Peter’s top ten list of tips to help consumers save money their medical care.

1.     Hospital owned providers and facilities have less flexibility in providing big discounts to self-pay patients.

2.     In most markets, there is an oversupply of ancillary providers (imaging, labs, home health, medical equipment, etc.)  Use this fact when negotiating.

3.     The more flexible you are for the appointment date and time, the better deal you will get.  Don’t ask for a Monday AM or Friday AM appointment, these are their busy times.

4.     Always state you will pay 100% at time of service and most importantly do!  This alone cuts 3% -8% off of a provider’s cost to perform services.

5.     Facilities that rely on doctor referrals like to “take care” of their mutual self pay patients.  Telling a facility what doctor you have the order from may help you with your final price.

6.     Know your pricing reference points – see this post.

7.     If you need a procedure that is done by a doctor in a setting other than the doctor’s office, ask your doctor for the most affordable site location.  In general, a procedure done in an outpatient surgery center is less than if done in the hospital setting.

8.     Plan ahead and do your due diligence for those medical services that are non-emergency.  Don’t wait until the last minute to price your service.

9.     If you don’t feel a bit embarrassed about your offer, you are probably not asking for a low enough deal!

10.  Above all is quality!  Concentrate on the quality providers with national accreditation, board certifications, and appropriate fellowships.  For example, the lowest price MRI listed on SelfPayMRI.com might not be the best for your situation – review accreditation, doctor bios, and their websites.

• Retail clinic: $110
• Physician office: $166
• Urgent care center: $156
• Emergency department: $570

Source: RAND Corp.

• Retail clinic: Allergies, strep throat, flu vaccinations, ear or sinus infections
• Urgent care center: Sprains, flu, minor cuts, headaches-migraine/tension
• Emergency department: Chest pains, trouble breathing, deep cuts, life-threatening symptoms

Source: Aetna

Almost ten years ago my daughter went to the hospital emergency room after her arm went through a glass door.   Seven stitches and five hours later we arrived back home.    Two weeks later a bill arrived from the hospital for $770.  That turns out to be around $100 a stitch.  The ER staff treated her wonderfully, but her injury seemed minor compared to some of the other patients being treated in the ER.  The $770 bill was entirely out-of-pocket.  After that expensive experience I always planned to use an Urgent Care Center the next time our family required urgent care treatment for a non-life threatening situation.

My husband’s recent experience at the Urgent Care Center was very positive.  He was treated immediately by professionals and returned back home in 75 minutes with five carefully sewn stitches on his lip.  We just received the bill which completely justifies why we chose the Urgent Care Center over the Hospital Emergency Room. The next time you have a non-life threatening situation and are considering going to the emergency room, I highly recommend you reconsider and check out a highly recommended urgent care center in your area.

Here is how the services and fees break down for the visit to the urgent care center.

• Once a year be sure to review the list of prescriptions you are filling   
• Pay attention to what you are paying for all your prescription drugs. Know the most recent prices you paid.
• If you are taking branded drugs find out if there are any generic equivalents of the drug available.  Be sure to talk to your doctor.
• Make sure you are purchasing (filling) these prescriptions in the most economical manner. This normally means using your health plan's mail-order pharmacy and getting 90-day supplies sent
• Use online tools to help you find the lowest cost online pharmacy in the U.S.
• Familiarize yourself with the large pharmacy chain generic discount programs including CVS, Kroger, Target, Walgreens and Wal-Mart.
• Use the generic equivalency tool (from the U.S. Food and Drug Administration) if you have questions about whether there is a generic version of a branded drug.

Know the real cost upfront -- so you can ask the provider for a discount.  Knowledge is power.  If you know the fair price for the service, you are in a better position to negotiate a discount if the provider’s price is too high.

Use online tools to look-up estimated prices for services – before you visit the provider.

Inquire about using outpatient services for surgeries - talk with your doctor about these options.

For better discounts -- pay by cash and be ask about a payment plan.

Find out about less expensive health insurance plans.  If you are spending more than $10,000 annually on premiums – research high deductible health plans.  With a high deductible health plan that offers much less expensive monthly premiums, you could end up spending much less on health care expenses over the 12 months.

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.

