If you have a health insurance deductible to satisfy, or if you are enrolled in a consumer driven healthcare plan, or if you have out-of-pocket costs that add up to more than $25/visit, I am sure you try to make the most of your health care dollars by finding low-cost providers that offer  the best value.  How do you find these low-cost providers?

 

Starting November 1^st, I am polling the community to find out how you search for health care prices.  I am interested in understanding how different consumers search for low-cost healthcare prices. What tools do you use to compare prices for health care services?  What “search terms” do you type in Google to find prices for health care services?

 

Let’s assume you visited your doctor and you need to have a non-emergency test or procedure performed.   How do you go about your search to compare prices for services like MRIs, x-rays, mammograms, vaccinations, lab tests, or a colonoscopy?  Do you ask your doctor for estimated prices?  Do you call the hospital or facility and ask for prices?  Do you ask your family, friends or neighbor to compare what they paid?  Do you call your health insurance hot-line for prices and recommendation on where to get the best value for this service?  Do you use Google to search?  If so, what search terms do you use? 

 

Send me an email to let me know what search terms you would use (or have used) to look-up and compare health care prices for specific services.   The first 1,000 people to respond will be entered in a drawing for a chance to win a $50 Amazon.com gift certificate.  Email entries will be accepted through November 30, 2008.

 

Here are the details to be included in the drawing for the $50 Amazon gift card.  Send an email to info@OutofPocket.com  and in your email message be sure to include:

 

(1)   What specific resources you would use (search engines, websites, online tools)

(2)   What search terms you would use to find prices for health care services

(3)   An email address where we can contact you, to notify you if you win the drawing

 

Good luck and thanks for sharing your search tips with us. 

 

Here's the scoop on the true price of an appendectomy.

If you are wondering what the true cost of an appendectomy is, keep reading....  Jaz-Michael King’s blog, A Scanner Brightly, provides the most thorough detail I have ever read on a patient’s charges for an appendectomy.  He wrote this blog earlier this year, and itemized the specific charges related to his appendectomy procedure.  A huge thank you to Jaz-Michael for sharing this detail with everyone to help us become better health care consumers.  I am glad everything turned out fine for Jaz-Michael and I would like to encourage him to keep up the great blog.  The data he shares is a wealth of information for consumers.

You definitely should read his blog entry, Hospital Bill: Appendix Ultimatum - it includes his comments and other useful information on the breakdown of costs for this procedure. 

 

Here are the itemized charges for an emergency appendectomy.

 

Appendectomy -- Itemized Charges	Charges	Actual Negotiated Price
Emergency Room:	$1,185.00	$419.68
Emergency Room Physician:	$1,461	$460.60
Cat Scan:	$2,015.00	$713.64
Operating Room:	$3,250.00	1,151.03
Surgeon:	$1,740.00	$626.81
Anesthetist:	$1,601.00	$787.50
Recovery Room:	$3,100.00	$1,097.91
Pathologist:	$35.00	$35.00
Semi-Private Ward:	$5,000.00	$1,770.81
X-Ray:	$127.00	$44.98
Per Diems:	$5,850.70	$5,850.70
Labs, Supplies, Medical Services	$1,627.04	$652.65
New York State Service Charge	$523.64	$523.64
Total Hospital Charges:	$22,718.70
Total Paid:	$12,078.38
The hospital visit was reimbursed at 53.2% of charges
Insurance: CIGNA

As the economy weakens, more people are looking for help from Prescription Drug Assistance Programs to pay for their medications . These programs are sponsored by pharmaceutical manufacturers and provide consumers with billions of dollars a year in free or low-cost drugs. In order to quality for this program, patients must meet very strict financial requirements. Here are some online resources where you can get help.

FINDING & NAVIGATING PATIENT-ASSISTANCE PROGRAMS

NeedyMeds.org online resource to find help with the cost of medicine Partnership for Prescription Assistance helps match patients to more than 475 private and public programs. This resource includes information on other types of assistance programs.

Partnership for Prescription Assistance helps match patients to more than 475 private and public programs.  This resource includes information on other types of assistance programs.

