ATLANTA — Channel 2 Consumer Adviser Clark Howard has a warning for you before your next doctor’s appointment.
“If there is something you need, a prescription, a medical device, or a test do not just pay whatever you are told right then and there,” Clark said shopping around will save you hundreds if not thousands.
After a trip to the doctor earlier this year, Marietta resident William Bauman was given an arm brace to help with a minor wrist injury.
“I specifically asked the medical assistant, ‘Is this covered by Medicare as DME(durable medical equipment).’ and she said, ‘I wouldn’t let you have it if it weren’t.’” Bauman said.
Weeks later Bauman received a bill from Breg, the company that made his brace. The cost of the brace to his provider was $525.
“Medicare covered $260 and I was on the hook for $240 for a wrist brace that I could have bought on Amazon for $35,” Bauman said he feels ripped off.
We checked online and found the same brace prescribed to Bauman for just over just over $36.
The total markup for his brace was right around 400%.
Natasha Taylor is deputy director of the consumer advocacy non-profit Georgia Watch. Taylor told Channel 2 that many times providers put consumers in situations where they cannot shop around.
“They need the equipment right at that moment,” she said the issue is the market can charge providers any rate because there is no baseline fee for durable medical equipment.
Taylor believes it is up to the provider to be transparent about the cost upfront.
“This really does seem like, a surprise billing issue,” Taylor said.
In 2022 the federal “No Surprises Act” went into effect. The law protects consumers from surprise bills from out-of-network providers aftercare at an in-network facility.
Bauman thinks more needs to be done to protect patients.
“The thing is this is that you can’t see the doctor unless you sign all your rights away. Nobody reads it. It’s like five pages of small print,” he said.
Breg, the company that made Bauman’s brace addresses price differences like his on its website: “When buying a product online there is no professional fitting or instruction for the brace, there are no insurance billing services available and nothing goes toward satisfying deductibles or coinsurance.”
Bauman worries people will avoid their physicians altogether because of these costs.
“It’s the implications of this, the cost to society and making poor health care choices because, we’re doing so, with a feeling of distrust and mistrust,” he said.
Clark said shopping around is not the only way to make sure you are getting the best price.
“Many times being a cash payer is cheaper than you using insurance,” Howard said.