How do you find the best health care provider? That's the question WhereToFindCare.com answers.  WhereToFindCare is an initiative that combines patient and visitor reviews with government quality and patient satisfaction data to give you a bigger picture of how good a provider is.  The best part is that reviews are designed by independent health care improvement experts, so you can get information on how a provider performs in specific areas that are meaningful to you.  For example, whether a physician’s appointments start on time or whether her patients feel comfortable asking her questions.

Besides physicians, WhereToFindCare.com also has information on more than 30 different types of health care providers such as hospitals, nursing homes and urgent care clinics so you can find the best provider for you no matter what stage of life you’re in.  It also has information and resources on finding low cost or free health care for those in need.

To add your voice to the initiative and submit a review, go to WhereToFindCare.com, locate your health care provider and click the Rate button.  Anonymous feedback is openly shared with the public and providers in order to promote the improvement of health care and reduce its cost for everyone. 

• People without health insurance
• People enrolled in high-deductible health plans
• People who want a better idea of what their co-payments might be for medical procedures

• 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:

An article in today’s CBS Moneywatch.com reviews diagnostics tests, their costs, purpose, concerns and if then test is worth getting.   If you are considering getting a non-emergency MRI, mammogram, CT scan, or nuclear scan, be sure to read this article.  If you want to learn more about prices for these diagnostic tests, you can search the Outofpocket.com directory to find true prices for these services.

From MRIs to Mammograms: Which Tests Do You Really Need?

Chalk it up as one more symptom of our broken health-care system: Americans waste more than $250 billion per year on unnecessary medical tests and treatments, according to a Thomson Reuters health-care analytics report. Often, doctors order expensive, high-tech tests to rule out unlikely possibilities, reassure worried patients, or as a CYA strategy against a possible lawsuit. An American Journal of Preventive Medicine study found that in 43 percent of cases where healthy people went in for routine checkups, doctors ordered an X-ray, electrocardiogram, or urinalysis. So how can you be sure you’re not wasting your money on medical tests you don’t really need?

Unnecessary medical tests don’t just take money out of your pocket. They can expose you to radiation, cause mental stress, and kill a day or more. Not to mention their cumulative effect: ever-climbing insurance premiums.

MoneyWatch wanted to find out whether five commonly prescribed tests are worth getting: mammograms, CT scans, PSA prostate screening tests, nuclear heart scans and MRIs for lower back pain. So we talked to experts in preventative and family medicine and pored through the latest research about the risks and benefits of these tests, which can cost up to $2,000 or more a pop. What we found may surprise you.

Of course decisions about medical care are intensely personal, and everyone’s circumstances are slightly different. If there’s a key takeaway it’s this: Medical tests are not analogous to checking your car’s tire pressure. Sure there may be benefits, but there can also be negative consequences. Be sure to educate yourself on the downside.

CT Scan

• Purpose: Non-invasive and painless, doctors use them to get detailed images of everything from cancerous tumors to signs of heart disease to bone injuries. You lie on an exam table that slides in and out of a machine. More than 70 million CT scans are done annually; 23 times the number in 1980, according to the Radiological Society of North America.
• Cost: Varies widely; average price is $1,150 for a brain CT scan, $1,800 for a chest CT scan and $2,175 for an abdominal CT Scan
• Concerns: Researchers are increasingly fearful that the scans’ radiation could lead to increased cancer risk and say that safer tests such as an ultrasound can sometimes do the job. Then, there’s the danger of medical error. Last August, 206 patients at Cedars-Sinai Medical Center in Los Angeles accidentally received eight times the normal amount of radiation during their CT scans. “A single CT scan for an isolated problem I’m not so concerned about. It’s when patients keep coming back for repeated exams that cumulative radiation starts to add up,” says Dr. Aaron Sodickson, assistant professor of radiology at Harvard Medical School.
• Worth getting? If your doctor orders a non-emergency CT scan and you’ve already had at least one previously, “ask your doctor if there are alternative tests that can be done,” says Greg Morrison, chief operating officer of the American Society of Radiologic Technologists. If you will undergo the test, first ensure that the facility is accredited by the American College of Radiology and that technicians follow the ALARA (As Low as Reasonably Achievable) protocol, so you’ll receive the lowest possible dose of radiation.

