Here are some highlights from this article:

• People often overpay for services just because they are not aware that you can get the exact same care at a different facility across the street for a fraction of the cost.  Do your research.
  
• Find out up front if the doctor or facility is in your insurance network. Using out-of-network services and providers can cost twice as much.
• Befriend your local pharmacist.  Take advantage of chatting with your pharmacist on a regular basis about your medication management.  Your pharmacist can also recommend generic alternatives
• Make sure you understand your health insurance plan.  Read the small print to make sure you understand what services are included, copays and out-of-pocket cost before you visit your provider
• Take advantage of websites that can help you lower your costs by letting you know what you should be paying for specific services.
  

• Tell your doctor up front if you are concerned about price and ask your doctor to help you save money
  
• Ask up front how much a procedure or service is going to cost
• Ask up front if a test the provider ordered is necessary
• Inquire if there is a cheaper alternative or generic version of the medication your doctor prescribed

There are a number of websites you should become familiar with.  These sites are free and can help you lower your health care costs by letting you know what you should be paying for services.

• HealthcareBlueBook – provides "fair" prices for medical procedures in your zipcode.  This site is a free price comparison website for consumers/patients.
  

• GoodRx.com – rated by Consumer Reports as the best application for find the lowest drug prices in store and online.  The site also shows generic alternatives and posts coupons, if available, to help you save money.

This one question, if deployed, would start to solve the issues facing patients, clinicians, payers, and hospitals – everyone involved in getting or receiving medical care.

What’s the question?

“How much is that?”

There are two things in play in the health care industry that fly in the face of marketplace sense. First is the lack of price transparency. Imagine going to the grocery store and seeing aisles upon aisles of food … without any prices posted.

“How much is that package of chicken breasts?” “That depends. How are you paying for it?”

My guess is that you wouldn’t shop in that market again. Health care is the only consumer-facing industry in the U.S. that doesn’t have price transparency. Worse, if you ask for pricing, you’re often met with blank stares and “I have no idea” as the answer.

Second is how the prices are set. You’ve heard of the medical billing codes – the Holy Codes that state Medicare and health insurance reimbursement payments for everything from lab tests to joint replacement. The price values for each of those billing codes is set by an American Medical Association (AMA) committee called the RUC: the Specialty Society Relative Value Scale Update Committee. This group meets behind closed doors, creates the pricing list for every single medical procedure, and then publishes it. This is not price fixing, since they hand the list to the Centers for Medicare and Medicaid Services (CMS) for publication, the AMA does not publish the list on its own.

Here’s a critical health policy issue: create price transparency. Require providers to know, and share, the cost of the services they provide to the customers they serve: THE PATIENTS. Doing this will accomplish what all the health care blue-ribbon committees and working groups in DC haven’t been able to pull off: downward pressure on health care costs.

Whether you love Obamacare or not, you know that the health care system in the U.S. must change, for the health of our families and communities as well as the financial health of our national economy.

As an example of the results that a health care consumer can get by asking “how much is that?” I offer you a story off the business pages of the Los Angeles Times. One woman discovered that the cash price for the medical procedure she needed was $1,054, but only after her insurer had been billed $6,707, of which her co-pay was $2,336. If she’d asked “how much is that?” she would have saved herself $1,282. That’s a hard lesson, isn’t it?

How broken is the health care payment model in the U.S.? It’s pretty darn broken, as evidenced by that anecdote alone. By asking for pricing information when making health care purchases, we can have a positive impact on our own financial outlook while simultaneously opening up new communication channels with our health care teams. Their work has value. That value, and its pricing, should be transparent to us. We’re paying the bill: through insurance premiums and co-pays, health savings accounts, self-pay for health care, or a combination of all three.

So the next time you’re buying health care services, ask that really important question: “How much is that?” If you don’t get an answer, consider shopping in another health care store.

That will start bending the cost curve!

Disruptive Women in Healthcare

Written by:  Casey Quinlan on October 24, 2012

Casey Quinlan is a digital health activist and author of "Cancer for Christmas: Making the Most of a Daunting Gift". She speaks frequently to both clinician and patient audiences about the power of participatory medicine and data-sharing, and is an advocate for price transparency in healthcare.

By Sara McFarland

1. Demand price transparency and turn to transparency tools online
2. Compare competing facilities’ quality and take into account things like; convenience, technology, physician involvement and patient reviews
3. Negotiate pricing when possible
4. Understand that high costs do not always mean better care and bigger does not always mean better.

Surgery to remove your appendix in one California hospital could cost $180,000. Have the operation at a different facility in the same state and the bill might be as little as $1,500.

That kind of disparity, typical across the country, combined with escalating medical spending and the increasing amount of data available online, has prompted several startups to get into the business of helping companies and their employees save health-care dollars.

“This is about changing the way people shop for health care, and as a consequence, changing the way care gets delivered,” said Giovanni Colella, co-founder of Castlight Health Inc., a San Francisco-based company that helps patients shop for medical care.

Medical spending in the U.S. increased 88 percent to $2.59 trillion in the last decade while out-of-pocket expenses rose 49 percent to $299.7 billion, according to data from the Centers for Medicare and Medicaid Services.

Castlight works by showing how much doctors, labs and hospitals charge for their services, as well as providing quality ratings. On May 1, the company announced it raised $100 million from investors. Other sites such as HealthcareBlueBook.com, ClearCost Health and Change Healthcare Corp. help employers identify less costly doctors and providers for their workers.

Travelocity for Health Care

With their out-of pocket medical expenses on the rise, more and more employees are open to ways to save. Last year, 13 percent of U.S. employees were covered by so-called high- deductible plans that require them to pay for most health costs, an increase from 3 percent five years ago, according to Mercer, a New York-based industry consultant.

Castlight targets companies with self-insured health plans and charges them a monthly fee based on the number of employees and dependents covered. It compiles paid claims data from employers and insurers, then publishes that information on a website for companies and their employees. The closely held company, which bills itself as a Travelocity for health care, serves more than 250,000 employees and their dependents at dozens of companies.

By helping people compare the cost of medical providers, Castlight has saved the companies they work for from 3 percent to 5 percent of their baseline costs, Colella said.

Cheaper Care

CareOperative LLC, another closely held company, debuted HealthcareBlueBook.com in January 2009. CareOperative lets consumers use the service for free, while charging companies a fee for finding health areas where they and their employees can save. The service promises to reduce an employer’s health-care costs as much as 6 percent by finding cheaper alternatives for employees and giving them incentives to switch doctors or hospitals. The Nashville, Tennessee-based site has “hundreds of thousands” of visitors a year, Aimee Stern, a spokeswoman, said in an interview.

Mona Lori Frisbie started OutOfPocket.com in 2007 as a crowd-sourcing tool for patients. When few visitors posted the prices they paid for services, she supplemented it with Medicare data as well as links to paid claims data on other websites. About 300 to 500 people a day use the free service, she says, which pays for itself with Internet advertising.

“Everyone wants to search and look, but not many people want to contribute and share,” Frisbie said in a telephone interview. “It doesn’t have the same effect as some of these other social media tools, where people like to share where they’re eating and staying.”

High Deductibles

One trouble with these services is that it’s not easy to make direct price comparisons with medical treatments and many consumers won’t take the time to do it even if such a service is available, said Paul Keckley, executive director of the Deloitte Center for Health Solutions in Washington.

“This stuff is over everybody’s head,” Keckley said, though, “there’s always going to be a certain group, we think it’s about 2 percent, that will really act on this.”

Keckley said he expects these services to continue to expand, albeit at a slow pace, as more employees are shifted onto high-deductible insurance plans.

While Colella wouldn’t say if Castlight is profitable yet, revenue is increasing “exponentially,” and the number of customers will more than double this year, he said.

Allison Brown, director of employee services at Regis Corp. (RGS), said using the Castlight service has paid off.

“We have had people actually challenge their doctors on what they were charged, based on what they saw in the Castlight system,” she said.

Wide Disparities

Arming patients with wide price disparities helps them negotiate, Brown said. And those disparities can be wide. Renee Hsia, an assistant professor of emergency medicine at the University of California, San Francisco, highlighted the pricing variations in a research report that looked at how much California hospitals charge for routine appendicitis. Bills ranged from $1,529 to $182,955, with a median cost of $33,611, according to Hsia’s report, which didn’t name the facilities.

“Health care is one of those things where there’s always going to be so much information asymmetry,” she said. “We just don’t know enough because it’s so specialized.”

While consumer services such as Castlight can provide valuable data, patients need to understand that cost differences may depend on the individual decisions made by their doctors facing highly individualized situations, she said.

Treatment Options

“Are you going to require a few CT scans or just one, or none?” she asked. “Are you going to require a different type of surgery? Even if they post that charge for appendicitis, it’s going to be very difficult.”

Understanding the differences among tests, medications and types of services is another hurdle, said David Belk, a doctor in Alameda, California, who wrote about the topic in a report, “The True Cost of Healthcare.”

“You know the difference between filet mignon and chuck steak, but you don’t know the difference between generic amlodipine and brand-name Norvasc,” which is Pfizer Inc.’s blood pressure medication, he said.

Another customer, Life Technologies Inc., a Carlsbad, California-based maker of gene sequencing machines, hired Castlight in early 2011, and more than half of employees on the system made a different decision than they would have without the information, according to a survey, said Carole Mendoza, a spokeswoman.

While publishing prices may spur more-expensive providers to lower costs, it could also prompt some physicians to boost fees if they’re on the cheaper end of the scale, according to an editorial published in the New England Journal of Medicine last year.

Making the Effort

Jon Cohen, chief medical officer for Quest Diagnostics Inc., said even with quality rankings available on doctors, most people don’t exert much effort finding the best providers. Patients “spend twice as much time deciding which model TV to buy as they do deciding which physician to chose,” he said.

Cohen, who spoke at a health-technology conference last month on why patients don’t act like consumers, said convenience is the biggest motivator for choosing a doctor.

“They’ll say this physician has office hours in the evening, or he returns my phone calls, or the parking is great, or the staff is nice,” he said. His own father didn’t consult him before choosing a doctor to operate on his hernia, he said.

The deciding factor? “He told me, ‘Well, he served donuts in the waiting room,”’ Cohen said.

To contact the reporter on this story: Ryan Flinn at rflinn@bloomberg.net

• Prices for these services are often 2-3 times higher than the median price for the exact same procedure.
  
• If the industry were to reduce prices for 300 common procedures to their median price nationwide, total medical expenses would be reduced by 3.5%, or $36 billion annually
  
• A major driver of price variation is the site of service; prices vary significantly by care setting and the percentage of services done in the hospital verses an office setting. 

1. Consider using a cheaper, generic version of a brand-name drug when appropriate.  Be sure to talk with your doctor about less expensive generic alternatives that provide you with the same results.
   
2. Talk to your doctor about the costs of a recommended treatment and any alternatives. Sometimes there are cheaper alternatives that that doctors don’t always bring up because they think your health plan covers all the costs.
   
3. One of the biggest savings can come from using the health savings accounts offered with many high-deductible plans. You contribute to these accounts with pretax dollars and use the money, tax-free, to pay for out-of-pocket medical expenses. Unused money can be carried over into future years.
   
4. If possible try to use urgent care centers rather than Emergency Rooms. This can save you hundreds and possibly thousands of dollars.
   
5. Try to stay in-network. Providers in-network can be a lot less expensive. If you go out of network sometimes you can offer to pay cash for services and receive up to 50% discount. Be aware that if you choose to pay cash, this medical expense will not be applied to your deductible.
   
6. Compare prices for health care services before visiting a provider. The Wall Street Journal published a directory consumers can use to look up prices, or you can view a list of public websites that provide health care pricing.

• Be aware that there is a huge price variation for the exact same procedure. If you are not careful you can end up paying up to 300-500% more for services.

