Ever tried to get a firm price tag before going to the doctor or the hospital? Good luck. Historically, the search for healthcare prices has been an exercise in futility.
But that’s starting to change. With healthcare costs rising and consumers on the hook for a growing share of their medical bills, doctors, hospitals and health insurers are feeling the pressure to make healthcare prices more readily available.
“We expect consumers to cover more of their care and decide how to expend resources. But it’s unacceptable to expect them to do that without providing them with what they need to make price and quality decisions,” said Suzanne Delbanco, executive director of the group Catalyst for Payment Reform.
Last week the nonprofit organization issued a report on medical pricing that graded states’ efforts to provide useful pricing information. In all, 36 states got a grade of D or F, including California, which got a D.
Under a state law that took effect in 2006, California hospitals must publish average charges for common procedures on the website of the California Office of Statewide Health Planning and Development. However, experts warn that typically these indicate what hospitals charge, not what they’re paid.
Although the usefulness of price information varies widely, there are a growing number of tools available to help consumers. Here are a few places to look for prices the next time you need to know what that lab test or procedure is going to cost:
• Try FairHealthConsumer.org, an easy-to-use website with a sophisticated cost calculator tool for medical and dental services.
Let’s say you’ve injured your knee and your doctor orders an MRI to see what’s going on. You have insurance, but you want to know how much of the test’s cost is going to come out of your own pocket.
Once on the site’s medical cost estimator you’ll input your ZIP Code, indicate whether you have insurance and find your procedure on a drop-down list. Up pops the estimated price.
Also on display will be the amount your insurer is likely to cover (you can adjust percentages based on the details of your health plan) and how much you would pay. You’ll also be informed about the extras. For example, a plus sign next to your procedure is a cue that it’s coupled with other services likely to drive up the price, said Robin Gelburd, Fair Health’s president.
• Pricing sites such as HealthBlueBook.com and NewChoiceHealth.com offer up the average cost that insurance companies pay for many inpatient and outpatient procedures in your area. You can use that as a starting point to negotiate with your doctor.
• SaveOnMedical.com is a new site set up to compare prices and quality ratings for services such as MRIs, X-rays and CT scans. Here you’ll be shown a list of providers by the price they charge once you input the service you need along with your ZIP Code or city.
Checking prices is not easy and sometimes unsatisfactory. Just ask Patti Singer, a Syracuse, N.Y., journalist who says she has become an avid healthcare shopper.
Because most tools offer a ballpark figure, she’s sticking with the old-fashioned method of calling both her healthcare provider and insurer, Singer said. “I want to know exactly what I’m paying. I don’t want an estimate. I want the price.”
Although she’s usually successful in getting a price, it’s often at the cost of many hours spent trying, Singer said. “I can spend three hours over a day or two days making the phone calls. If I worked at a job without access to a telephone all the time, I couldn’t do it.”
Why do this? A study published last year by Delbanco’s group on price variation, for example, found that colonoscopies varied in cost from one provider to another by as much as 1,000%.
These forces have prompted a kind of arms race among insurers, employers and public and private websites to build cost calculators and other tools that show medical costs.
According to Robert Zirkelbach, spokesman for the insurance industry trade association America’s Health Insurance Plans, most health plans make available to policyholders the average cost for procedures within a geographic area or ZIP Code; some even show cost by specific healthcare providers.
For instance, insurer Aetna Inc. has a Member Payment Estimator tool that provides cost estimates for more than 550 commonly used health services. Members can view 10 cost estimates at a time for the procedure they need in order to shop for the best price. According to the company, members searching more than 30 commonly used services spent roughly $170 less on their care than the average price estimate for that service.
“The specific type of information varies from plan to plan. And you’re seeing a lot of innovation in this area,” Zirkelbach said.
Employers often are in the cost calculator game as well, and have been the main drivers behind the movement toward releasing healthcare prices from their black box. If you get health insurance at work, check with your employer and your insurer to see what, if any, tools are available.
When using any of these cost estimation tools, it’s crucial to keep in mind that hospitals, doctors, anesthesiologists and labs may all bill separately. You’ve got to consider the full picture to get a handle on your likely costs. Also remember that lab tests, MRIs and even surgeries are often less expensive at independent medical centers than at hospitals, said Matt Schneider, co-founder of SaveOnMedical.com.
And do your homework in advance of receiving non-urgent care, he said. “If you’re armed with information, that’s a much better point than after the procedure and after you get a bill. Usually those are very difficult to negotiate.”
Despite the efforts underway, our fragmented healthcare system still puts up barriers to getting accurate medical costs. But the experts are optimistic that the mystery surrounding medical pricing is disappearing.
“Slowly but surely, the veil is being lifted,” Delbanco said.
Zamosky writes about healthcare and health insurance.