RxAssist.org allows patients to search a database of patient-assistant programs by medication. Provides tips on free and low-cost medications.

DISCOUNT DRUG CARDS

Together Rx Access – sponsored by nine major drug companies, this free card offers 20% to 40% discounts on retail prices for more than 300 drugs.

Merck & Pfizer offer separate discount cards for many of their medications. Discounts range from 15% to 50%.

OBTAINING LOW-COST GENERIC DRUGS

Rx Outreach offers more than 350 generic medications at a cost of $20-$95 for 180-day supplies. Xubex Pharmaceutical Services offer more than 250 generic medications at a cost of $20-$30 for most 90-day supplies.

Walmart, Target and Safeway and other retail chains offer many generic drugs at $4 for a 30-day supply with no eligibility restrictions. Some retain chains have recently lowered prices on 90-day supplies to $10-$15.

A recent visitor to OutofPocket.com contacted me because he couldn’t find prices for a specific procedure he was looking up in our directory. This is a great question and I want to share my response with others.

It’s important to understand that the OutofPocket.com directory is a collection of user generated content. Because insurance plans and providers are not willing to make their true prices public, we rely on consumers to post/share prices they paid for actual visits – to share with other consumers. Our database is limited to the prices/services supplied by other consumers. As awareness for OutofPocket.com builds, we will have a more comprehensive directory of services and prices supplied by consumers – including services like the one you are looking up but cannot find in OutofPocket.com.

If you do not find your service in OutofPocket.com there are several other tools you can use to research prices for specific health care services, procedures or tests. The Government CMS website includes a tool that can be very useful. If you know the specific CPT code you will be able to match the exact procedure to determine what CMS reimburses providers for that procedure. CMS Medicare payment data is always a good starting point if you need to know the lowest possible payment for any CPT code. I'm not sure insurance plans have negotiated rates as low as Medicare, but it's a good benchmark.

Here are links to four tools you might find useful to look up prices for specific health care services.

AMA CPT Code Search Tool to look up CPTs to determine Medicare reimbursement amounts

MyHealthScore online tool to look up fees for specific procedures

USA HealthCare Costs online tool to look up what Medicare pays for specific CPTs

VIMO search tool to compare medical procedure prices at hospitals

How to find a low-cost MRI

 

Everyone is talking about “consumer driven health care” and “price transparency”.   What does this really mean and how does this benefit you?  Recently, there have been a number of unrelated blogs written by consumers describing their experience shopping around for the best price for an MRI.  The fact that consumers are shopping around to find the best price for health care services, calling providers and facilities -is a positive statement about consumers taking more control of their own health care and making smarter decisions.   This is what consumer driven health care is all about.

 

To provide you with some background, an MRI is a diagnostic test that can cost consumers anywhere from $400-$3500, depending on where you go for the test, and what insurance you have (or don’t have).  There is a huge disparity in MRI prices so it definitely pays to shop around to get the best deal.  Consumers can save hundreds of dollars if they comparison shop before scheduling an appointment for their MRI because stand-alone diagnostic facilities offer more competitive prices than hospitals. 

 

Two years ago I began my quest for the true price for an MRI.  Since my experience,many other consumers have been blogging about their own experience and how they shopped around to find the best value.  Here are a few blog entries from consumers that I thought were worth sharing.  After reading these stories, you will have a better understanding of the problem with our current health care system and how you can be a smarter health care consumer.

 

The Cost of a Hospital is Difficult to Pin Down

How Much Does an MRI Cost?

An MRI from Wake Forest

Shopping for an MRI

Quest for the True Price for an MRI

The Priceless MRI

 

If you would like to learn about some of the price transparency tools available today, download my research here.

 

Here are some useful articles to read that will help you make informed choices -- before you visit a provider and before you purchase health care services.  With the end of the year approaching, many employers are offering open enrollment, and many individuals are looking to purchase health insurance.  Here is a list of some aticles that provide very useful information.