• Do your homework before you visit your provider. Find out a fair price for the health care procedure using tools like HealthCareBlueBook.

• Have a good conversation with your doctor before you have the procedure done to negotiate a fair price upfront for services.

The following guest article was contributed by Angie Hicks, founder of Angie's List.

When I first founded Angie’s List 15 years ago, I tried to help consumers find the best local home and property experts. Before I knew it, Angie’s List was offering consumer reviews in about 350 service categories in every major American city. A few years ago, responding to member demand, we began accepting reports on 150 health and wellness categories, as well.

Most health care consumers are more aware of their actual medical costs these days, thanks to health insurance changes. Angie’s List members, already conditioned to research what others are saying about local contractors before they hire, are applying those same investigative skills to health care providers. And they’re coming around to negotiating health care costs, as well.

Many consumers – including Angie’s List members – don’t know they can negotiate health care costs. More than half of respondents to a recent Angie's List member poll said they’d never tried to negotiate medical bills, but 74 percent of those who did were successful; some ended up paying less than half of the original charge.

This isn't a matter of trying to avoid paying a fair cost for health care. It's making sure you're paying the correct amount and accessing options that are available. Most of our members said they would happily shop around if they knew what to look for. So we partnered with Healthcare Blue Book to make that process easy for them. Knowing what the insurers will pay the doctor is key information to have before starting a negotiation.

Obviously, patients shouldn’t choose a doctor based on price alone. We’re working hard to offer reliable information on local doctors, based on real-life consumer experiences, so that part of the story can be seen as well.

My family has a high deductible health plan with a $5,200 annual deductible and a Health Savings Account (HSA).  I really like our health plan because it provides my family with great coverage in case of any major medical events, and our monthly premiums are considerably lower.   In a typical year, we never meet this deductible.   

This calendar year my family has accumulated some medical expenses and it looks like we might be meeting our deductible by the end of the year.   I have a number of prescriptions filled at our local Walgreens Pharmacy so I joined the Walgreens prescription savings club to save 25% on all my prescriptions.   This is a huge savings for my family.  Almost a month ago I realized my prescription out-of-pocket spending was not being applied towards my annual deductible and since this was almost $2000 in Rx expenses – I was concerned. 

It turns out that if you join the Walgreens savings club and use your savings club discount when you pay for prescriptions, Walgreens does not submit these drug claims to your health insurance plan.   In order for these expenses to be applied to my deductible, I am required to submit these receipts myself.  Why Walgreens cannot forward these claims is a mystery.  But now that I know, I will make sure these drug expenses get applied to my deductible.

• Deaconess offer a low, flat-rate price for three different medical imaging scans, so that consumers and their doctors know in advance the cost of certain tests, including CT Scans, MRI Scans and Diagnostic Ultrasound procedures.

• Deaconess works with the Radiologists, so the price includes both the Hospital and Radiologist fee.  

• One price for each of the three types of scans (regardless of body part), so that our pricing would be both simple and transparent.

• Consumers with high deductible health insurance plans with health savings accounts, consumers who have private health insurance plans with allowable fees above our new prices, as well as consumers who pay directly for their health care, can all save money.

• The new flat prices have reduced the costs for several insurance plans by reducing the mutually agreed upon contractual price.

• Deaconess recognizes that consumers make decisions based on the lowest cost and the highest quality.  Deaconess offers other features and services including the convenience of same day scheduling and a very quick turnaround of results.

• These prices do not apply to consumers with Medicare or Medicaid coverage.  The new prices set by Deaconess are above what the government pays the hospital and the hospital is not allowed to offer price discounts to either of these government plans.

A new research paper from The Healthcare Blue Book entitled Surgery Pricing Secrets: The Challenges Patients Face, shows that it is almost impossible to get prices ahead of time if a patient plans to have surgery in a hospital.

Healthcare Blue Book researchers found that:

• Information on alternative and traditional health care treatment options
• Useful information on supplements
• Symptom checkers and online quizzes to point you in the right direction
• First-aid and safety tools
• Consumer quizzes on health related topics
• Personal health record resources and tools
• Drug information tools Resources to learn more about health care
• Tools to find a doctor, specialist or hospital

When it comes to our health care system, the basic economic rules do not apply. Prices for identical goods and services are usually the same or very close at competing businesses. That's not the case when it comes to health care — not by a long shot. In Pensacola, Florida there are huge price disparities for MRI tests. It's not a matter of greed or poor decision-making by MRI providers or a lack of consumer awareness.  For better or worse, it's the way our insurance-based health care system works.  Read the full story.

• Check to find out if your health insurer offers tools for members
  
• Use tools like PriceDoc.com, HealthcareBlueBook.com and Outofpocket.com to look-up prices
  
• Research state transparency initiatives to look-up hospital prices in your state
  
• Call the provider to find out specific price information
  

Read the complete story, “Lifting the Veil on Pricing for Health Care” by Anna Wilde Mathews.

First you need the tools to find the real price; the price that you will actually pay, not what a provider charges. Insurance companies and providers have a contractual relationship that disallows most providers from sharing negotiated discounts. If you don't have insurance the process is easier, but either way, you'll need to do your share of the research. The best place to start is the Internet.

Websites like outofpocket.com or your insurance company's site are the best places to start. They'll provide local prices for common procedures. If you don't like what you find there, then use search engines to look for the service you need based on price. Questions like "How much does an MRI cost?" will likely yield the results you need. I mention MRIs because it's something I know a great deal about. I own/run an MRI clinic that offers any MRI for a flat rate of $600 to every patient regardless of how they pay, insurance or not.

We have patients travel from out of our area on a regular basis. Recently we had a patient drive all the way from Minneapolis (We're located in Milwaukee). She reports to have saved almost $2500 for her trouble. In the past, patients have flown in from Texas, Colorado and Canada. American patients said that they were able to fly into Milwaukee, rent a car, stay in a hotel, go out for a great meal, and still have money left in their pockets from the savings. Canadian patients were happy to pay the $600 to have their scan months before they would have in Canada. The one thing that all of these patient/consumers have in common is that they found us on the Internet.

MRIs are just one example of a medical product where shopping around can save thousands. Nearly every medical procedure has an enormous range in price. Research is the key to savings, and the Internet makes shopping over a larger geographic area feasible. One word of warning, be certain to confirm any price you find on the Internet for any medical product or procedure, and be certain to verify quality before you travel anywhere (even across the street) in an effort to save money. Low quality medical services are not a value at any price.

Don't forget to buy me a T-shirt if/when you do decide to take advantage of medical tourism, my favorite is the old standby- "My friend went to Milwaukee and all I got was this lousy T-shirt" The savings will be all yours!

-- Contributed by Eric Haberichter

Eric Haberichter is co-founder of Smart Choice MRI, an outpatient health care facility that specializes in MRI services.  Eric is passionate about quality and value in healthcare.  He enjoys spending time with his family, practicing martial arts and enjoying the outdoors.  Be sure to check out Eric’s new blog, The Debunker- Truth in Healthcare. 

If you need to have a non-emergency MRI and live within driving distance of Milwaukee, Wisconsin, be sure to contact Eric at Smart Choice MRI.  His outpatient facility will only charge you $600 for your MRI, regardless of who is paying the bill.

Last week I had the opportunity to use my local retail clinic, Take Care Clinic.  It was 5:30 PM when my daughter announced that her sore throat was “really bad.”  Since the pediatrician’s office was closed for the day, we decided to visit the Walgreen’s Take Care Clinic to have a strep throat culture.

When we arrived at the clinic, there were about six people ahead of us, all in line to get their $24.99 flu shots.  The clinic’s semi-automated queue let’s you know how many patients are ahead of you, because it’s first come, first served as you sign-in at the kiosk.   There is no administrative staff available to answer your questions as you wait in the queue to see the Nurse Practitioner (NP), who is busy seeing the patient’s ahead of you.

When our name was called and it was our turn, we were greeted by an assistant that took us into one of the two private rooms where we filled out the typical paper work (insurance card, driver’s license/id, reason for visit, age, birth date, etc.).  We asked for a strep throat culture and they took a brief history, including blood pressure, weight, height , and finally a throat culture…..  After this data was collected we moved into the next private room where we saw the NP.  The NP reviewed the chart and results of the throat culture.  She examined my daughter’s ears and throat.  She used her laptop computer to walk through a protocol (series of questions about my daughter’s health and symptoms).  We received a receipt for services, a prescription for antibiotic (her culture was positive) and were out of there in 45 minutes.  The clinic transmitted the Rx directly to the Walgreen’s pharmacy so all we had to do wait 10 minutes to have the prescription filled.

How do the prices for services compare?  Having never visited a retail clinic before, I had no idea what to expect.  The clinic list prices for their services, but it’s not always obvious what service the patient will need, in addition to a throat culture.  What I do know from past experience is that if we visit our pediatrician for a “sick visit” the pediatrician’s office charges $70 for the visit (this is the BCBS-IL negotiated rate for the service), and a throat culture is an additional charge of $27 at the pediatrician’s office.  If I went to my pediatrician for my daughter’s strep throat, I would pay $97 for this service (see table below.).

Conclusion

My visit to the Take Care Clinic was surprisingly expensive.  I was charged $108 for a new patient, comprehensive office visit and $17 for a rapid strep culture.  Total charges for this visit were $125.  I don’t think the “comprehensive office visit” was necessary. The clinic submitted the bill directly to my insurance company, and my health plan offered slight discounts (see table below.)  The convenience of visiting the clinic immediately, rather than wait to see the pediatrician the following day, was a great service.   The following day a staff member from the Take Care Clinic did a follow up call to our house to see how my daughter was feeling and asked if we had any questions --that’s good customer service.  After this visit I researched and discovered that I could have just had the rapid strep throat culture done, without the added cost of an office visit at the clinic.  It appears that they over treated my daughter at the clinic.  All we asked for and all she needed was a rapid strep throat culture, but they unnecessarily did a full office visit.  Had I know this when I went in, I would have demanded a “strep throat culture” only.  Next time I will know better and hopefully, you’ll learn from my mistake.

Out-of-pocket expenses

Here’s what I learned:  the two most blatant culprits of the overcharges were due to Secret Prices and Coding Errors/use of an Internal Coding System…I’m sure that’s no surprise for OutOfPocket Blog readers.

A little background

It was suggested that I go to the Emergency Room by my doctor who had prescribed a course of oral antibiotics for an infection. I then came down with a stomach virus and was unable to keep down the medication.  My infection progressed, so my doctor instructed me to go to the ER for IV antibiotics.  I went, received excellent care, stabilized within six hours, went home and had a full recovery.

Then I received my first billing statement.  Those antibiotics and basic blood tests cost $7,051.  Then my PPO policy negotiated it down to $3,525, with no explanation.  These prices seemed so arbitrary to me, I just wanted to know they were fair and reasonable, as determined by industry standards. 

By working with a patient advocate at Southwest Bill Review, I learned that up to 90% of all hospital bills are coded incorrectly.  My patient advocate told me that there is supposed to be transparency in the billing system – and that there are definitive coding guidelines that apply to each hospital.  However, this hospital administers their own coding system – making it impossible to determine exactly what is being charged.    I learned that this is very common.

I then developed a 10-step-process to hospital negotiation. My hope is that this information will help people navigate through the current medical billing system.

The 10-step-process can be found at my blog, Hospital Overcharges 101. Also be sure to check out the Youtube video of my experience.

Free Medical Cost Savings Tips For All

I can be followed on Twitter at: MedOvercharg101 and the Facebook Fan Page, Medical Overcharges 101 – when the 140 characters on Twitter just isn’t enough. 

--By Lynn Jordan

Lynn Jordan is an award winning freelance producer and writer having worked in the television and live event production industries.  This is her first time with the hospital billing system and her hope is that what she has learned will help other people confront their medical bills.

