I'm now covered by my employer's health insurance. We're used to shopping around for health care, so we expect to spend $80 to $100 at the doctor if we're sick.
My wife has an understandable expectation that insurance is supposed to cover every visit to the doctor's office, but I made it clear to her that we get high-deductible insurance and pay out of pocket up to the deductible, and we're typically better for it financially.
She was sick, and wanted to go to the doctor, so I told her to price it and go, but prefer to stay in our insurance's network. I made it clear that I expected her to ask for the price from both the insurer and the provider, which she did. She was led to expect, based on a friendly phone conversation with an insurer representative, that she should spend no more than $80 (any poorly communicated caveats notwithstanding). She asked the doctor's office what she should expect to pay, and they refused to say, stating that the insurer would tell her.
She scheduled an appointment with the in-network doctor, and canceled her appointment at the clinic she expected to spend around $85 at.
Now we get a bill stating the total for her visit is $230. A phone call with the insurer (telling them I don't expect to pay any more than $80) revealed something about a billing code for a new patient setup fee (I'm misremembering the precise words).
My specific question is: What can I do to overcome this lack of transparency and apparent abuse, both now, and in future?
(Secondary public policy concern: how can we ever get health care costs under control if there's so little transparency? And if it's any help, I've had several insurance and securities licenses, and plenty of business school education including risk-management and insurance classes.)
Edit Good suggestion from comments (Joe): go to the doctor and ask them to remove the undisclosed charge.