PSA Prostate Cancer Test

• Purpose: Doctors encourage men to get this simple blood lab test every year to help them avoid the second leading cause of death among U.S. males. But the PSA, or prostate specific antigen test, may do more harm than good.
• Cost: About $45; up to $1,500 if the test leads to a biopsy
• Concerns: The American Cancer Society does not support routine testing for prostate cancer, because of the risk of over diagnosis and overtreatment. Studies recently published in the New England Journal of Medicine found that PSA screening does find more prostate cancer, but the early detection does not translate into lives saved. For every man whose life is saved by early detection of prostate cancer, 48 others will undergo unnecessary treatment with possible side effects including impotence and incontinence.
• Worth getting? Discuss your options with your doctor. Some men opt for regular PSA screenings, but not to have surgery or radiation therapy unless an aggressive cancer is detected.

Nuclear Heart Scan

• Purpose: Doctors usually order these two- to four-hour tests after patients have had unexplained chest pain or pain brought on by exercise. The scans are designed to help detect narrowing of the arteries, damaged heart muscle, or to evaluate how well your heart is pumping blood. After a radioactive ‘tracer’ is injected into your veins, you take a stress test, walking on a treadmill or riding a stationary bike at increasing speeds. Then photographs are taken, showing your heart after strenuous exercise.
• Cost: About $2,000
• Concerns: Although this type of imaging can be useful for diagnosing heart disease, it’s overused. A pilot study of 3,035 scans for the American College of Cardiology (funded by insurers and cardiology groups) found that about 18 percent of the nuclear heart scans were done unnecessarily; another 16 percent were ambiguous.
• Worth getting? Ask your doctor whether an alternative test is available, such as a stress echocardiogram, which does not involve exposure to radiation and costs about $1,000. Discuss the amount of radiation you’ve been exposed to in the past to determine whether you may want to avoid future radiation, when possible.

Lower-Back MRI

• Purpose: A spinal magnetic resonance imaging (MRI) test can find changes in the spine and other tissues, infections, herniated discs, and tumors without using radiation. You typically lie on a moveable table that slides into a tube surrounded by a magnet. Newer standing, or open, MRI machines are also available.
• Cost: About $2,000
• Concerns: MRIs can show every bump and lump, which may lead to procedures causing more harm than good. The Health Affairs journal found that the increasing availability of MRI is linked to an increase in surgery for lower back pain even though symptoms for most back pain sufferers often resolve themselves without invasive surgery. The researchers theorized that doctors ordering the MRIs have a tendency to find something to blame in the resulting images.
• Worth getting? Experts say that if you have lower back pain, wait at least a month before submitting to an MRI. “The main reason you’d have an MRI of your lower back is if you’re going to have surgery,” says Dr. Daniel Merenstein, Assistant Professor and Director of Research in Family Medicine at Georgetown University Medical Center. “But for routine low back pain, surgery has not been shown to be any better than Motrin or other non-steroidal anti-inflammatory drugs or acupuncture.”

Mammogram

• Purpose: The 10-minute X-ray procedure can be done for breast-cancer screening purposes in the absence of symptoms or for diagnosis purposes after a doctor detects a change in a woman’s breast.
• Cost: About $125
• Concerns: For years, women were advised to have routine screening mammograms every year or two starting at age 40. Last fall, the U.S. Preventative Services Task Force recommended less routine screening, concerned that mammograms on women in their 40s yield a high number of false positives. For women without risk factors, such as a history of breast cancer among close relatives, the panel now recommends biennial screenings starting at 50 and until age 74.
• Worth getting? Although the panel advises women in their 40s without significant risk factors to discuss the usefulness of a mammogram with their doctors, leading breast cancer experts, including American Cancer Society and Susan G. Komen for the Cure, still strongly recommend women get screening mammograms beginning in their 40s. “The American Cancer Society acknowledges the limitations of mammography [but] overwhelmingly believe[s] the benefits of screening women 40 to 49 outweigh its limitations,” Dr. Otis Brawley, chief medical officer of the American Cancer Society said, in a statement. “We believe the evidence does show there is survival benefit for women who get screening in their 40s, although we acknowledge that benefit is not great,” says Susan Brown, director of health education for Susan G. Komen for the Cure. So until the medical community reaches a consensus, it seems best to get the mammogram.

However, medical negotiation, the practice of reviewing and negotiating payment of your medical bills and procedures, is providing individuals the opportunity to prevent medical bills from spiraling out of control.

“Many people don't think of medical negotiating as a practical option to reduce their medical costs; though they anticipate negotiating when purchasing a home or pricing a car,” says Derek Fitteron, CEO of Medical Cost Advocate (MCA), an expert medical cost reduction company.