Write a good letter.  Consumers (patients) who write insurers to appeal a claim are more likely to succeed if they include in their letter references to medical research.  Some advocacy groups and associations offer helpful letter templates for common denials.   You can look up these organizations in Google.  Be sure to include every detail in your letter like dates, who you talked to, titles and contact information.

Get a second opinion.  Obtaining an extra, concurring opinion adds credibility to your argument.  Prestige also matters.  Recruiting top doctors in the field can help your appeal.

Stay calm and collected.  When the appeals process reaches a second round, the consumer will often get to talk on the phone or meet in person with a medical director from the insurance company.  These conferences are as little as 10-15 minutes long.  Staying calm and avoiding yelling and screaming will waste your time in this meeting/conference call.

Look for loop-holes.  Many employers have outdated or poorly written summary plan documents, also known as your contract with insurers.  These outdated documents can sometimes help “open doors” in the appeals process.  Copies of the contracts should be available in an employer’s benefits office.  If you have individual health insurance, make sure you keep a copy of this contract when you sign up for the health plan.

Private health insurers reject tens of millions of medical claims every year, leaving patients scrambling for alternatives.   The October issue of SmartMoney includes an interesting article, Paging Doctor No that shadows an insurance-company medical director to see how the toughest decisions get made.

Everyone likes to get a good deal.  This is normal consumer behavior.  We don’t always think about bargain hunting for health care services, but health care is becoming more consumer-focused and comparison shopping can be a huge advantage for patients.  CNN Senior Medical Producer, David S. Martin’s recent article shares some tips to help you find the best value for health care services. 

·         Use websites and tools to help you comparison shop for health care services – and make sure you do this before seeing a provider.  The Outofpocket search engine references 100+ price transparency websites and tools, so it’ a great place to start your research.

·         Don’t forget to check out some of the 16+ state hospital association websites that allow you to comparison shop for inpatient procedures.  

·         You also should visit your state website to comparison shop for services.  Some states including New Hampshire, Minnesota, and Pennsylvania have launched websites to help consumers comparison shop.   I highly recommend comparing prices in your state, to other states, in order to determine an average price for a specific service.   

·         Be sure to use some of the vendor tools like Health Care Blue Book and New Choice Health - that identify average costs insurance plans pay for procedures nationwide.

Over the past two years, I have been researching price transparency tools and frequently update my research to include the new tools as they become available.  My list of tools and websites is getting longer and longer.   If you would like a list of websites/tools that provide price transparency, please contact me at info@outofpocket.com and I’d be happy to send you this research.

Every day people make purchasing decisions based on firsthand knowledge of price, quality and service.   We do this all the time. You might not realize this, but consumers apply this behavior every time they purchase groceries, books, automobiles, and electronics and even when they book travel reservations.  Consumers can make informed purchasing decisions because they have access to meaningful tools and data that enable them to comparison shop and find the best value.

In the health care industry, consumers should be able to easily navigate through treatment and provider options, so they can research the appropriate quality and price information for needed services.  If we engage consumers in the health care decision making process, people will act more responsible.  I also believe our health care system should include programs that encourage accountability for providers, patients (consumers) and health plans.

The good news is health insurers are making progress in this direction.  Some of the larger health plans are finally accepting the fact that their members should be treated like customers and they are working to provide their members with meaningful tools because they realize this is “good customer service.”  What’s very interesting is that empowering their members to act more like customers benefits all the stake holders. 

Over the past month, I have reviewed price transparency tools offered my some of the major health insurers including Aetna, Anthem Blue Cross Blue Shield, Cigna, Humana, Regence and United Healthcare.  The tools are designed for members of the health plans and attempt to deliver some price and quality transparency, to help members make informed choices.  It’s definitely a step in the right direction but there is a lot of room for improvement.    We are all pioneers in this area and as the transparency tools evolve, consumers can expect to see some innovative, decision-making tools to help them make informed choices – before visiting a provider. 

John Stossel’s article in ABC News suggests why health care costs are out of control.   In his article he asks us to think about what would happen if you had an insurance policy that paid for your groceries.  You wouldn’t care what things cost.  Why buy hamburger?  Just buy expensive steaks.  Why look for sales?  Why shop at the store across the street?  If the insurance company’s paying, who cares? 

People with consumer-driven health plans are motivated to find the best value before spending their own money.   They comparison shop, do their research, and might even negotiate the price of service before visiting a provider.  They care because they are spending their own money.

In an effort to keep health care costs down, Whole Foods management decided to offer its employees high-deductible health insurance.  With this plan, employees have an incentive to find out what provider offers the best value (price & quality).  If they are savvy consumers they can make their health care dollars go a lot further by spending wisely.   Health care costs at Whole Foods went way down because employees started asking “what things cost” before visiting a provider.  The employees like the plan so much they decided to keep it.  The employees now ask “how much will this cost?” because now it matters.  It’s their own money they are spending.   The Whole Foods experiment works because:

Facts:

1. When consumers spend their own money, they spend less because they care about what things cost.
2. When consumers shop around before spending money, costs go down.
3. When consumers make informed choices, health care costs go down.

The CEO of Whole Foods Market has some interesting ideas on how to lower the cost of health care for everyone --without adding to the deficit.   John Mackey, the CEO at Whole Foods wrote an Op/Ed piece in the Wall Street Journal last week.  Some of his reform ideas are powerful, practical, obvious and definitely worth mentioning:

1.       Remove the legal obstacles that slow the creation of high-deductible health insurance plans and Health Savings Accounts (HSAs).  These plans have been adopted by more than 12 million consumers and all the recent research indicates these plans are not only successful in holding down costs, but consumer satisfaction is rising for CDHPs .  Read about consumer-driven health plans.

2.       Balance the tax laws so that employer-provided health insurance and individual health insurance have the same tax benefits.  Today employer health insurance benefits are fully tax deductible, but individual health insurance is not.

3.       Repeal all state laws which prevent insurance companies from competing across state lines.

4.       Repeal government mandates that determine what insurance companies must cover.

5.       Pass tort reform to end the damaging lawsuits that force doctors to pay insurance costs of hundreds of thousands of dollars per year. These costs are passed back to consumers through much higher prices for health care.

6.       Make prices transparent and give consumers more freedom to pursue health care value. Provide meaningful tools to help consumers understand what health-care treatments cost. How many people know the total cost of their last doctor's visit and how that total breaks down?

7.       Reform Medicare. Medicare is heading towards bankruptcy and we need reforms that create greater patient empowerment, choice and responsibility.

Whatever reforms are passed, it is essential that they be financially responsible, and give consumers the freedom to choose doctors and the health-care services that best suit our own unique set of lifestyle choices. We are all responsible for our own lives and our own health. We should take that responsibility very seriously and use our freedom to make wise lifestyle choices that will protect our health.

Price variations for health care services, even within the same market and provider network, may be thousands of dollars. So knowing what the fair price is can help consumers better manage the cost of their health care.

Healthcarebluebook.com is easy to use. Type in the kind of healthcare service needed plus a zip code and the Healthcare Blue Book pulls up the fair price based on fees paid by Preferred Provider Organizations (PPO) to doctors for services in that market. Consumers can then use the suggested Healthcare Blue Book price to discuss prices for services and treatments with their doctors and other health care providers.

Health care costs are expected to continue climbing throughout 2009. The National Survey of Employer-Sponsored Health Plans conducted by Mercer, reported that in 2008, PPO deductibles doubled at many companies from $500 to $1,000.

Americans do price/value comparisons for their homes, cars, vacations and the majority of goods and services they buy. “Why not health care?”  asks Dr. Jeff Rice, Healthcarebluebook.com founder.  The former CEO of CareSteps, Rice has a long history in the health care industry of developing innovative products for consumers.

“Patients should not assume that a high price means good quality,” says Rice.  “It is up to patients to ask about the cost of services and to learn about the quality of their providers.  Doctors and hospitals that charge a fair price, often provide the best value.  Healthcarebluebook.com can help consumers figure out what they should pay.”

Consumers need better education about the health care services they purchase and 2009 is a good year for them to start. Using www.Healthcarebluebook.com can help people learn how to obtain fair prices for their health care.

For additional information, contact  Dr. Jeff Rice, jrice@healthcarebluebook.com

Ten Ways Consumer Driven Health Care is a Proven Success

By Greg Scandlen

A revolution is underway in American health care, but you won’t read about it newspapers or see it on TV.

The revolution involves a growing number of Americans who are reclaiming their right to buy health care goods and services that they decide are beneficial. They are shrugging off the heavy hand of regulation by Washington politicians, insurance companies, pharmaceutical firms, hospitals, medical organizations, federal agencies, and giant employers, all of whom are fighting over who gets what of the trillions of dollars Americans spend each year on health care.

This is a Consumer Driven Health Care Revolution.

The revolution got underway six years ago, when consumers were able to redirect some of the health care money they earned into new deposits such as health savings accounts, health reimbursement arrangements, flexible spending accounts, and insurance policies with low premiums and high deductibles.

Empowered by control over their own money, consumers increasingly demanded the information needed to make good decisions about their health care. Once they possessed both the money and information, consumers forced changes in the delivery of services to make health care more efficient, more accountable, more convenient, and certainly more affordable.

Instead of paying an insurance company for maximum coverage they were unlikely to use, increasing numbers of consumers decided to buy less-expensive insurance for expensive services and products while banking the monetary difference to pay for services only when they needed them. Employers liked the revolution, too, because it left them more money with which to raise wages or fund a savings account.

Recent studies find that consumer driven health care plans are being used by 20 percent of the privately insured population.1 This is an astonishing rate of growth for an approach that began just six years ago.

But these insurance plans are only the beginning. The important thing is what happens after consumers have more control. Already, consumer driven plans are having a profound effect on the health care system.

The growing use of generic drugs, retail clinics, medical tourism, concierge medicine, physician owned specialty hospitals, and the reduction in the use of hospital emergency rooms may all be attributed to the growth of consumer driven health care.

Even the current recession is highlighting a new era of consumerism in health care. Health care spending usually grows in times of recession because workers who fear losing their jobs—and their insurance coverage—try to maximize their use of services before they get laid off. But during this recession, consumers are deciding how best to spend their own money, and are choosing to preserve their funds instead of spending them on unnecessary health care services. As a result, spending on prescription drugs dropped by 2 percent in the year ended Sept. 30, 2008, physician office visits are down 1.5 percent, and hospital admissions are down by 2 percent.

The Consumer Driven Health Care Revolution has only just begun, and here’s why it will grow:

1. Consumer Driven Care dramatically reduces premiums
2. Consumer Driven Care reduces the rate of increase from year to year
3. Consumers can use the savings to fund their accounts
4. The money consumers put in the account is triply tax advantaged, saving even more
5. Consumer Driven Care is good for the sick as well as the healthy
6. Consumer Driven Care is good for the poor as well as the wealthy
7. Consumers may choose their own provider and their preferred service
8. People with Consumer Driven Plans change their behavior to get more value out of the system and become better informed about their treatments and costs
9. Consumer Driven Care is taking over the insurance market
10. People with Consumer Driven Care are increasingly satisfied with their coverage

Click here to read the complete article

Greg Scandlen is the director of Consumers for Health Care Choices, a project of The Heartland Institute. He may be contacted at gscandlen@heartland.org.

 My current auto insurance policy offers me discounts on my premium for: 

-       Save driver (accident free)    

-       Multi-car policy                     

-       Good grades for teenage drivers in the household

-       Anti-theft device installed in vehicle(s)

-       Air bags installed in vehicle(s)

What if health insurance policies started offering premium discounts for behaviors like:

-       Taking a health risk assessment

-       Exercising on a daily basis

-       Eating healthy

-       Reducing weight

-       Stop smoking

-       Lowering blood pressure

-       Lowering cholesterol

-       Monitoring and follow-up on chronic diseases 

As more consumers take personal responsibility for their own health, these kinds of tactics will become more common. 

