Tuesday, April 17, 2012

Hidden Health Care Pricing and Costs

More and more employed people who have health insurance are facing large deductibles so they are actually paying "out of pocket" for tests, Xrays and doctor visits.   Health care policy-makers talk about involving the consumer in the cost of care as a way to force competition and hold down prices.  But finding out how much something costs can be a herculean effort and take hours of time phoning around.   Despite a law in California that dates back to 2006 that requires hospitals to post common test prices, it is nearly impossible for a patient to find out ahead what something costs.

I gave my patient an order for a hip Xray to evaluate pain that would not go away.  Because she has a $5000 deductible with Anthem Blue Cross insurance, she knew that she would be paying for it.  She spent hours calling local hospitals to compare prices and became more frustrated and confused as time went on.  She was told they couldn't look it up without a code.  She was asked what hospital campus she would use for the Xray.  (implying there are different prices at the same hospital if you used a different X-ray machine)  She was placed on hold and cut off when transferred.  She was quoted a price of $745 at one hospital and $886 at another and this did not include the radiologist fee for reading the Xray.

I have advised her to call her insurance company, but I have doubts they will tell her their contracted price (which becomes her cost) in advance.

This is the reality of health care in the United States.  Even patients who have insurance struggle with decisions about cost and benefit of tests and spend hours trying to get information to make health decisions.  It is time for patients and employers who buy health insurance to stand up and demand transparency of costs.


oc1dean said...

You should read about ePatient Dave trying to get cost information. It could be humorous if it wasn't so sickening.

Anonymous said...

I was glad to see that you’re arguing for cost transparency (and ease of price discovery) as opposed to returning everyone to “no-hassle, first-dollar” coverage.

Nicholas Newsad said...

Castlight Health and Change:Healthcare are providing healthcare pricing transparency to employees at self-insured companies that buy their online tools while MedicalBillExchange.com has created a crowdsourcing model for patients that searches insurance EOBs and medical bills for providers' negotiated allowable amounts with each insurance company.

Anonymous said...

My patient's insurance was charged $8000 for an Emergency room visit, including a CT scan. She paid over $3000. Really? I figure the CT scan was $4000 or thereabouts, so the ED visit was $4000. Outrageous.

Dr. DC said...

We just got a hearing evaluation bill for our son from a year ago -- $1200. Would have passed on that if we would have been able to perform a cost-benefit analysis.

Michael Kirsch, M.D. said...

I am as confused as the patients. When a patient asks me how much their colonoscopy will cost, I don't know. They find this incredulous, but colonoscopies are like seats on an airplane. No two folks pay the same price.