MCA uses health care pricing information along with data showing the cost of typical medical and surgical procedures, and works with medical providers to negotiate costs on behalf of the consumer. MCA will negotiate any medical bills including those not fully covered by insurance like surgery, hospital and professional charges and those not covered at all including cosmetic, bariatric and dental. This can be done prior to the procedure (negotiating a set price) or after it occurs to help arrive at a reduced price for the consumer.

“While individuals can negotiate bills themselves, they often don’t have the skills, knowledge or time necessary to achieve success,” says Fitteron. “MCA negotiators include attorneys and former healthcare billing professionals that know how to negotiate bills and have industry data to leverage. All negotiations are conducted tactfully with utmost respect for the patient provider relationship.”

With an 80% success rate of reducing bills ranging from $250 - $250,000 by 20-50 percent, MCA follows a no-risk negotiation policy for consumers; if they don’t save the customer money, the customer doesn’t pay.

“Consumers should make a habit of medical bill negotiation,” says Fitteron. “Actively participating in the billing process both before and after a procedure or treatment provides consumers with an opportunity to get their debt under control. In todays increasingly consumer directed health care environment many families need a trusted cost advocate on their side.”

Fitteron also offers the following five money-saving tips to help consumers save money on their medical bills:

1. Be sure that you understand your insurance coverage. Review and understand your insurance summary/declaration sheet and know in-network and out-of-network provisions. Have a firm understanding of your co-payments, deductibles and co-insurance rates and when they apply.

2. Research before buying. If you plan to use or go out-of-network, do extensive research on a doctor’s capability and costs. A professional like Medical Cost Advocate can help you in this process and can help you negotiate a rate or payment plan before your procedure.

3. Take advantage of health savings accounts and other tax advantaged products to reimburse medical expenses like HSAs, HRAs, and FSAs which are frequently available from employers or directly.

4. Ask for details about your procedure charges including an itemized bill with procedure costs. Be sure to wait for an Explanation of Benefits (EOB) from your insurer, and always review both items to make sure you received what you thought you were getting.

5. Find a trusted medical cost negotiator, like Medical Cost Advocate, to help reduce bills. As most people lack the time, expertise or desire to negotiate their medical bills, they should hire an expert (that works on a pay-for-performance basis) to negotiate bills on their behalf.

About Medical Cost Advocate

Medical Cost Advocate (MCA) is a medical cost reduction company that lowers consumers’ medical bills before or after treatment through the power of professional negotiation. Serving consumers, their employers, benefits consultants and financial institutions, MCA leverages industry experience and proprietary data to regularly save consumers between twenty and fifty percent on their medical bills. MCA can negotiate any medical, surgical or dental bill for insured and underinsured consumers. With out-of-pocket healthcare costs steadily increasing, MCA provides the professional advocacy every consumer needs to realize savings without risk.

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.

• Colonoscopies in the Chicago area can range from $900-$2600 (source: Leslieslist.org)
• For a colonoscopy in Milwaukee, Wisconsin average prices range from $600-$1200 (source: NewChoiceHealth)
• Colonoscopy in zip code 53202, average price is $1239 ($450 physician service + $373 facility fee + $415 anesthesia).  Source HealthCareBlueBook.
• According to CostHelper.com, if you are not covered by health insurance, the cost of colonoscopy varies by provider and geographic region, usually ranging from $2,010 to $3,764, with an average of $3,081, according to Blue Cross Blue Shield of North Carolina.  A colonoscopy often is covered by health insurance if the patient has symptoms that warrant it or if the patient meets age and risk criteria. According to the 2007 Colorectal Cancer Legislation Report Card, 21 states have laws mandating colonoscopy coverage.  For patients covered by health insurance, out-of-pocket costs can range from zero to more than $1,000, depending on deductibles, co-pay and coinsurance amounts. For example, a Medicare patient at Dartmouth-Hitchcock Medical Center would pay $1,477, including deductibles and coinsurance. However, some insurance plans, such as the Blue Cross Blue Shield of Michigan Community Blue PPO plan, cover "wellness" screenings 100 percent, with no deductible or co-pay, usually with some restrictions.
• A colonoscopy typically cost $900-$1100 according to Blue Cross Blue Shield, Massachusetts is (source: www.bluecrossma.com)
• According to MainStreetMedica, colonoscopies cost between $600-$2400 (source: MainStreetMedica)

If you find the information in Outofpocket.com useful, please send me an email at info@outofpocket.com. 