CNNMoney.com published an article, “10 ways to beat the rising cost of health care.” This article includes some excellent tips for consumers.  Here are some great ideas that can help you manage your health care dollars.

1.       Before you visit a provider, ask “how much will this cost?”  Negotiating is important if you have a high-deductible plan, are uninsured, or using a provider out-of-network.  The good news --providers are becoming more accustomed to patients asking for discounts.   All you have to do is ask.

2.       Discounted prescription medications.  Medications can be very expensive.  If you can take advantage of mail-order pharmacies or even retail chains that offer generics for just $4 - you can save a lot of money.  There are hundreds of mail-order pharmacies, and you can find them by doing a Google search.

3.       Take advantage of employer sponsored Flexible Spending Accounts (FSAs).   According to Mercer, about 80% of large employers offer FSAs, but only 22% of employees enroll in these plans.  This is tax free dollars that you can set aside for health care expenses.  If you are in the 28% tax bracket, a $1000 FSA may save you about $350. Beware that money FSA dollars that aren’t spent by year-end are lost. 

4.       Be sure to look into high-deductible health plans (HDHPs).  We are starting to see a higher rate of adoption for these plans because they encourage personal responsibility, create financial incentives for consumer to make informed choices for staying healthy and are successful at reducing health care expenses! These HDHPs offer lower-monthly premiums and can save you thousands of dollars a year on reduced premiums, but require you to satisfy your deductible before your insurance kicks in.  For many people, saving $5000-7,000/year on premiums and paying a $5000 family deductible is a great deal.  In a healthy year, you might not even have met your deductible!   Do some research to determine if this plan is right for you.

5.       Health Savings Accounts (HSAs).  With an HSA you can save pre-tax dollars to pay for health care expenses.   In 2009, a family can contribute $5950 and single person can contribute $3000.  As an extra bonus, American Chartered Bank offers free HSAs.  It’s definitely worth checking into.

6.       Walk-in retail clinics are less expensive than office visits for non-emergency, routine medical services.  They post their prices upfront and most now accept insurance.   

7.       Stay insured if you lose your job.  A federal subsidy covers qualifying individuals with 65% of the COBRA premiums. 

8.       Make healthy life style choices.  Employers are implementing wellness programs where they often reward employees for behavior changes (losing weight or quitting smoking).  The personal benefits of making healthy choices and taking personal responsibility are priceless! 

9.       Avoid Medicare mishaps.  Before you sign up for Medicare, or Medicare supplement programs like Medicare Advantage, make sure you understand what is covered and what is not covered. 

10.   Adding vision and dental expenses to your health plan can inflate your premiums.  If your health plan does not cover vision and dental, remember vision and dental expenses can be paid for through your FSA or HSA.  If you pay high monthly premiums for dental and vision, be sure to calculate the total cost of coverage vs. your annual expenses.  You might be surprised at the savings if you decide to opt out of dental/vision coverage and pay out-of-pocket.  And be sure to ask your dentist or eye doctor for a discount!

Recently in the Wall Street Journal, Steven Burd, the CEO of Safeway Inc., and founder of the Coalition to Advance Healthcare Reform, wrote an article on reducing health-care costs.  Mr. Burd discusses how market-based solutions can reduce the national health-care bill by 40% and the key to achieving these savings is health-care plans that reward healthy behavior.    While comprehensive health-care reform is extremely complicated and needs to address a number of critical issues, personal responsibility and financial incentives are the path to a healthier America.  This is a proven fact. The Safeway team calculates that if the nation adopted their approach in 2005, the nation’s direct health-care bill would be $550 billion less than it is today.

Financial incentives certainly help modify behavior.  Rewards like reduced premiums, rebates, discounts, gift cards, free health club memberships, bonuses, certainly help influence employees healthy behavior.   And the greatest rewards of all --ones that provides you with “feeling terrific, looking terrific” and “living healthier” are priceless.

Most consumers’ sign up for health insurance plans without fully understanding the 100+ pages of detail that go over the plan specifics.  In fact, most of us select our health plans based a high-level  outline and never bother to read the fine print details that describe coverage limitations that spells out what’s covered and what’s excluded, identifies lifetime limits/coverage caps , deductible terms--- basically things you need to know so you can understand the out-of-pocket you will be expected to pay.  It’ all very confusing and complicated.  And let’s face it, it’s written in a language that consumers find it practically impossible to understand. 

An article in the Wall Street Journal written by Anna Wilde Mathews, The Importance of Deciphering Your Insurance, does an excellent job describing the consequences and complications resulting from not understanding your health policy.  Anna describes how confusing this is to consumers and discusses some specific situations where consumers were stuck with large medical bills because they did not understand their coverage limitations (the fine print) when they purchased their health policy.

Some things to look over very carefully when evaluating a health policy:

·         Know your out-of-pocket maximum, which represents the most you should have to pay for care in a given year

·         Pay attention to the terms of your deductible

·         Understand how your plan covers out-of-network providers

·         Check for excluded benefits and coverage caps, including lifetime and annual limits on payouts

·         Know what services are covered and what services are not covered

If you are a savvy consumer you probably review all the bills you receive before you pay them, to make sure they are accurate. This is a really good habit. Have you ever received a bill that was not yours, or a credit card statement with charges that are not yours, or the wrong discount/sale price taken off your retail purchase, or cell phone charges that you should not have been billed for? This happens to consumers all the time. Human errors, billing errors, software updates – there are lots of reasons these errors occur. Whenever you receive a bill for health care services, utilities, charge card statements, electronic purchases and sometimes even groceries – you should take a minute to review the bill for accuracy. When you purchase an item on sale, or use a coupon, don’t you always look at your receipt to make sure you were charged the right amount? This same "double checking" rule applies to medical services. When you receive a bill (or statement) from a provider or an EOB from your insurer, take a minute to review the information to make sure it is accurate. If you have a health insurance policy that covers screenings, office visits and lab tests, make sure you are not being billed for these services.

You also need to review your health plan coverage very carefully so you know exactly (1) what services (exams and lab tests) are covered at 100%; (2) what services you will be billed for; and (3) what percentage you are expected to pay for these services. Some employer health plans are starting to cover 100% of the full cost of routine exams and preventive services (such as physicals, colonoscopies and mammograms) to help employees stay healthy. This can be a great benefit, but if you’re not careful, you might erroneously get billed for these services. Patients are sometimes billed for preventive screening exams that their health plans cover at 100% because of errors in billing/coding at the doctor’s office. Patients can unknowingly receive care that their health plans don’t consider preventative.

Always review your bills for errors. An article in the Healthy Consumer in last week’s Wall Street Journal discusses why patients may be billed for free exams.

NeedyMeds is a non-profit organization that provides information about assistance programs that are available to low-income patients and their advocates.  The NeedyMeds website provides access to a wealth of databases of information on clinics and patient assistance programs including:

Low-Cost Medicine Programs

Patient Assistance Programs provide free or low-cost medicine to low-income people who are uninsured or under-insured.  

Additional Assistance Programs (PAPs)

·         Application Assistance is a resource of organizations that will help you find and apply for PAPs for free or a small fee.

·         Disease-Based Assistance programs that help with the costs associated with specific diseases or conditions.

·         Government Programs are state and federal programs that assist low-income residents.

·         Discount Drug Cards provider consumers with discounts on prescription medication.

Free/Low Cost Clinics

The NeedyMeds database identifies more than 4,000 clinics that are free or low cost with a sliding scale base on income.  To find a clinic in your area, click on a map. 

Discount Drug Cards

There are many different types of drug discount cards. Some offer significant savings while others are not a good deal. Drug company discount cards offer discounts only for certain medications while others offer a wide range of discounts. You may find it best to use certain cards for some medications and others for other medications.

1.       Drug Company Discount Card

2.       State Discount Cards

3.       NeedyMeds Drug Discount Card

To learn more about these programs, visit the NeedyMeds website.

Here are some resources that can help you make sense of your bills.  Keep in mind that some of these organizations offer help -- for a fee.

Claims Assistance Professionals

HealthCare mediation LLC

Health Proponent

Health Champion

Hospital Bill Review

ICS Healthcare (Ingenix)

Medical Cost Advocate

INSNet

Patient Advocate Foundation

Patientcare

To shed some light on health care prices, Anna Wilde Mathews wrote an interesting article in last week’s Wall Street Journal about how much it costs to have a baby.  She researched prices at hospitals in advance and broke down the different expenses she incurred after her baby was delivered.   She certainly takes the mystery out of how much it can cost to deliver a baby as she reviews some of the itemized costs that appeared on her invoice from the hospital.

If you are expecting a baby and have the opportunity to research prices in advance, take her advice and do your homework to eliminate the guesswork on how much out of pocket expenses you will be responsible for.  Here are some interesting charges from her report:

Miscellaneous items and charges on the hospital bill:

Your actual costs will be based on your deductibles, co-pays co-insurance, the new baby’s deductible, out-of-pocket maximum and the specific services provided by the hospital.

Thank you Anna for sharing this information with other consumers!  If you have some interesting prices to share with consumers, please add them to the OutofPocket.com directory by clicking here.

Consumer driven health care has arrived on the scene to try and generate competition within the health care market. Consumers need to be more aware of the hidden health care costs, and start holding the health care industry accountable.

A key area neglected due to rising health care costs is proper laboratory testing. Does your family have a history of any of the following: heart disease (652,091 deaths / year), cancer (559,312 deaths / year), diabetes (75,119 deaths / year)? Many people may not want to incur the cost going to a doctor for a lab order, and then having to pay for the lab. Many should have a lab test done every 6 months – 1 year. These costs can pile up quickly when paying full price out of pocket. Having your lab tests done at your doctor’s office can be a lot more expensive than having your lab test(s) done at a stand-alone facility, or ordering your lab tests online. Today, consumers will find a number of websites where they can order lab tests online at a discounted price. One of these sites you should definitely check out is PrePaidLab.

As consumer driven health care expands, we now have the ability to take control of our own health care management via the Internet. PrePaidLab is committed to help health care consumers control costs. PrePaidLab offers the ability to browse and order several hundred lab tests through a secure shopping cart. Tests can be ordered with or without a doctor’s order. In most cases receipts can be submitted to an insurance carrier (if applicable) and the cost of the test will be applied towards the deductible.

Consumers should compare prices with cash pay and other Internet based lab sites. PrePaidLab provides deep consumer savings, and a pleasant customer experience. They have a friendly customer service staff that is available to assist you in finding tests, and answering any questions regarding the process.

If you have never ordered lab tests online before, PrePaidLab has outlined the five easy steps to this process:

(1) LOCATED A LAB NEAR YOU. Check to see if there is a PrePaidLab Laboratory center near you. PrePaidLab uses only nationwide CLIA-certified Medical Reference Laboratories with Patient Service Centers close to where you live or work for the blood draw.

(2) SELECT THE LAB TEST YOU NEEED. Go to PrePaidLab and browse the test categories on the left side of the page. There is also a search box on the top left you if you know the test name.

(3) PROVIDE INFORMATION TO ORDER THE TEST. Select your test and fill out the order form and payment information. A HIPAA form is also available which can be used to give PrePaidLab permission to release the results of the lab directly to your physician via fax.

(4) RECEIVE LAB ORDER REGISTRATION. In 48 - 72 hrs you will receive an email from the PrePaidLab secure email system containing the Lab Order Requisition Form. This needs to be printed out and taken to the Laboratory center at your convenience. The requisition tells the Laboratory Technician what test(s) needs to be performed, and shows that you have paid for the lab service.

(5) RECEIVE YOUR LAB RESULTS. 48 - 72 hrs after the lab work is completed; PrePaidLab will send another secure email containing the lab results.

Take control of your health care costs today!

