I had a persistent skin condition, and my dermatologist thought I should see someone with more experience caring for that kind of lesion. So, I went to a new dermatologist, I will call her Dr. Freezeitoff. At the front desk, the clerk reminded me that Dr. Freezeitoff wasn’t in my insurance network, and therefore I’d have to pay for my visit out-of-pocket, as little as $180 and as much as $250, depending on the length of the visit.
Dr. Freezeitoff seemed capable, with some new ideas about how to treat my condition. The visit wasn’t very long, but it didn’t feel rushed either. She injected my lesion with a medication and then zapped it with liquid nitrogen, the injection and zapping adding maybe two minutes to the visit. I expected that meant I would come out on the higher end of the clerk’s estimate, probably $250 or so.
But I was charged more than $400. The difference in cost was all related to the three minutes of zapping. There is an idea, quite popular in health policy circles these days, that if we expose patients to higher out-of-pocket costs, they will respond as empowered consumers, demanding low cost, high quality medical care, thereby helping the country rein in soaring healthcare costs. My visit to this well-intentioned dermatologist illustrates one of the flaws of this idea of consumer empowerment.
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