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.

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. 

Wondering how you can reduce your medical bill?  David Whelan’s recent article in Forbes.com, “How to Cut Your Doctor Bill,” describes real-life situations where savvy patients comparison shop to find the best value, and negotiate prices with their health care providers to get a discount.   

Comparison shopping can be tricky and you need to be persistent.  The good news is your effort and research can pay off. 

The Forbes article lists a few websites consumers can use to look up prices of procedure to help you negotiate a fair price. 

Healthcarebluebook.com

Changehealthcare.com

Outofpocket.com

Myhealthscore.com

If you are not successful in negotiating the price of services before visiting a provider, or have trouble negotiating your medical bill, you can hire a bill negotiation company. These companies typically charge a fee based on the percentage of savings achieved.

Myinsnet.com

Medicalcostadvocate.com

Billadvocates.com

As health care reform dominates the news, most consumers will benefit from remembering that there are things they can be doing today – before any meaningful reform occurs – to help drive down their health care expenditures.  Creating affordable health care has as much to do with consumers taking the time to educate themselves on purchases as it does on what Washington decides to do.

That is one of the reasons that HealthHarbor.com was created.   HealthHarbor is an online information source dedicated to helping people become smarter consumers of health care.  By offering dozens of pages of original content on money-saving techniques and using health coverage effectively, as well as providing online tools to help people make their health care dollar go further, HealthHarbor is excited to be one of the pioneers, along with Outofpocket.com, in helping drive education and price transparency to the industry.

While there are dozens of ways that health consumers can save on costs through increased education, HealthHarbor’s content is particularly useful in these three areas:

1.    Ensuring consumers understand how to be assertive and thoughtful clients of their health coverage.  Many people have health coverage, but when it comes time to use it they are in over their heads.  Having an uneducated consumer trying to work through issues with professionals employed by an insurer can create for very unbalanced discussions.  Arming people with the information to be intelligent about their coverage is critical in this environment.

2.    Helping people make good coverage purchase decisions.  Even if someone has insurance, it doesn’t mean they have the right coverage.  Sometimes people have policies that don’t cover their particular medical needs, and other times they are paying a $500 price tag for premiums when their medical needs could be better served by a hybrid plan that may cost half that.  Still other times, people are buying coverage that they don’t really need.  Given the amount of money that is spent on monthly premiums, the point of purchase decision is critical to managing your family health care budget.

3.    Making smarter decisions when seeking care.  Being able to make an educated financial decision week seeking medical care requires information, and that information is becoming more and more available thanks to sites like OutofPocket.com and HealthHarbor.com.  Whether someone is trying to figure out what a routine medical service will cost them, or determining where they can find affordable prescriptions, adding price transparency to the health care industry is critical and is fortunately happening thanks to innovative sites like these.

     Article by Heather Johnson, Healthharbor.com

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

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!

CanUSAmeds has been in prescription consultation since 2001. Some of the benefits of ordering your prescriptions from CanUSAmeds include:

• Speak directly to owners when you call their toll free number --not a call center
• Offer very competitive prices, from 30-80% off retail
• Email prices@canusameds.com or call their toll-free number (877) 469-9616 to ask questions/place an order
• Located centrally in the Chicagoland area for exceptional customer care
• Dedicated to providing U.S. consumers with the highest quality and service in the pharmaceutical industry
• Affiliated with one of the largest fully licensed pharmacies in Canada, to provide you with the highest quality pharmaceutical products
• Use licensed Canadian Physicians to carefully review your specific prescription needs

Canusameds has many options for you. A very customer –friendly approach is their philosophy. They go the extra mile for you for your choice of options. There is no pressure; they are there to consult with you for no upfront fee. They also can connect with you with low cost lab tests, and imaging.

Here are some examples of the discount prices you will received at CanUSAmeds:

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.
  

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.

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.

A virtual colonoscopy test can cost anywhere from $500 to $1,500, depending on where you go to have the test done. Another reason to consider a virtual colonoscopy test – it is half the cost of a standard colonoscopy. Before you make any decisions, make sure you check with your insurance plan to see if the virtual test is covered for routine cancer screening.

Wall Street Journal published a story on CT Scans and included some price comparisons at different facilities. If you have insurance or are paying cash, make sure you talk with the billing department before you have the test done, to understand your out-of-pocket costs for your specific situation.