If you have health insurance, your health plan has negotiated discounted rates with each of your providers in the health plans network.   These discounted rates are called “contracted rates.”  When you visit a provider in the network, and show them your insurance card, they will charge you (or your health plan) the contracted rate for services.  The “list price” for services is reserved for people without insurance, and without a doubt, is an inflated price.   The Medicare rate for services is the rate the Government has negotiated for services under the Medicare plan.  Medicare is the lowest rate for services and often does not cover the provider’s true cost of delivering the services.   If you do not have health insurance, be careful because providers will charge you the “list price” for their services.  This list price is an inflated price, and if you pay cash, you should expect to receive a discounted rate, but remember ---you have to ask for it.  Everything is negotiable – including your health care bills.  It varies from provider to provider, but I have seen cash-pay discounts that range from 20% to 60% off the list price!

Bargaining down those medical bills

I conducted an experiment to find out if it was more cost effective for me to pay cash for visiting a provider, or to pay the contracted rate my insurance plan has negotiated for services.   To give you some background, I have a high-deductible health plan and this looks like a very healthy year for my family so I doubt we will come close to meeting our deductible this year.  In other words, we will most likely pay for all our health care expenses out-of-pocket.  Our high-deductible health plan is really a good deal for us because we save about $8,000 a year on less expensive premiums for this type of plan.  So if I spend less on health care out-of-pocket expenses throughout the year by being a cost-conscious consumer, I have more money in my pocket to spend on other things like vacations and get-away weekends.   That’s a topic for another day.

Last week I visited a specialist for a follow-up office visit. No tests.  No equipment. No supplies were used.  Just a follow-up consultation.  When I checked in for my appointment, I inquired about paying cash for my doctor visit rather than have the office staff bill my insurance plan for the service.  The office staff was very confused by my request.  They consulted with three office staff, including the billing manager, and concluded that I needed to wait until after the doctor visit to know what the price is.  This makes sense. They cannot give me an estimate for services until after I see the doctor so they know what level of office visit to charge me for.  After I saw the specialist, I went back to the front desk and asked them what today’s charges would be if I paid cash.  They looked up the CPT code for today’s visit and said, “the cash pay rate for today’s visit is $86.”  I know from earlier visits to this provider, that my insurance plan negotiates a contracted rate of $70.  The list price for this visit is $109.  So here’s what I learned:

• $109.20 is the list price for an office visit with this specialist 
• $ 70.00 is the contracted rate my insurance plan has negotiated with this provider
• $ 86.00 is the cash-pay price the provider charges if you do not have insurance

After all that, I decided to have this office visit processed through the regular insurance claims process, because it provided me with a larger discount. 

Conclusion

My health insurance plan has negotiated some terrific discounts with their network providers.  The best part is that I directly benefit from these discounted rates for services.  When I signed up for my health plan, this topic never came up with the insurance agent that sold me this plan.  These network discounts appear to be one of the strongest selling points for this high deductible health plan since I end up paying 100% of the negotiated price for these services (until I meet my deductible.)  If there was more transparency in our health care system, consumers would be able to look-up provider prices for services for specific health plans, and determine upfront what their out-of-pocket expenses would be.  In today’s health care system, this is impossible to know ahead of time.

It’s easier and much less expensive to stay healthy.  In today’s tough economic times, it has never been more important for people to really take control of their health and prevent unnecessary health emergencies.  Even though at times it seems like an awful lot of trouble to stay fit, exercise, eat healthy foods and take good care of yourself by having regular checkups and screenings – this behavior is actually a great return on your investment.  When you get sick, things can get very expensive. Many employers reward this type of healthy behavior and insurance premiums are sometimes reduced if you take good care of yourself.   So why wouldn’t you choose to stay healthy? 

In Colorado, a non-profit organization called 9Health Fair promotes health awareness and encourages individuals to assume responsibility for their own health by providing consumers with 20 free and 4 low-cost health screenings.  The low-cost screenings include:

·       Prostate Specific Antigen (PSA) screening; identifies a man’s risk for prostate cancer, for $25

·       Blood Count screening; identifies a person’s ability to fight infection, risk for anemia and blood-clotting abilities by checking white and red blood cells, hematocrit and hemoglobin levels for $15

·       Blood Chemistry screening, which tests 28 separate things including cholesterol, blood glucose, liver, kidneys, thyroid and more, for $30

·       Colon Cancer Screening Kit; this take-home/mail-in kit checks for human blood in the stool which can lead colon cancer for $20

Wouldn’t it be nice if everyone had access to affordable screening programs like this?  If you know of any programs like9Health Fair that we should tell others about, be sure to let me know and I’ll post it on the OutofPocket.com website, to share with others.

If you are uninsured, under-insured, or have a high-deductible health plan, don’t skip taking care of yourself.  In fact, I encourage you to use this information about low-cost prices 9Health Fair offers for screening tests to your advantage.   Call a provider and see if they will match these prices, or at least offer you a discount.

Wondering why your medical bills are so high?  New Hampshire Public Radio’s health reporter, Elaine Grant, revealed some interesting information about hidden facility fees in an interview last week with New Hampshire State Senator Jackie Cilley, Joe Loring, Executive at St. Joseph Hospital and James Unland, President, The Health Capital Group.  Click here for the full transcript.

Let’s face it, health care has a lot of “secret pricing”, but state lawmakers are starting to tackle one of the best kept secrets in health care – facility fees.  These facility fees can add hundreds and even thousands of dollars to your medical bill.  Hospitals say the fees are essential to their bottom line, but critics point to these fees as a major contributor to the high cost of health care.   

When you are paying out-of-pocket costs for health care services, these prices can make a huge difference.  For consumers that are uninsured or that have high-deductible plans, knowing the difference between an independent practice lab or one owned by a hospital can save you hundreds and possibly thousands of dollars.  When consumers go to a hospital-owned practice or facility, their bill includes the cost of the hospital’s overhead – aka “facility fee.”  This explains why hospital outpatient services usually cost more than the exact same services offered by an independent  stand-alone facility.  For example, an independent diagnostic facility charges $65 for an x-ray, while the hospital charges more than $260 for the exact same service.  The average consumer has no idea these fees even exist.   In many cases, the facility fee is simply included in the total cost of the visit, making it impossible to see.  Many consumers are not even aware that the provider they’re visiting is owned by or affiliated with a hospital.   So be sure to call and ask before you make an appointment at a facility.

In 2006 facility fees made national headlines when patients brought two class action lawsuits against Seattle hospitals.  One of the patients had a five-minute procedure performed at a clinic owned by the University of Washington Medical Center and was billed more than $8000.  Nearly $7000 of this bill was for the facility fee.  The medical center settled the case and agreed to disclose its prices.   Interestingly, once the prices were made public, the hospital could no longer justify the unreasonably high prices so they discounted their fees by 40% for about 1400 outpatient procedures.  Here is a link to the hospital’s public prices.

Let this be a lesson for all:  you can save a lot of money by asking providers what a procedure will cost – beforehand. 

One out of every ten patients now has a consumer-driven health plan, so hospitals are starting to become proactive bill collectors.  An article in the Minneapolis Star-Tribune discusses how hospitals in the Twin Cities are starting to telephone patients before their scheduled procedure to review how much they will owe out-of-pocket.  As strange as this seems, it’s really a step in the right direction for our health care system.  Patients (consumers) are becoming more aware of the true prices for health care services.  This behavior encourages consumers to comparison shop to find the best value and make the most of their health care dollars.  If patients continue to pressure providers for true prices, we will start to see health care prices become publically available, resulting in competitive pricing, innovative services and improved  patient care. 

This is very good news for health care consumers.

Today’s Wall Street Journal shares some helpful tips on how you can cut your medical costs.   Many of these tips have been mentioned in earlier posts on this blog, but this information is important enough to repeat once again.  These tips can actually help make a difference in making your health care dollars go further.  I am an advocate of consumers taking control of their health care, including making informed choices, shopping around for the best value and doing your research – before visiting a provider.  

For the full article, read Financial Prescriptions:  Seven tips for cutting your medical costs.

1.  Find the right health insurance plan for you and your family.  You need to know what your health plan covers, what’s not included and what your maximum out-of-pocket expenses are.   Read the fine print very carefully.  Consider looking into CDHPs with high-deductibles.  A high-deductible health plan can seem daunting, but when you understand and take into account all your costs including premiums, co-pays, deductibles, co-insurance fees, you can actually come out ahead with a high-deductible plan.

2.  Shop around for the best care.  Consumers are expected to compare quality and prices for providers and services, but this sometimes is easier said than done.  Comparison shopping is possible to accomplish, but you need a lot of patience and persistence and to be resourceful.  Keep a spreadsheet of providers, prices, inclusions and start making those phone calls.  Call your providers.  Call your health plan.  Make sure you contact your health insurer, potential providers, their competitors, and hospitals --to determine your out-of-pocket expenses for specific procedures.  Be sure to take advantage of websites that publish prices for consumers including vimo.com, healthcarebluebook.com, costhelper.com,  newchoicehealth.com and of course, outofpocket.com.   For a more complete list of websites that provide pricing, visit Tools For Consumers to Look-up Prices.  

3.  Take control of your treatment.  You are your own best advocate for your health.  Take an interest, ask the provider questions, bring along another person for a second set of ears, seek a second opinion, and be sure to research the provider before services are performed. 

4.  Take care of hospital bills.  Don’t pay providers directly until you receive the EOB from your health plan.  When you receive the bill, make sure you scrutinize the bill for errors.  If you are uninsured and paying cash, make sure you negotiate with the provider to receive a 50% discount from the list price or 125% of the rate Medicare would pay for this service.  By the way, you can easily look up Medicare payment amounts on this public website  

5.  Manage your medications.  Always make sure your primary care provider knows about all the medications you might be taking because it may not be necessary to take all the medicine being prescribed.   Some medications might be a version of the same medication, or cause harm when taken together.  Inquire with your doctor about using less expensive generics.   Look into mail-order pharmacies and comparison shop for drugs using the Consumer Reports website.  

6.  Focus on prevention.  Being healthy is definitely less expensive.  Simple changes like eating healthy, exercising daily, get enough sleep at night can make a tremendous improvement in your overall health.

7.  Be careful about skipping care.  When money is tight, many people cut health care spending and this can sometimes result in more expensive care later as the condition progresses.  Some procedures can be postponed.  Instead of skipping preventative care, you should look into more affordable options like retail clinics, local community screenings, immunizations and urgent health care centers (rather than emergency room visits.)

OutofPocket.com was launched in 2007 to help consumers look-up prices and find affordable health care services.  For two years, OutofPocket.com has been the consumer’s voice promoting price transparency in health care, appealing to the 47 million Americans that are uninsured and consumers with CDHPs.  Today, with so many employers struggling with rising health care costs, consumer driven health plans are rapidly becoming the number one choice for their affordability.  As these employers adopt CDHPs for their employees, OutofPocket.com becomes a useful tool to help employees reduce their out-of-pocket expenses and make informed choices before purchasing health care services. 

Being a savvy health care consumer saves you money and reduces your health care costs.  In addition to reducing your out-of-pocket expenses, here are some other practical tips you can use from CheckPoint HR Benefits Group, on how to reduce your health care costs.

Work with your doctor.  Most doctors understand the business and processes of insurance. Tap into their knowledge base for the best possible hospitals for specific procedures.  Many doctors can provide patients with guidance in negotiating fees and/or working with the insurance companies on lowering out of pocket costs. In some instances, doctors will reach out to the hospital's finance department (on behalf of the patient) and request that consideration be made when dealing with the finances of certain procedures. Bottom line, communicate and work with your doctor!

Know all of the benefits available to you.  Insurance programs are aligned with a lot of ancillary benefits that consumers should be made aware of. Benefits such as gym reimbursements, employee assistance programs, massage therapy, chiropractic care, acupuncture, vision reimbursements, weight loss programs, free or low cost flu shots or immunizations, disease management programs, health coaching or nurse advice lines, are no cost preventive benefits. Make sure you read the fine print and take advantage of everything that is being paid for via premiums.

