How to save money on health care, if you're on vacation and have all day

Here's just one example of why American health care costs so much more than anybody else's.

My husband is going to have outpatient hernia surgery in a couple of weeks. His doctor told him he had to get an EKG before surgery. He suggested that he go to the local urgent care facility to have it done. Being consumer-oriented types, we decided it would be a good idea to find out how much it was going to cost.

First, David called the urgent care center. They were sorry, but the billing office was closed. Could he call back the next day.

No problem. This morning he called the billing office. They were sorry, but they didn't know how much it would cost. He would have to contact his insurance company.

So he called Blue Cross Blue Shield Illinois. The EKG, they told him, would be billed as an outpatient procedure. There would be no co-pay, and since he had already paid his deductible, he would be responsible for only 20% of the cost. Right, said my husband, but how much will the cost be? They were sorry, they said, but they didn't know. That would depend on the provider's tax ID number and the diagnosis code.

So David called the urgent care center again. They gave him the provider's tax ID number and told him there was no diagnosis code, since this was a pre-op procedure. They thought, though, that the charge would be around $250.

At this point, David had to go meet an appointment, so I took over. I called Blue Cross Blue Shield, gave the information to the agent, and waited while she tried to figure out the answer. "We can't do pricing for hospitals," she told me at one point. Hospitals, it seems, have just too labyrinthine a discount policy for even the insurance agents to figure out. But bless her, she kept trying.

She needed a procedure code, however, which is different from a diagnostic code. After eight minutes of checking her own resources, she put me on hold and called the urgent care center herself. They referred her to the hospital's billing center, so the agent put me on hold again and called the hospital. (Say what you will about Blue Cross Blue Shield, they do have excellent customer service.) The hospital provided the necessary code, so the agent went off again to check.

Alas, she finally told me, this was indeed a hospital procedure, and therefore she would not be able to tell me what the cost would be. However, she thought it would be around $250, which means that our portion would be around $50.

Let me ask you something else, I said. Suppose David goes to a doctor and the EKG is done right there in the doctor's office. Would we then pay only the copay for a doctor's visit - $20 for a generalist, $40 for a specialist? The agent checked, and told me I was absolutely right. She sounded surprised.

She thanked me for my patience, and I thanked her for her excellent service (and indeed she was very accommodating). The phone call lasted 22 minutes, and I still was not sure what this procedure would cost.

Next I called a nearby medical group and asked if they are equipped to do EKGs right there in the office. Yes we are, said the receptionist. And, I pursued, if my husband sees a doctor who then immediately does an EKG, do we then just pay the copay? Yes indeed, she said.

So my husband has an appointment for tomorrow afternoon, and it's going to cost us $20 instead of $50 (more or less - we never did find out for sure), and it took only about an hour of our time to figure this out, plus of course whatever it cost Blue Cross, the hospital, the urgent care center, and the doctor's office who helped us.

In France, by contrast, charges are posted on the doctor's office wall for all to read.

Interestingly, the per-capita cost of health care in the U.S. is nearly double its cost in France. Personally, I think socialized medicine is a great way to keep costs down and increase efficiency. But if I were a total free-market type, I'd be equally disgusted with the U.S. system. How can consumers possibly influence the market if providers make it almost impossible to know costs?

If this is the invisible hand at work, it's giving us the finger.