• Your Doctor May Be Clueless About Cost (U.S. News)
• How To Cut Health Care Costs (Forbes.com)
• Health care costs rising, but expenses can be controlled (USA Today)
• This Open-Enrollment Season, Beware of Out-of-Pocket Costs (Wall Street Journal)
• Logging On for a Second (or Third) Opinion (The New York Times)
• Six Ways to Save Money on Prescription Drugs and Doctors (CNN.com)

Beware of out-of-pocket costs

 

When you sign up for next year’s health plan during the open enrollment period, beware of out-of-pocket costs.  The key to making an informed decision is to understand the (1) real costs you will be expected to pay and (2) the specific coverage your health plan offers.  Unfortunately, many of the costs are not obvious and you really need to read the fine print to understand exactly what is covered and you will need to ask a lot of questions to know the specific costs you will be expected to pay.

 

With health care costs rising every year, you will be paying more for your health plan benefits in the form of increased monthly premiums, co-payments, co-insurance and deductibles.  Many employers are encouraging workers to select consumer driven high-deductible plans (CDHPs). These plans require employees to pay more out-of-pocket charges for visits and services, but have a much lower monthly premium.  CDHPs can save you hundreds of dollars on premiums per month and very often high-deductible plans are paired with health-savings accounts (tax free dollars)   When you select a high-deductible plan, you will be financially motivated to make the most of your health care dollars and you will be more than willing to shop around for the best value before visiting a provider.  Most people don’t realize this but it is possible, with a high-deductible plan, to actually spend less out-of-pocket dollars during the year.  Here’s how.

 

Plan	Monthly/Annual Premium	Deductible	Co-Pays throughout the year	Out-of-pocket health care costs for  the year	OutofPocket Amount Spent
High-deductible	$300 month,  $3,600/year	$5,000	$0	Premiums + Deductible	$8,600
Traditional plan	$900 month, $10,800/year	$0	7 co-pays @ $35 = $245	Premiums + Deductible + Co-pays	$11,045

 

Here’s what you need to know before choosing a new health plan. 

 

Identify what your co-payment amount is for health care service like doctor visits, hospital stays, outpatient procedures and diagnostic tests.   Be aware of co-insurance charges, which typically require you to pay a percentage of the total cost of service. 

 

Understand what services are NOT covered.   Read the fine print and don’t assume anything. 

 

Before you sign up for a health plan, you should try to understand how your insurance plan’s contracted rates (with health care providers) compares to other insurance plans contracted rates.  In other words, what amount are you expected to pay when you visit your doctor? Is the fee $100, $70 or $50? If you need to have an MRI will your plan require you to pay $600 or $2000? I should warn you that this is very difficult information for consumers to obtain, but it can save you hundreds of dollars on out-pocket expenses when you understand these negotiated prices.  A provider typically has many different prices for the exact same service because insurance plans negotiate different prices for the service.  Your health care dollars will go a lot further if your insurance plan has negotiated low rates with health care providers. 

 

Consumers are starting to find more cost-effective options for elective surgery by traveling to foreign countries where they have the procedure done and save themselves tens of thousands of dollars. A Wall Street Journal story in late September reported that an open heart surgery in the U.S. can cost about $100,000 and can be done an at internationally accredited hospital in India for only $8,500. A hip replacement surgery in the U.S. averages $45,000-$50,000 but can be performed for $12,000 in Singapore.

According to the Deloitte Center for Health Solutions, 750,000 patients traveled abroad in 2007 for in-patient and outpatient procedures. A private health-care provider in Singapore says the number of U.S. patients they treated in 2007 doubled from a year earlier.

What’s interesting is a growing number of insurers are starting to realize the cost-savings of medical tourism. Not only does the insurer save money, but the employer and the employee also benefit from the reduced costs. For the complete story on Paying Workers to Go Abroad for Health Care, be sure to read the article in the Wall Street Journal

When it comes to saving money and shopping around for the best value when purchasing groceries, books, electronics, clothing, automobiles, and vacations - you have the tools you need to help you find the best value. You know how to compare costs, clip coupons, look up prices and research recommendations to determine value. But do you know how to save money on your prescription drugs, contact lenses, dental care and doctors visits?  CNN.com recently published an article to help you save money on drugs and doctors. The article covers tips on:

Dental Care: Have you considered using dental schools for your next dental check-up? These schools charge a lot less than regular dentists. The American Dental Association publishes a list of accredited dental schools you can review.