Be a smart consumer.  Individuals today have better access to information than ever before. With more control over their own health care, consumers are able to make educated and more informed decisions about options, procedures, costs, and treatment. Some insurance companies now have released the costs for certain procedures covered under their plans on their websites. This information allows individuals to better understand the true costs of care before they utilize their plan and allows them to make better financial decisions based upon quality as well.  If your insurance plan does not provide this information, you can use tools like OutofPocket.com to look up prices and find the best value.

Go generic.  High deductible plans are taking traction in the workplace and with that so does the need for employees to manage their costs with more scrutiny. One consideration for maximizing your benefits without sacrificing quality is to ask your doctor about a generic drug. When working with your doctor, ask them if the prescribed medication has a generic equivalent that will work for you. If there is a viable equivalent, make sure the medication is listed on the formulary list that your insurance carrier make available on their Website.

Focus on wellness.  One of the best ways to reduce health care costs is for people to get healthy! Companies today are rewarding employees who are proactive in their decision making and who lead healthier lives through physical fitness and increased presenteeism. Corporate Wellness programs offered today focus on tobacco cessation, know-your-numbers (BMI, Blood Pressure, Cholesterol), walking clubs and programs that increase physical activity and reduce negative behaviors towards health.

• Drink more water
• Eat breakfast every day and try to include protein and fiber
• Increase your fiber intake
• Eat more fruits and vegetables.  Remember to eat a variety of colorful fruits & vegetables (red, orange, green, yellow and purple)
• Get at least seven hours of sleep a night
• Floss your teeth every day
• Find your spiritual self
• Develop a supportive network of friends
• Stop drinking soda
• Smile more often

Over the past few years, I have researched most the price transparency tools that are available to consumers.  Some of these tools can be accessed only by members of health insurance plans.  Some tools require a subscription or fee to access the pricing report data.  There are many other free tools that enable consumers to look-up prices of health care services.

Here is a short list of free public tools that consumers can use to look-up price of health care services.  If you would like the list of URLs to access these tools, please send us an email info@outofpocket.com

• AMA CPT Online
• Carol
• Cost Helper
• DoctorPricing
• Healthcare Blue Book
• Health Pricer
• LesliesList.org
• MainStreetMedica
• MyHealthScore
• New Choice Health
• OutofPocket
• Spectrum Health
• State Hospital Websites
• USA Healthcare Costs
• Vimo

When consumers have high-deductible health plans, they are rewarded financially for making good choices.  Spending health care dollars is spending their own money so they are interested in making cost-effective choices.  Everything changes.  People become responsible about their health and their health care costs, and expenditures drop like a rock.

Healthcare Prices:  Looking Behind the Curtain is a new blog that you should follow. Jeffrey Rice, CEO, HealthCare Blue Book, covers healthcare transparency news and discusses issues that you will find interesting.  His recent post discusses the disparities in health care pricing and how paying more doesn’t always mean better quality.  The fact is that the price for an MRI can range from $500-$2500 in the same geographic area.  Let’s take a look at some of the real out-of-pocket savings when consumers choose a provider that charges $500 for an MRI, rather than the provider that charges $2500 for the exact same diagnostic test.

• An individual with a co-pay would save $100 out-of-pocket by selecting the $500 MRI , rather than using the $2500 provider
• An individual with a high-deductible would save $2000 by selecting the $500 MRI
• Employers that are self-insured would save ½ million dollars a year just on MRIs of the knee, if they encouraged employees to use the cost-effective provider that charges $500 for their MRI.
• Total dollar amount of claims would be reduced, and this could result in lower premiums
• Just imagine how much $$$$ insurers would save if consumers adopted cost-effective behavior 

One of the greatest challenges in getting people to use cost-effective providers is how do we encourage and enforce this cost-effective behavior?  One of the few unquestionable principles of economics is that people respond to incentives.  If you give people more of a reason to do something, they will do more of it.  If you make it easier to do more of something they are already inclined to do, they will also do more of it.  Reducing my out-of-pocket expenses is enough of a reason for me to select the provider that offers the best value. 

• Preventing illnesses by following routine precautions and basic cleanliness.
• Adhering to a healthy lifestyle – not smoking and drinking, eating healthy food, exercising regularly, drinking enough water, and keeping your mind relaxed and stress-free.
• Preventing accidents and keeping your home safe from potential hazards.
• Following safety precautions and road rules to avoid meeting with accidents that could prove to be extremely costly affairs.
• Getting yourself checked routinely to identify potential health risks.
• Understanding your illness, if you have one, its conditions and implications, and making an informed decision about the best treatment.
• Opting for treatment before conditions become serious and hence more expensive.
• Taking the medication that’s prescribed for you – some people stop taking them when they begin to feel better, but it’s imperative that you finish the course your doctor has prescribed.
• Reviewing your medication on a regular basis (if you have a chronic condition like diabetes) and ensuring that you’re not taking any that are not necessary.
• Asking questions about medication to ensure that they’re necessary and to know what they treat.
• Switch to generic drugs that are as effective but not as costly as the branded ones.
• Asking relevant questions about any prescribed diagnostic tests to ensure that they are absolutely necessary.
• Understanding the benefits you are entitled to under your insurance plan.
• Planning ahead for pregnancies and other medical routines that can be put off.

It’s a well know fact that health is wealth, and it’s absolutely imperative that we’re physically and mentally fit if we’re to enjoy and savor life. It’s also true that prevention is better than cure, so do your best to prevent diseases before they catch you. And if you still fall sick, make sure you do all it takes to get better soon rather than spend unnecessary time and money at the doctor’s office.

This article is contributed by Sarah Scrafford, who regularly writes on the topic of online pharmacy technician training. She invites your questions, comments and freelancing job inquiries at her email address: sarah.scrafford25@gmail.com.

Ask the provider upfront (before services are delivered) for a price break. Each provider has their own rules about negotiating bills, and you should always ask. Explain your circumstances and offer to pay cash at time of service or develop a payment plan.

Bill review. Be sure to review your medical bills for possible errors. I can’t tell you how many times I found small errors on my medical bills just by casually browsing through the detail. As soon as the bill arrives, read through all the line items and make sure that you are being charged the correct price and charged only for services you received. Medical billing errors occur all the time. Why pay more than you have to? I am assuming you already review many of your household bills (cell phone, utilities, cable, appliances, groceries, auto insurance) for accuracy. Treat your medical bills with the same level of scrutiny.

Compare prices using online tools. Insurers sometimes provide their members with tools to look up out-of-pocket costs for a specific plan. Other online tools are available to give you an idea of a fair or estimated price for a specific service. The more you know about fair pricing, the better price you will be able to negotiate. In addition to outofpocket.com be sure to check out healthcarebluebook.com, AMA CPT online, and costhelper.com to look up prices for services. For a more complete list of price tools, refer to the this list of price transparency tools. Remember also that where you go to receive care can also make a big difference in your costs. Emergency-room visits tend to cost $300 to $1000, compared with $150 at an urgent-care center, $65 to $75 at a doctor’s office, and $35 to $45 at a convenience-care clinic. For non-emergencies, it pays to call your insurer’s 24-hour advice hotline for guidance on where to go for care. Make sure the facility and provider are in your health plan’s network. In fact, don’t wait for an emergency to find the nearest ER or urgent care center in your network. Look it up now and keep this information handy so you can easily refer to it in case of an emergency, when it is often difficult to make cost effective decisions.

Discounts can make a big difference. You should make the most of discounts that are available to you from your insurer, dental/vision programs, prescription medications, and incentives from your employer. All these discounts help reduce your medical bills. Many insurers offer discounts on services to promote healthy lifestyles, including gym memberships, smoking-cessation and weight loss programs, chiropractic service and acupuncture. Ask your insurer or employer about these programs. Providers also offer discounts for paying in cash, or paying at time of service.

Did you know:

• The national average cost of an MRI is nearly $2,000
• Heart bypass surgery costs about $57,000
• The average cost of a 30-day prescription of one name brand drug is $71 compared to $22 for the generic equivalent
• National healthcare expenditures are expected to nearly double over the next 10 years

Knowing what you're spending and keeping an eye on health care costs are important parts of keeping health care affordable for all of us. Here are some things we can all do to make a difference:

• Ask for FDA-approved generic drugs instead of more expensive name brands
• Make sure you're getting the right treatment, and always ask your doctor any questions you may have
• Review all explanation of benefits for accuracy, and ask about any costs that you don't recognize or understand.
• Understand what your out-of-pocket costs will be before you receive medical services. Online tools are available for consumers to look-up average prices if your insurer or provider cannot answer this question.

Price variations for healthcare services, even within the same market and provider network, may be thousands of dollars. So knowing what the fair price is can help consumers better manage the cost of their health care. Unlike many other health care price tools, Healthcare Blue Book is very easy to use.  Type in the kind of healthcare service needed plus a zip code and the Healthcare Blue Book pulls up the fair price based on fees paid by Preferred Provider Organizations (PPO) to doctors for services in that market. Consumers can then use the suggested Healthcare Blue Book price to discuss prices for services and treatments with their doctors and other healthcare providers.

Americans do price/value comparisons for their homes, cars, vacations and the majority of goods and services they buy. “Why not healthcare?” asks Dr. Jeff Rice, Healthcarebluebook.com founder. The former CEO of CareSteps, Rice has a long history in the healthcare industry of developing innovative products for consumers.

“Patients should not assume that a high price means good quality,” says Rice. “It is up to patients to ask about the cost of services and to learn about the quality of their providers. Doctors and hospitals that charge a fair price, often provide the best value. Healthcarebluebook.com can help consumers figure out what they should pay.” Consumers need better education about the healthcare services they purchase and 2009 is a good year for them to start. Using the Healthcare Blue Book can help people learn how to obtain fair prices for their healthcare.

In addition to fair pricing, the website provides information on useful resources for patients including a list of websites by state that provide health care pricing.

An article in the Los Angeles Times Health Section, Cut health costs, not your care,  provides some valuable tips and techniques to help you reduce your health care costs  - while you continue to take care of your health. Here are some of the highlights:

Saving Money on Prescription Medications

• Compare drug prices before making a purchase by using tools like destinationrx.com and drugstore.com
• Save up to 80% by selecting generic rather than brand-name drugs
• Consider purchasing your medications in bulk to save money
• Do your research to find drug companies offering discounts on brand-name drugs
• Consider purchasing medications online (be sure to visit the U.S. FDA site for consumer information)
• Look for discounts on brand-name drugs by searching for coupons at www.internetdrugcoupons.com

Save Money on Doctor Visits

• Stay proactive about your health.  A doctor visit is a lot less expensive than an emergency room visit.
• Use network providers whenever you can.  Ask network providers for referrals from your network if you need to see a specialist.
• Consider bartering to help pay doctor fees. 
• Utilize retail clinics for non-emergency medical services
• Utilize urgent care centers rather than emergency rooms for conditions that are not life threatening
• Visit community health centers to locate medical help at low cost.
• Use resources like public libraries to find affordable medical services in your area.
• Contact disease/condition foundations for additional resources and options on affordable screenings.
• Negotiate a price for services if you are paying cash to save 50% or more off the list price.
  

In the Personal Journal section of today’s print version of the Wall Street Journal, Aetna has a full-page ad.  The headline of this ad, “How Aetna can even help you keep your wallet healthy,” caught my attention because the ad promotes a few tips on how consumers can keep health care costs down including:

·         Use generic prescriptions rather than brand-name

·         Use mail order service to fill prescriptions

·         Preventative care to keep yourself healthy

·         Stay in network when selecting providers (hospitals, doctors)

I have a tip for the health insurer --  why not keep health care costs down by eliminating expensive advertising!  I wonder how much this full-page ad cost Aetna.   With the rise in health care costs, including insurance premiums, cost of service, and administrative fees, I find it disconcerting that health insurers spent so much money on this ad.  If I had my choice, I would prefer my health insurer save me money and reduce my monthly premiums, rather than spend extravagant amounts of money on unnecessary advertising. No offense Aetna, but with health care costs spiraling out of control, consumers are more interested in reducing their out-of-pocket costs.   I’m not sure this ad keeps my wallet healthy.