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.

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. 

Why would a consumer overpay for any health care service?  This happens all the time because consumers have no idea what they are being charged for a service, and they have no idea what the fair price is for this service.  Since our health care system doesn't provide consumers with meaningful tools like Amazon.com, Expedia.com or Travelocity.com to research and compare prices/services --consumers are basically on their own to determine the best value.

I just read about a consumer that paid $1900 for an MRI at Wake Forest Baptist Medical Center.  The consumer has BCBS health insurance so we are not talking about an inflated price for someone that is uninsured.  About six months ago I conducted research on "the quest for the true price for an MRI".  I ended up researching 50+ tools available to consumers to help determine the price of an MRI at many providers around the country.  The results:  an MRI (in this example for a knee) can cost a consumer anywhere from $600 (in Milwaukee at SmartChoice MRI) to $3500 (Dartmouth Hitchcock Medical Center in New Hampshire) - for the exact same diagnostic test. An MRI is an MRI is an MRI.  Isn't it?  So why the huge variance in price?  In fact, if you are charged more than $1000 for an MRI I would suggest you negotiate down the price, offer to pay cash at time of service and start negotiating with the price that Medicare reimburses providers for an MRI- which is $463.  You can download a copy of my research here.

To help you make the most of your health care dollars and find the best value for routine services like MRIs, x-rays, mammograms, vaccinations, office visits, lab tests, vision and dental services, I suggest you use OutofPocket.com to compare and share prices of health care services so you know what others are paying for similar type of services.  Information can be powerful.  

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.

" 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.

If you think you were overcharged for health care services, you should contact MYINSNET.com, an insurance negotiating service that offers consumers assistance in negotiating medical claims.   This company states they have saved insurance companies millions of dollars and an average savings per claim is about 25%.  The same techniques and resources they’ve used to save insurance companies money are now available for individual consumers.  Any patient with a medical bill greater than $200 is eligible to send their bill to INSNET for negotiation.  Consumers can use services such as INSNET to determine if the amount they paid for health care services is reasonable.  If the charges are deemed excessive, INSNET will attempt to negotiate directly with the provider and INSNET charges a fee based on the amount saved on the patient balance.  There is not risk for consumers because they charge no fee if there is no savings.   When you visit the MyInsnet, be sure to indicate you heard about their service on OutofPocket.com and they will offer you an additional savings.

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

When I looked into this program for Cook County, Illinois, I discovered that many different counties across 47 states (excluding Connecticut, Rhode Island and Vermont) participate in this prescription discount program.  Be sure to checkout the NACo website to find out if your state/county participates in this free program.  This program targets the uninsured, and insured consumers where prescriptions are not covered by their insurance plan.

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

If you are one of the many consumers out there shopping around for an MRI because you have a high deductible plan and you are trying to manage your out-of-pocket costs --you are not alone.  How much will an MRI cost you?   Interestingly, prices for MRIs can range from $600 - $3500.  See for yourself, use OutofPocket.com to find out what other consumers have paid for an MRI.  Why the huge price difference for the same test?  Isn’t an MRI an MRI?  What’s the difference between a $600 MRI and a $3500 MRI besides $2900?  Personally, I’d much rather save the $2900 for summer vacation and find a trusted provider that offers me the best quality at the lowest price for the MRI.

If you live in the Milwaukee, Wisconsin area and need an MRI, you need to know about SmartChoiceMRI.com.  This independent outpatient MRI facility charges $600 for all MRIs, for every insurance plan.  They negotiated this rate with the 50+ insurance plans they accept.  How did they do this when all the other providers have “secret” negotiated pricing with insurance plans that can include sometimes up to 100 different prices for the same provider for the exact same service – but for different insurance plans?   I’d like to see more pricing models like www.smartchoice.com in the future.  It makes it so much easier for the consumer to compare costs, easier to budget, and makes the consumer feel like they are not being overcharged for the MRI.   

Results of this pricing model: 

• encourages competition
• creates more consumer-choices
• drives down prices, improves services
• encourages innovation
• increases patient care and improves the quality of care

This is a model we would like the health care industry to strive for!

Mona

This year there has been a lot of advice written by consumers, financial analysts, health industry experts, bloggers and even physicians, on how to lower your medical bills.  All the advice suggests that consumers should try to negotiate prices with providers for discounts.   Yesterday I worked up the courage to try out my negotiating skills with a pediatric specialist.  First of all, it was surprisingly easy and I definitely got the impression the office manager was asked this question enough that she had a prepared response.  