Contact Lenses: Why pay more than you have to for contact lens? You can purchase your next pair of contact lenses online and save yourself up to 50% of what your eye doctor charges for the exact same contacts. Here is one of many online shopping sites to compare costs.

Prescription Drugs: If you don’t have a sufficient prescription plan, why pay more than you have to when you fill your prescriptions? The Consumer Reports Best Buy Drugs website tells you if there is a less expensive drug that could work the same as the one you’ve been prescribed.

Hospital Bills: It is common knowledge that hospitals often make billing errors. You should always review the detailed charges on your bill, and expect to find errors. The Patient Advocate Foundation will help you review your medical bill for no charge.

If you need to become a better consumer of health care (who doesn't?) be sure to read the book recently published by change:healthcare  titled "My Healthcare Is Killing Me."  This book is available online and provides a practical guide to health care covering insurance basics, some helpful terminology, how to choose a provider, and how to select an insurnance plan that's right for you.  The book includes many helpful resources, definitions and examples.  This is a quick read of 140 pages -- well worth your time.  . You will be a more informed health care consumer after reading this book.  Congratulations to the change:healthcare team that wrote this book.

Providers Paying Consumers $$$ for Sharing their EOBs

Here’s an interesting approach to exposing “true” health care prices (the negotiated price providers really charge for their services).  As you well know, most providers and health plans are unwilling to share pricing information before services are delivered.  In a bold move, two innovative health care providers are collecting contracted prices for services from consumers - for a reward. In April 2008, Alliance Community Hospital in Ohio launched a program offering consumers $100 if they share their EOBs so the hospital can find out how much health insurers paid for health care services received at rival hospitals. They received a lot of participation and this program is still active today. Just recently, Wuesthoff Health System in Florida announced a new transparency initiative offering consumers $100 in gas cards if they share cost information on health care services from providers in the surrounding area. This is an attempt to provide consumers with meaningful information on the true cost of health care services.

Transparency brings good things for consumers like:

1. lower prices
2. more innovative services
3. expanded choices
4. better patient care

Wouldn't it be nice to see more providers sharing true price information with consumers?

Today, HSAeducator.com, an online community and educational website on HSAs, posted a blog entry about a consumer's personal experience using OutofPocket.com to look up prices for a strep throat culture. 

" I typed "strep throat" into the OutofPocket.com website and POOF, it gave me pricing for strep throat testing in my area. The tests ranged from $10.00 to $55.00. Unfortunately, the locations listed were really not that near my house, so I couldn't hit the $10.00 strep test store. But I will have an idea of whether the price of the test was good, bad or ugly. "

Thanks for sharing your story.   We invite everyone to use this search tool to look-up prices for routine health care services (MRIs, vaccinations, x-rays, lab tests, office visits, mammograms, dental, vision) and don't forget to post/share prices you paid for actual visits after you receive your statement or EOBs for the service.

Good news for consumers. There are some simple steps you can follow to make sure you keep control of medical bills and make sure you are not being overcharged for services.

First, review your bill very carefully. You can request an itemized bill. Use free online tools to find out what other consumers paid for similar services using OutofPocket, CMS Medicare CPT look-up tools, and Vimo.

Second, you should know if your insurance covers your treatment. If your procedure falls into a gray area, you should submit letters and official paperwork from providers, including referrals that explain why the treatment was necessary.

Third, remember you always have an opportunity to negotiate down the charges. The total charges that appear on your medical bill have no relationship to what the provider will accept as payment in full.  Health care providers bill everyone the same amount, from Medicare to private insurers to the uninsured.  However, the full charges that appear on your bill are much higher than the provider’s actual costs.  The Government and