Happy New Year!  Spending wisely for health care services is definitely a priority in 2009 and with a little knowledge; you can easily save hundreds –even thousands of dollars.   To get you started, here are some excellent tips on how you can save money on routine health care services. 

Affordable Medical Care Services

Federally-funded by the Health Resources and Services Administration (HRSA), there are thousands of health centers around the U.S. that provide low-cost health care to people based on financial need. You pay what you can afford, based on your income. For more information visit www.findahealthcenter.hrsa.gov, or you can call (888) 275-4772.

Hill-Burton facilities: There are around 200 Hill-Burton health care facilities around the country that offer free or reduced-cost health care for people that cannot afford to pay for services.  To locate a facility or to see if you qualify, visit www.hrsa.gov/hillburton or call 800-638-0742.

Free clinics: These are privately funded, non-profit, community-based clinics that typically provide care for common illnesses and injuries to those in need, at little or no cost. There are around 1,000 free clinics nationwide. To locate one in your area, call your local hospital or visit www.freemedicalcamps.com for more information.

Indian Health Service (IHS): A government agency within the Department of Health and Human Service, IHS provides free medical care to American Indians and Alaska Natives in 35 states. Visit www.ihs.gov for more information.

Remote Area Medical: A non-profit, charitable organization that provides free health, dental and eye care to uninsured or underinsured people in remote areas of Tennessee, Kentucky and Virginia but may be expanding to other states in the future. Visit www.ramusa.org or call (865) 579-1530.

Making Sense Out of Existing Data

Did you know that health care price data exists today --it's just not available to the public. I am passionate about bringing consumerism to health care, and dedicated to promoting price transparency.  My goal is to make sense of the existing price data to help consumers make informed choices. 

For CONSUMERS

• Hunting down true out-of-pocket expenses for health care services – in advance, can be frustrating.  Unless you are an experienced data minter, this type of hunting can be intimidating and time-consuming.  If you are uninsured, under-insured, looking for an out-of-network provider, or have a high-deductible health plan, you are probably trying to make cost-effective choices before purchasing health care services.  And you are probably interested in knowing your true out of pocket cost for the services BEFORE you visit the provider.    That’s just being a good consumer.  You need useful and relevant tools to help you make good choices.

For INSURERS

• You are the keeper of all the claims data for your members.  You know exactly the negotiated (contracted) price for every provider, for every service, for every different insurance plan you offer.  You also know how much of a member’s deductible has been met.  You have databases of prices paid for every service for every member and could make life a lot easier for your members and possibly change health care if you agreed to share this data to make it publically available.  Yet you insist on keeping this data a secret. 

For OUTOFPOCKET.COM

• I am inviting consumers to post/share prices they paid in the directory.   Everyone wants to look up prices, but very few are willing to take a minute to post/share their prices.  We could wait years for legislation to pass, insurers to agree to make prices public, or we could do something today.  Consumers are invited (and encouraged!) to collaborate and share prices they paid on OutofPocket.com.  If enough consumers participate and share prices, consumers collectively will create a very powerful directory of true out-of-pocket prices.

For PROVIDERS

• You have an opportunity to transform health care as we know it today.  You can help promote transparency by publishing your prices for services.   Why not let consumers know up front what your services will cost them?  OutofPocket.com invites you to include your prices/services in the directory - free of charge.  This not only promotes your practice, but also helps consumers understand what they will be required to pay for services at your facility.

Imagine how easy it would be to comparison shop for health care services if relevant data was available. If consumers had access to true healthcare price data, comparison shopping for health care services could be a lot like your experience shopping for a book on Amazon.com, booking a vacation on Travelocity.com or purchasing an item on eBay.com. 

Tell a friend about OutofPocket.com and be sure to add prices you paid for health care services to this directory.   Not only will you be sharing data, but you will be contributing to a powerful directory of prices that will help promote more affordable health care services.

Doctor Review Websites

The November 28 edition of Slate.com included an interesting article by Dr. Kent Sepkowitz.  His article sheds some light on all the doctor rating websites available today.  Dr. Sepkowitz spent many hours reviewing doctor rating tools, including free sites and sites that require subscriptions or fees to obtain this information.  His conclusion:  the online doctor rating tools are very lean, content-free and lack any useful information. 

Last month I posted a blog about finding the best value (understanding the quality side of health care in addition to finding the best cost) and listed 25 different websites that offer doctor ratings.  I neglected to mention that I never use these doctor rating sites because they are not useful.   They lack meaningful data.  All of them.  Instead, I ask my doctors, family, friends, and community for their personal recommendations.  Then I go online and start to research the doctor’s certifications in more detail using many websites, tools and blogs to read other patient’s comments and experiences.  Since this is user generated content, you need to be able to read between the lines.  Sometimes people just have a bad day and they should skip writing reviews online until they have 24 hours to think about what they want to write and their mood stabilizes.

Price Transparency Tools

I am dedicated to promoting price transparency in health care.  This is what I do and that’s why I launched OutofPocket.com almost two years ago.  If I can help consumers make more informed and cost-effective choices before visiting a provider, then I have accomplished my mission.   When consumers start making more informed choices, become active participants in their own health care and demand greater transparency  --- good things result including lower costs, more innovation, more choices and improved access to medical care.
 
OutofPocket.com is not the only price transparency tool available.  Dozens of others are out there and I research all the new tools to evaluate their usefulness so I can talk about these tools in my next presentation.  Unfortunately, the price transparency tools seem to have the same disease as the doctor rating tools.  Each has some amount of data, but not enough to be meaningful and comprehensive.  Wouldn’t it be interesting if these tools collaborated and consolidated their data to produce a robust tool where shopping for routine health care servcies would be comparable to the experience of shopping for items using eBay or Amazon.com, where you can easily compare quality, prices and recommendations?

Here is the short list of 20 price transparency tools.  If you would like my comprehensive list and review of each tool, please send me a note and I’d be happy to forward this information to you.

Alijor
AMA CPT Lookup Tool
Carol
CostHelper
DoctorPricing
HealthcareBlueBook
HealthPricer
HospitalVictims
MainStreet Medica
MedcareCompare
MyHealthScore
MyMedical Costs
MyRegence
OutofPocket
PatientCare
RemakeHealth
Spectrum Health
UCompreHealthCare
USA Healthcare Costs
Vimo

Doctor Ratings

I love the idea of empowering consumers to exercise choice, encouraging them to become an active participant in making decisions about their health care, and incenting them to find the best value before seeking health care services.  It’s important to note that value is about quality and price so if you end up finding the lowest-cost provider, but the quality of service is less than desirable – you have not found a good value.  I often use recommendations from family, friends and community members when researching a new doctor, facility or hospital.  Asking consumer’s questions like, “what did you think of that doctor? Would you recommend their services? What didn’t you like about the facility?”  These are all very helpful questions for you to ask when trying to learn about a new provider.   

If you’d rather use online tools to lookup recommendations and ratings of doctors, there are a number of sources available.  For additional information, you can read a white paper on MD Rating Websites: Current State of the Space and Future Prospects.  Ruth Given has written a 39-page analysis that takes a comprehensive look at many of the doctor rating sites that exist today.

Here’s a list of doctor rating websites to get you started.

alijor.com

angieslist.com

bookofdoctors.com

careseek.com

checkMD.com

doctorfeedback.com

doctorscorecard.com

drscore.com

findadoc.com

healthcare.com

healthgrades.com

healthworldweb.com

kudzu.com

mdnationwide.org

mydochub.com

ratemds.com

remarkabledocs.org

revolutionhealth.com

suggestadoctor.com

thehealthcarescoop.com

vimo.com

vitals.com

wellness.com

whitecollarfinder.com

zocdoc.com

Do you know how to find affordable lab tests?

Fortunately I have good health insurance.  Four years ago I signed up for a high-deductible health plan for my family in order to keep our premiums down.  My deductible is $5,200 and as a result, I am getting really good at shopping around for the best value, negotiating cash prices with providers, calling around to get prices and using available tools/resources to comparison shop/understand fair prices.  The more money I am able to save on finding affordable health care, the more money I have to spend on family vacations.  That’s enough incentive for me.

My health insurer has negotiated special deals (discounts) with providers in my network.   When I use these network providers, I am charged the discounted rate for services.  This carefully guarded rate is difficult to find out until after services are provided because health insurers keep negotiated prices a secret.  That’s why I encourage consumers to post/share rates they paid for actual services in OutofPocket.com directory, to share with other consumers.  If insurers and providers will not reveal these prices, consumers should!

I recently had a series of blood tests done that were required for my upcoming surgery.  I realized if I went to my doctors office to have these blood tests taken, my out-of-pocket costs would be much higher, so I selected a stand-alone lab testing facility that offers affordable lab tests.  I went online to find Quest Diagnostics and scheduled my appointment.  I just received my EOB and here’s what I discovered

Prices For My Lab Tests for Comprehensive Blood Test

Total Quest Labs billed to my insurance plan      $ 193.78

Total discounted by my insurance plan                 $ 143.78

Amount of my out-of-pocket for my lab tests         $   50.00

If I wasn’t careful, I could have easily ended up paying a lot more for my lab tests.  If I did not have insurance, I would have negotiated a cash discount with the lab when I scheduled the service, to make sure I get a fair price.  Because of my cost-effective choices, I saved about $144.

Here are some resources you can use to find affordable lab tests in your area.

www.PrivateMDLabs.com

www.MedLabUSA.com

www.DirectLabs.com

www.LabSafe.com

www.MyMedLab.com

www.QuestDiagnostics.com

• Amounts paid by the employers two health insurance companies for MRIs ranged from below $700 to more than $2,400
• Amount billed to the employer’s insurance companies (before discounts were applied) ranged from $1,100 to over $4,000
• Approximately 300 MRIs were done annually in this population. If employees were to choose the lowest-cost provider for an MRI instead of the highest-cost provider, it would save the employer about a half a million dollars per year for just one type of diagnostic procedure
• If an individual consumer shops around for the best price for an MRI, they can save themselves hundreds of dollars on this diagnostic test. If all employers/employees in one city shopped around for the best value, imagine how many hundreds of millions of dollars per year could be saved on health care costs just by choosing the lowest-cost providers?
• Why don’t employers simply require their employees go to the lowest-cost provider? The employees don’t know who the lowest-cost provider is. This information is not available. Health plans carefully guard ‘secret’ payment information because they have different negotiated prices with different providers. They don’t want one provider to discover that another provider is being reimbursed more for the exact same procedures. So when an employer chooses a health plan for its employees, the negotiated prices for services are already set. Services provided will be reimbursed at the plan’s negotiated amount (whatever that is).

Other interesting facts

• The rate of MRIs has tripled over the past ten years
• One-third of the MRIs provided are considered unnecessary
• MRIs generate significant revenue for health care facilities. Often there are financial incentives encouraging their use
• Studies indicate that radiology costs (includes x-rays, MRIs, CT scans) have risen faster than any other category of health care costs

Consumers --- do your homework and research prices BEFORE visiting a provider. Use available tools, make phone calls and compare prices and quality before you decide on a provider. You can save yourself hundreds, and possibly thousands of dollars annually.

Employers -- provide comparison shopping tools for your employees to use to help them make informed choices. Employers can also encourage and incent employees to make cost-effective choices. This not only reduces health care expenses for employees, but also reduces employer health care costs. A win-win situation.

