One way Surest creates clear prices
What’s the most logical, fair way to bill for medical services? Doctors could bill by the hour, or the appointment. Or should they bill by the procedure, since it seems more demanding to perform surgery than check blood pressure?
You can see the dilemmas for hospitals, too. Open-heart surgery is much more draining on hospital resources than surgery to repair knee ligaments.
How do you set all those health care costs? What’s included in each price?
The medical profession has faced this question for decades. In the more distant past—and up through the Great Depression—a doctor might accept a chicken or bushel of tomatoes for a house call. For a long time, health care services were bundled. If you went to the hospital for a minor surgery, assuming your visit didn’t result in a much more complicated treatment or an overnight stay, the hospital charged you a price for that surgery.
But as their costs rose and health care providers sought ways to be more profitable, prices became unbundled. The Current Procedural Terminology (CPT)—a list of descriptions of billable medical services authorized by the American Medical Association—was first published in 1966. There were 3,500 CPT codes then.
Eventually even small medical acts—like clipping a pulse oximeter on a patient’s finger—triggered charges to be added to a patient’s bill. Pretty quickly, health care billing codes grew complex. The CPT list had over 10,000 entries in 2019.
Health insurance companies have found their own ways to classify types of care. Palliative care might be charged differently than critical care. Chronic conditions like diabetes might be billed in one price category, while the complications that diabetes causes—kidney failure, heart disease, deterioration of the eyes—could trigger a different category.
It’s a complicated issue, one Surest has been addressing by identifying types of care.
Surest tries to price health care in a way that makes sense to the consumer.
We want you to pay for what you get, as opposed to paying for care or services you don’t need.
The Surest health plan is designed to make those costs and coverage clear in advance. That’s why Surest bundles health services that often occur together and prices them accordingly. By grouping these services—like combining all the tests and services that accompany a major medical procedure into one price—we’re trying to make it easier for you to pay a single price for a health care event, and to know that price before you even go to the doctor.
In health care, some care is plannable in advance. An annual check-up with your doctor, some routine tests—you can know in advance that these things are going to happen. When you’re having a baby, you know long before delivery that it’s coming.
But some types of care you can’t see coming.
Say you have to visit the emergency room. People rarely see that coming. That’s what insurance is really for. In most health insurance plans, you have no idea how much a visit to the ER will cost. There are fees for using the ER, fees for tests and fees for treatments. And often these fees trickle in over a period of weeks, long after you’ve gone home. But if you can know in advance what those health care costs are going to be, you can focus on getting healthy and avoid the anxiety of unknown costs.
Surest is identifying types of care that frequently nest inside others.
Say you’re not feeling well and make a doctor’s appointment. You’ve already had your annual check-up—this is different. There’s a very good chance your provider is going to order some routine tests. Surest prices the doctor’s visit so the amount you pay includes those routine tests.
The same is true if your doctor orders advanced tests.
In the process, some routine tests are usually performed. Surest prices the advanced test so the cost includes those routine tests. You’re not going to get a separate bill from the lab. Similarly, if you’re having a major medical procedure but the doctor has to perform a minor procedure during the same surgery, you get charged only for the major procedure.
In every way, the goal of the Surest plan is simple:
More clarity, less confusion and prices you can know before you make health care decisions.