A survey conducted by the Consumer Reports National Research Center found only 31 percent of Americans have tried to negotiate the price of medical bills.  Of those consumers who tried, 93 percent have been successful at least once and more than a third saved over $100.  If you are insured with a high-deductible, uninsured, or under-insured, or looking out-of-network for services, you should ask the provider for a discount.   A physician I talked to from Mount Sinai Hospital suggested patients should offer to pay the provider the amount that Medicare reimburses and start negotiating from that amount.

I have a high-deductible health plan with Blue Cross Blue Shield.  This year my family was blessed once again with good health and we never got close to meeting our deductible.   During the last week of December, I scheduled an appointment with a pediatric specialist for a non-urgent consultation with my daughter.  This specialist came highly recommended and is out-of-network, and charges high rates for consultations -- a perfect opportunity for me to ask for a discount.  Before we saw the physician, I talked to the office manager and offered to pay cash for services even though I had health insurance.  The regular fee for a consultation is over $100 and they offered to charge only $50 for the office visit if I paid cash.  This is a great deal!  Benefits to the provider: they would not be submitting a claim to my insurance company for this service, they would not have to send me a bill for the office visit and they receive payment upfront.  Benefits to the consumers:  I saved more than 50% by writing a check at the time of visit.  Not a bad deal and for your new years resolution I recommend you try this out in 2008.

Happy New Year!

Are you paying too much for your health insurance?  Before you go out and replace your current health insurance plan, you really need to do your research to understand the different options that are available for you to choose from.  

Years ago, health insurance was almost always provided by your employer.  The only choice you had to make through your Human Resources Manager was whether to choose plan A, B, or C.  Today, more individuals are now purchasing health insurance on their own.  As the cost of health care continues to rise, many employers can no longer afford to provide their employees with health insurance.  Some businesses are even offering their employees more affordable options that are described with words like “consumer directed”, “high deductible”, and “HSAs”.  What exactly does all this mean to you?  If you have always had traditional first-dollar coverage employer-based health insurance, this could all be very confusing to you.  My advice to you -- before you go out and purchase health insurance on your own, you should get up to speed on some important issues that can save you thousands of dollars and avoid making painful mistakes selecting the wrong plan for you/your family.   Purchasing health insurance requires a level of knowledge that many of us are not comfortable with.  

I just read a book that does an excellent job informing consumers on how to save money on your health insurance.  This easy to read book, Get a Good Deal on Your Health Insurance without Getting Ripped Off, written by Jonathan Pletzke was recently published and is a must read if you are a consumer in the market for health insurance.   I highly recommend this book if you feel like you’re paying too much for your health insurance and want to understand your options.  For $16.45 at Amazon.com your return on investment (ROI) is substantial.  You can save yourself hundreds of dollars a month by becoming a well informed consumer and can avoid making the costly mistakes from purchasing the wrong type of health insurance plan for your family.   The book and accompanying website is available at www.BestHealthInsuranceBook.com. 

Happy Holidays,

Mona

This past summer when my kids went to the Pediatrician for their routine checkups I saved hundreds of dollars -- $475 to be exact!  When the doctor mentioned that my kids were due for vaccinations I said “no thanks”.  Instead, I asked the doctor to write down the scheduled vaccinations.  I informed the doctor that we were going to the Village to receive our vaccinations for $5 each.  The doctor was happy to accommodate my request.  In fact, I think the doctor’s office knew all about this cost savings program but never mentioned it me.  I never knew about this program until just recently, so I never asked.  

The Village of Arlington Heights, offers $5 vaccinations on the third Monday of every month to families that are uninsured or under-insured (where your health plan does not cover vaccinations).  The vaccinations are administered by professionals in a very clean environment and held at the recently remodeled Senior Center conveniently located near my home.  We only had to wait 5 minutes to fill out some forms.  Many other villages and the county offer these low-cost or free vaccinations for children and full-time students.  Definitely worth checking out if your health insurance does not cover vaccinations or if you are uninsured.     

As more costs are being passed on to the consumer, it has become even more important for consumers to understand and compare prices of health care services before receiving treatment.  Here is some advice that can save you real money.

