record.

      “Poring over the medical jargon, I was able to discern the five tests I would need. And, as it turned out, there are many sites on the Internet where you can register and schedule to have blood work done at local facilities through Quest and LabCorp without a prescription and receive the results directly yourself.

      [Sites include:,,,,,, and (requires Rx).]

      “So I registered online for the five tests I needed and chose the office location most convenient—which was, by the way, just a floor below the doctor’s office! I paid the total for the tests of $183 and the time and date of my appointment was confirmed.

      “The LabCorp office was very efficient and had all paperwork in order. It was evident on the receipt that if I had not paid for the blood work through the online site, it would have been $700 for the five tests. (They say the doctor’s office usually adds on medical waste disposal fees, etc. to this amount.)

      I provided the results to my doctor’s office and the subsequent consult was direct and informative and a mere $125.

      “What I have learned is to be more aggressive about my own health care than ever before. While I did not have a choice—it was either find a more affordable solution or do without—I encourage others to research and aggressively inquire about expenses of non-emergency health care. This year, being proactive, what cost in excess of $1,200 last year was kept to a minimal $300 level, and managing the monthly prescription costs is a third as expensive.”


     In my opinion, one of the best attributes of the new health care system set up by the Affordable Care Act is the emphasis on consumer choice and decision-making. American consumers are wise participants in our free enterprise system and know how to weigh the costs and the quality in their decision-making parameters.



John Paul Galles is the publisher of Greater Charlotte Biz.
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