Are these tools useful?

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

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

 

 

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. 

 

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

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

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

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

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

MyHealthScore online tool to look up fees for specific procedures

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

VIMO search tool to compare medical procedure prices at hospitals

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

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

Beware of out-of-pocket costs

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

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

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

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

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

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

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

Third, remember you always have an opportunity to negotiate down the charges. The total charges that appear on your medical bill have no relationship to what the provider will accept as payment in full.  Health care providers bill everyone the same amount, from Medicare to private insurers to the uninsured.  However, the full charges that appear on your bill are much higher than the provider’s actual costs.  The Government and private insurers negotiate a reduced price for services.  Here’s an idea to consider – start by asking your provider how much Medicare would pay for a procedure similar to yours.  Using this information, you should talk to the CFO or billing manager and ask for a reduction to the provider’s actual cost, plus 25%.  By the way, doctors have also suggested patients without insurance try this approach.

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.

Source: Elizabeth Ody, “Some simple steps to keep control of medical bills,” Premium Health News Service, September 1, 2008.

The next time you have an injury or illness that requires immediate care, consider using an urgent care center rather than the traditional hospital Emergency Room.  Urgent care centers are staffed by physicians, offer sort wait times, are less crowded, cost a fraction of what hospital ER visit would cost you, and you can walk in without an appointment.  The urgent-care centers are equipped to handle anything from a simple cut and treating broken bones, to deploying advanced life-support equipment.  Some offer discounts and payment plans and many health insurance plans cover urgent-care clinics.

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.

AOL recently posted tips to help you save money on health care costs.  Consumers should not have to pay full price for services.  One of the tips recommended that consumers should use OutofPocket.com as a tool to help them compare costs and find out what other consumers paid for similar services.  "Providers are often willing to negotiate, with both insured and uninsured patients and those whose insurance only covers a portion of their health expenses", says Jonathan Pletzke, author of "Getting a Good Deal on Your Health Insurance Without Getting Ripped Off."

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.

A recent article, Click here for the best health care, offers some very practical advice on how consumers can make smarter decisions when selecting doctors and hospitals - and how to plan ahead for medical expenses. 

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. 

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

 

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

 

 

In January, the Consumer Health Care Blog posted ten useful tips to help consumers reduce their medical bills.  If you haven't read this article that was originally published on BankRate.com, be sure to check it out.

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

 

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

 

 

Several years ago I decided to switch to a high-deductible health insurance plan (HDHP) for myself and my family.  I pay 100% of my own health insurance premiums and one of the factors that influenced my decision to switch was how expensive my insurance premiums were getting even though I basically made no insurance claims over the past five years, other than annual check-ups.  After my accountant suggested I look into high-deductible plans, I calculated that I could save $7000 in premiums every year and use my HSA to help pay for my medical expenses.  With my HDHP I have become a cost-conscious consumer of health care services, and I shop around for the best value, just like I would shop around for a car or electronics.  The only problem is there are no Consumer Reports for health care where I can easily find the best value for health care services.  I have no meaningful tools to help me make informed choices about where to find the best value for routine health care services like MRIs, X-rays, vaccinations, mammograms, and office visits.  How do I avoid the overpriced providers with poor performance ratings?  Now that I pay out of pocket for these services (up to $5000), how do shop for value?  How do I find out what other patients think of a physician that is listed in my plans network?

 

-- posted by Moni Lori