It’s natural to skimp on care when it’s costly

“Have you ever been told you have a heart murmur?” a young doctor gently asked my friend, Ben. Ben’s mind reeled. Ben was in his early 30s, relatively young and healthy. But his father had died from a heart attack before age 50. And his mother had a heart problem. What did this question signal for him, he worried.

“Um, ah, no, I haven’t,” Ben managed to murmur in reply. The doctor told Ben he wanted to get a sonogram to have a picture of Ben’s heart. He scribbled an order on a form and told Ben of a nearby cardiologist. Ben thanked the doctor and wrapped up his appointment. As soon as he left, Ben called me. We have been friends since grade school, and we shared everything. When I heard his voice I could tell he was upset.

It was his first visit to the new doctor, a young physician at a trendy new concierge practice. He said he worried the doctor was jumping to conclusions in his recommendations. Puzzled, I reminded Ben that the test was merely a preventative measure. But, I suggested, with his family history, he would be wise to get his heart checked out. An ounce of prevention is worth a pound of cure, I teased. Then the real truth came out: Ben was worried about the cost of the test. Ben explained he called the cardiologist before he called me. He was shocked to learn a sonogram was $1,200 if he paid out of pocket.

“Twelve hundred bucks?” Ben complained over the phone. “That’s outrageously expensive for a simple test,” he whined. I found myself momentarily distracted by wondering about the costs of technology, malpractice insurance costs, physician practice trends, but I bit my lip. “I agree,” I simply said. And I did agree. I could rationalize a few elements in a cost analysis, but like Ben, I felt $1,200 was too just too much for the simple test.

Then the obvious question hit me. “Wait, why pay in cash, Ben?” I asked. “Why not have your insurance pick it up?” Ben had a good job with great insurance. Surely the insurer would cover at least part of the tab.

“I’ve not met my deductible yet this year,” he explained in a dreary voice. “I already called them and would be on the hook for about four hundred, even with insurance.”

That was a mere third of what Ben had been quoted if he paid out-of-pocket, so I didn’t see why he was still reluctant to have the sonogram. Ben explained that his budget was tight and even $400 was a lot for him. When Ben and his wife had a baby several months prior, I had wondered at the time how expensive the couple of weeks in the NICU had been. Now the pieces came together.

I sighed. I knew where Ben was coming from. Years ago I had avoided the dentist for far too long. Though I saved on a dental plan in the short term, my neglect led to pricey repair work down the road. It’s natural to want to skimp on care when it’s costly.

Recollecting my thoughts, I explained that while preventative tests may not be cost-effective for large swaths of a population, with his family history and doctor’s recommendation, I thought he should have the test.

***

Several days later I received a phone call from Ben. He had been to the cardiologist and did not have a heart murmur, he explained happily. But he did learn something very important.

The sonogram showed that part of his heart wall was enlarged. His doctor surmised that hypertension was the likely culprit. Since hypertension increases the risk of heart problems, with Ben’s family history, the doctor put Ben on a low dose of blood pressure medicine. The cheap generic prescription cost Ben only $4 a month at the pharmacy.

I asked Ben how he felt about the outcome.

“Honestly,” he said, “I am relieved to know what’s going on with my health.” He sighed.

“That four hundred dollars was a lot, but it may have saved or lengthened my life,” he said in a serious tone. “And, for the price of just four dollars each month,” he said more lightly, “now I’ll be around for even longer.”

I thought of my friend and his new baby. And I smiled.

“Yes, you will, Ben,” I said. “Yes, you will.”

Josh Trent was a participant in the 2012 Costs of Care Essay Contest.

This post originally appeared on the Costs of Care Blog. Costs of Care is a 501c3 nonprofit that is transforming American healthcare delivery by empowering patients and their caregivers to deflate medical bills. Follow us on Twitter @costsofcare.