Today there are about 46 million uninsured Americans and this number continues to increase as the recently unemployed lose their jobs and join the uninsured.   In these tough economic times, you have to ask yourself “how do all these uninsured consumers shop for affordable health care services when they need medical attention?”  Regardless if you are uninsured or insured, how much more can you afford to spend on out-of-pocket costs?  Many of us are living on very tight budgets and need to make the most of our health care dollars.  Protecting ourselves from being overcharged for medical costs and finding affordable health care service is more important today than ever before.

With the holidays approaching in this economic downturn, consumers are responding by tightening their budgets, becoming more cost conscious and relying more heavily on comparison shopping engines to help them shop around for the best value.  The same behavior applies to shopping for health care services.  Unfortunately most consumers have no idea how to comparison shop for health care services.

A new start-up, Out-of-Pocket Protector, works with consumers to protect them from inflated costs and billing errors.  If you have read my earlier posts you already know that I strongly encourage consumers to do research upfront --before you even visit a provider, to make sure you negotiate a fair price for service.  If for some reason you skip the research step and find yourself needing a second opinion to review your medical bills for errors, and possible overcharges, there are a number of services to help you through this process.  Ideally, consumers would take charge of this on their own, but if you feel intimated by the whole process, you can take comfort in knowing that services are available to help you.  These services often charge membership fees or charge you a percentage of the money they are able to save you.  One such service is called Out-of-Pocket Protector (no relation to OutofPocket.com).  According to Out-of-Pocket Protector, what sets them apart from competitors is their “focus on the whole process, from finding and negotiating affordable care upfront, to offering consumers a second opinion on their medical bills after they receive care.  The vast majority of consumers want to promptly pay a fair price for the health care they receive.  With help, that’s just what our members are able to do.” Membership for this service is $14.95/month or $165/year.  If you would like more information on this service visit www.outofpocketprotector.com.

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. 

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.

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.

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.

• 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.

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. 

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

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.

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?

" 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.

Fourth, hire an expert to help you review and appeal your medical bills. If your medical bills are complicated and large, you can hire a medical billing review service.

The CDC published interesting statistics on the unnecessary and overuse of hospital Emergency Rooms. In 2005, 115.3 million people visited Emergency Rooms and only 5.5% of the patients needed to be seen immediately. Only 21% of theses ER visits were identified as semi-urgent and needing to be seen within one to two hours, and 14% of these visits were evaluated as non-urgent

Source: Laura Landro, "Options Expand For Avoiding Crowded ERs," Wall Street Journal, August 6, 2008.

Pay cash upfront.  Providers sometimes will offer you the same lower rate that they negotiate with insurance companies, or possibly even a cheaper rate if the consumer agrees to pay cash at the time of service.  I tried this and it worked!  Just be sure to ask up front.   

Compare Costs.  Check your providers rates against other doctors in your area.  You can look this information up through tools provided by your insurer, or by using the community search tool, OutofPocket.com to view patient posts of actual prices paid for services.  Providers have been know to lower their fees to stay competitive so be sure to do your homework and research prices before you visit the provider.

Paying cash up front helps consumers save money because providers do not have to process billing and insurance forms, and are often willing to discount prices in return for payments at time of service. 

Be sure to compare costs before purchasing health care services.  The more you know, the better informed you will be to negotiate a fair price for services.

Bottom Line Secrets published an article several years ago on tips you can use to fight back if you think you are being overcharged for health care services.  This article was recently brought to my attention because this information still applies today.  Here is a brief summary of some of the tips.

To avoid paying more than you should for doctor bills

1. Remember to negotiate.  Try asking your doctor for a discount. 
2. Have blood tests done at a lab, rather than at your doctor’s office. 
3. Don’t pay for follow up visits. 
4. Ask your doctor if tests prescribed are necessary. Doctors often order unnecessary diagnostic tests including MRIs, CAT scans and X-rays. Ask what these tests will determine.

Tips on how to spot over billing on hospital bills

1. Request a daily itemized bill. 
2. Avoid using the hospital pharmacy.  Have your prescriptions filled at your local pharmacy.
3. Watch out for double billing and review your bill detail carefully.
4. Don’t pay for the last day at the hospital if you are discharged before noon. 

Selecting the right doctor

Consumers can find out about a doctor's experience and a hospital's success rates, and even find information on what these services cost.  First, get to know your doctor.  Do some research to find out what other patients have to say about the doctor.  Personal recommendations carry a lot of weight and people trust what other consumers have to say.  Check if your doctor is board certified.  Search the American Board of Medical Specialties to find out.  Make sure your doctor has done this procedure before.  Use Vitals.com to find out how many times a doctor has performed certain procedures in a year, and look up historical data to determine if there are any sanctions or malpractice claims.  If you cannot find this information on public sources, call the doctor’s office and ask. You want a doctor that has lots of experience.  Know the price before you visit the provider.  If you have out-of-pocket expenses, it’s well worth your time to call your doctor and your insurer to determine the amount you are responsible for.

Selecting the right hospital

Hospitals provide a lot more performance data.  Just like doctors, hospitals get better with experience.  You can use Vimo.com to find out how many times a hospital has performed a procedure.   RevolutionHealth.com also provides similar information.  HealthGrades is an excellent source of quality ratings for hospitals. You can purchase a report from HealthGrades to obtain cost and quality information. 

I am pleased to announce the new release of OutofPocket.com, version 2.0.  Our new search engine enables consumers to look-up prices for health care services, and allows providers to list their prices/services in the directory - free of charge.  In addition, the search engine features expanded search technology and searches for health care price data across other public price transparency tools.

I welcome all your feedback and comments on this new release and I would appreciate if you could help us spread the word.  As you know, the more people that contribute and use this tool, the more powerful it will become for everyone.

Thank you for all that you do to help promote health care price transparency. 

NEW FEATURES IN OUTOFPOCKET.COM VERSION 2.0

(1) Enhanced search engine provides more relevant search results

(2) Easy for consumers to post/share their own visits and prices they paid for services

(3) Comprehensive search results - searches other websites that publish pricing and websites that offer price transparency tools

PRICE DATA COLLECTED FROM MULTIPLE SOURCES

·         Providers can submit price lists for their services

·         Consumers are invited to post/share prices they paid for actual visits, along with their personal recommendations on the provider

·         Claims Data from Businesses, Health Plans or TPAs

·         Government CMS Medicare payment data

·         Websites that publish prices for health care services including hospitals, diagnostic testing facilities, clinics and physician practices

·         Price Transparency Tools on public websites including health plan tools and state price transparency tools

BENEFITS for BUSINESSES

·         Load your claims data into OutofPocket.com to enable your employees to search for their true out-of-pocket costs for specific service

·         Employees can use OutofPocket.com to search for prices for specific services in your network plan

·         Encourage employees to collaborate and post prices they paid for health care services, to share these good deals with other employees

·         Eliminate providers that overcharge - Use OutofPocket.com to direct your employees to affordable, low-cost providers

·         Avoid providers with poor performance by encouraging employees to share recommendations on provider visits

BENEFITS for CONSUMERS

·         Look-up prices, comparison shop and find the best value for routine health care services in your neighborhood

·         Tool makes it easy for you to post/share prices you paid for actual services with other consumers

·         Share your recommendations on a specific provider with other consumers

BENEFITS for PROVIDERS

·         Add your true prices/services to the directory – free of charge

·         Consumers can easily find your services and link to your website

·         Include additional information about your practice, services

·         Search results links directly to your website

·         Provides additional exposure for your services

The California HealthCare Foundation (CHCF) offers some great tips for consumers that are interested in comparison shopping for non-emergency hospital services.    The consumer tips provided by the CHCF are based on the results of a recent mystery shopper study conducted at 64 California hospitals.  Here are some of the highlights, but be sure to visit their site to read all the tips. Most important, be sure to ask the right questions before using hospital services.

1.     Call first.  Consumers should call a hospital to obtain pricing information, rather than wait to ask for pricing in-person.

2.     Know the CPT or ICD-9 code.  This is the specific American Medical Association (AMA) code assigned to each medical procedure or service and is used for billing purposes.  It’s actually a lot like a specific part-number for an electronics you purchase.   When you know the specific code (part number), you can compare apples-to-apples.  Once your doctor has explained the service or procedure you need, ask your doctor for the CPT code.  It will save you time and money.

3.     Ask about a discount.  If you don’t ask, it almost certainly won’t be offered.  Find out how much and under what conditions discounts apply.  You might find that paying by cash or using your credit card entitles you to discount.

4.     Find out what’s included.  There’s little consistency among hospitals in terms of the type of prices quoted, making applies-to-applies comparisons difficult.  You should ask as many questions as necessary until you are comfortable with the information about what specific services are included.  If you are not getting the answers you need, ask to talk to someone in Admitting, Financial Counseling, Billing or the Cashier’s Office.

• Take advantage of walk-in clinics
• Consider alternative therapies 
• Try using a nurse practitioners instead of a doctor
• Research medical tourism
• Check out a health fair for free routine screenings
• Volunteer for medical school clinics
• Use phone medical services for less complicated issues
• Avoid the weekend
• Review your bill for errors
• Negotiate your bill

• Shop around and compare prescription prices using resources like Consumer Reports, the AARP or the Medicare Rights Center
• Buy store brands for over the counter medications
• Request generic prescriptions
• See if you qualify for freebies 
• Double up on medication
• Cut your medications in half 
• Get creative. Work with your doctor or pharmacist to see if you can't find a lower cost solution to your prescription drug costs
• Reuse and recycle. Friends, neighbors or even a church group may have equipment that can suit your needs at a greatly reduced cost 
• Shop for frames at retail stores or large chains instead of the eye doctor’s office

Be sure to read the article When Consumers Are Driving Health Care, in the March 6, 2008 edition of the Raleigh News & Observer written by Max Borders, a Policy Analyst at the Civitas Institute. 

The seven million consumers with high-deductible health plans and HSAs, will definitely be able to relate to this story.

1. Ask your doctor to be your ally
2. Compare costs by using CPT codes
3. Find friends in the billing department
4. Negotiate lower prices, payment arrangements
5. Ask if recommended services are necessary
6. Explore state-sponsored hospital web sites
7. Check your insurance company’s website
8. Ask for the Medicare rates
9. Go generic
10. Sweat the small stuff

On January 24, Vanessa Fuhrmans wrote a story in the Wall Street Journal about insurers paying doctors to prescribe generic drugs, rather than name-brand drugs for their patients.   According to the story, Doctors Paid to Prescribe Generic Pills, the basic idea is to reduce health care costs for patients, employers and insurers by implementing an incentive program set up by health insurers to reward physicians for prescribing generic drug prescriptions instead of the more expensive, brand-name drugs.

I think this approach to reducing health care costs is wrong.  Consumers --not the providers are the ones that should be recipients of incentives by asking for generic rather than brand-name drugs.  If consumers can directly benefit by becoming cost-conscious, consumers will be motivated to ask for discounts, request generic prescriptions, and shop around for the best value in order to save money.  In fact, this type of behavior already exists with consumers that have high-deductible health plans.  Do you think a consumer that is responsible for paying $2000-$5000 out-of-pocket would choose to pay $230 for a brand-name prescription when he can save $170 and pay only $60 for a generic drug?  This already happens today just by asking your pharmacist or physician for a generic equivalent when filling a prescription.  Consumers are not rewarded by insurance plans for this cost-conscious behavior, but they do save money by shopping around for good deals.   Insurers and health care industry experts underestimate the intelligence and responsibility of consumers.  In every other industry, consumers are self-motivated to shop for the best value.  The same motivation would occur in health care if consumers were paying out-of-pocket for these services.  I’d like to see health plans reward consumers for making cost-effective choices by offering premium discounts to reward this good behavior.  Automobile insurance policies reward consumers with discounts for good driving records, anti-theft features on your car, vehicle safety, accident free, and new student drivers with good grades in high school. 

Mona