Negotiate

Dr. Kathryn Stewart, Medical Director of Care Management at Mount Sinai Hospital in Chicago, believes patients should be more proactive about seeking the best prices for services.  In fact, Dr. Stewart suggests patients negotiate a payment arrangement with the provider before they have the service performed.  Dr. Stewart advises, “Patients can always negotiate the price before or after the service is received.  Don't just accept at face value to pay what the provider is charging.  Most hospitals would be glad to give a deep discount (up to 50% or more) if patients pay at the time of service. The discount is less if patients drag payments out over a long period.   Keep in mind that charges and payments have almost no relationship to each other and charges are a pie in the sky number that no one pays except for the self-pay patient, and that is only if they are not smart enough to negotiate a lower payment for themselves. Most important - after you have received the service you are not in a good negotiating position.  However, before you receive the service, you are in a better position to negotiate the price.”

Ask for the Medicare Rate

If you are uninsured, you really need to negotiate a better price.  Ask the provider what Medicare would reimburse them for this procedure.  Start with this price and see where you end up. 

Good luck.

"You can't drink that!" my wife reminded me as I mixed the fruit juice concentrate.  “You have the health screening tomorrow morning and you must fast for 12 hours."

My wife shops for healthcare and she found a great deal offered by the Village of Mount Prospect’s Human Services department and Resurrection Medical Center.  For $30, I receive blood tests including: complete lipid panel, complete metabolic panel and complete blood count.  For $20 more, I can receive a prostate screening.  The village also offers a free blood pressure test.

So this morning, feeling a little hungry and caffeine-deprived I arrived at the Village Hall for my screening.  After I paid with a personal check, I quickly walked through the stations which included blood pressure, blood draw, and even filling out a self-addressed envelope for my results.  I asked the lab technician how the prices could be so low when the same tests would cost $200-300 at a physician’s office.

“The hospital considers it a community service and breaks even by using it as a tax deduction,” she said.  “We do these screenings a couple times a month at village halls, churches, and senior centers.”

The last station was a table of bagels, donut holes, juice and coffee.  Say, this is a good deal.  My doctor never fed me breakfast!

-- posted by Pat Frisbie

I was a competitive runner for more than 25 years, and several years ago I started to experience a pain in my knee that just would not go away.  No matter how much ice, rest, and physical therapy – the pain was persistent.  I finally made an appointment to see a sports doctor.  After the doctor spent 10 minutes with me, he suggested I have an MRI on my knee – which is a very expensive test for someone that has to pay for the entire bill out of pocket.  I mentioned to the doctor that I had a high-deductible insurance plan and he gave me several diagnostic facilities to contact.  I called every single facility.  In fact, I even called my health plan provider.  I called diagnostic facilities in and near my neighborhood.  I learned that an MRI is an expensive test that can cost anywhere from $500 - $2500, depending on where I decide to go for the test.  And to make matters worse, not a single provider, or insurance carrier could tell me what my out of pocket cost would be for an MRI with my health current insurance plan.  I learned that my health insurance plan negotiated discounts with providers.  Some discounts were more substantial than others and this could make a big difference in MY PRICE.  Every health care provider and health insurance representative I talked to would not share this with information with me. This rude awakening was the beginning of a journey for me.  I realized first hand that consumers need easy access to meaningful tools to help them make informed decisions about where to find the “best value”.  To be honest, I was not shopping for a complicated surgical procedure; I was just looking to find the best price and quality for an MRI so I could find out why I am in so much pain when I run.  I did not want to be overcharged - I just wanted to pay a fair price.  Is that asking too much?

I think most consumers would be outraged if they knew the true cost of health care services.  There are so many different prices for the exact same service.  How are consumers expected to know the difference?  I learned about similar experiences from many other consumers that had similar stories of “the priceless MRI”, so I decided to do something about this problem.  Using the power of the internet, and taking advantage of social-networking, I decided to build a portal where consumers could share prices and personal recommendations on providers, with other consumers.  If enough consumers participate to share prices, consumers will end up creating a powerful tool to help make informed health care purchasing decisions.  Until the industry catches up, consumers are going to have to be creative and resourceful when researching providers and facilities to make the most out of their health care dollars.  I encourage you to check out the website, www.outofpocket.com.  Be sure to tell your family and friends about this project, and let me know what you think.  The best part about this initiative is that is benefits all consumers, including the insured and uninsured, without having to wait for legislation to pass, complicated programs to be initiated, or waiting for the country to decide how to reform our health care system.   

- Mona Lori