You need to be an educated consumer of your healthcare. Taking control and educating yourself regarding your healthcare will enable you to make better choices about your health and wellness, and save you money along the way. 

A recent article by Jackque Wilson, 4 Ways to Control Your Health Care Costs, provides some excellent consumer advice on how you can control health care costs.   This article is a must read if you have a high deductible, pay cash for services, use out-of-network providers, or have no health insurance.

Here are some highlights from this article:

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

Fair questions to ask your doctor:

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

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

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

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

This time of year millions of consumers are encouraged to get the flu shot.  According to the CDC (Centers for Disease Control and Prevention), everyone who is at least 6 months of age should get a flu vaccine this season. It’s especially important for some people to get vaccinated.  Those people include the following: people who are at high risk of developing serious complications like pneumonia if they get sick with the flu, people who have medical conditions including asthma, diabetes and chronic lung disease, pregnant woman and people who are 65+.

If you don’t have health insurance, or if your health insurance does not cover the flu shot, it helps to know how to shop around to find the best value.  Many people pay out of pocket for a flu shot and prices for this vaccination can range from $15 to more than $50 if you include the cost of an office visit.

In terms of quality, safety and effectiveness, there is no difference between immunizations at a store clinic or a doctor s office. It’s perfectly safe, says Jim Turner, the executive director for the Department of Student Health at the University of Virginia and a past president of the American College Health Association.  They are buying the same vaccine doctors’ offices buy.  Retailer clinics must also follow state regulations on administering vaccines.L NAME

Even for consumers who get their shots free with insurance coverage, it still pays to shop around for the best flu shot promotions because some of them are far more generous than others. 

Here’s a sampling of flu shot prices and promotions and where consumers can get flu shots.

FastMed Urgent Care -   $15. FastMed has several locations in the Triangle, including Apex, Cary, Raleigh, Chapel Hill, Durham, Holly Springs, Fuquay-Varina and Wake Forest.

Harris Teeter -  $24.95. Through Dec. 31, customers getting flu shots receive coupons for $5 in free groceries. The coupon is good through Jan. 7. And, if you’re a new Harris Teeter pharmacy customer, you’ll receive a $20 grocery credit loaded to your loyalty card.

Kroger -   $25. A recently expired coupon on their website shaved $15 off the price but these digital coupon offers are frequently reissued so it’s well worth checking.

Rite Aid -   $29.99. Customers receive coupon booklets with savings valued at $100 and 25 Wellness+ points that can be applied toward future shopping perks.

Wake County Human Services -   $30. However, the shots are free to many groups of people, including uninsured pregnant women, family members and caregivers of infants under six months of age, students attending any college or university in North Carolina, and children who qualify for the federal government’s Vaccines for Children Program. Weekly clinics are held at the Public Health Center at 10 Sunnybrook Road in Raleigh. Additional clinics are scheduled throughout the county. Go to wakegov.com/humanservices for more information.

CVS -  $31.99. Customers getting flu shots receive 20 percent savings passes valid on regular-price merchandise.

Walgreens  -  $31.99.  Special promotion offered through Oct. 31, customers getting flu shots receive 1,500 Balance Points, which is equal to a $1.50 credit in Walgreens’ new loyalty card program.

Corporations - Corporations often offer their employees flu shots. Business would rather keep employees at work rather than out sick, so offering a flu shot can be a cost saver. Costs range from free to being covered by insurance. Employers often pay an administration fee to have the shots given. Cash payments usually range between $20 and $30.

Doctor's offices - Many often flu shots are given in your local doctor's office. If you have insurance, you will make a co-payment for your appointment. Seasonal flu shots are covered by most insurance policies. If paying cash, a doctor's visit can cost $20 to $200, plus the cost of the shot, which can be $20 to $30.

Retail outlets - Big-box retailers or retail pharmacies also offer flu shots in the early fall. Walmart, Target, Walgreens, Rite Aid Pharmacy and CVS/Pharmacy all offer clinics at certain dates that are subject to change and vary according to location. Check the stores' individual websites for times and locations. Insurance covers the seasonal flu. Cash payments range from $20 to $40.

Senior Facilities - In many communities, local departments of public health offer flu shots to senior citizens. People 65 and older make up 90 percent of deaths from the flu, so health officials often ask seniors to get vaccinated. Medicare Part B covers the cost of a seasonal flu shot for seniors.

Public Facilities - Sometimes flu shots are offered in public locations such as libraries or YMCAs or other public-access facilities in order to reach large segments of the community. These are often sponsored by a local charity or by a public health outlet and usually take cash payments to cover the cost of the shot.

Schools, Colleges and Universities - Colleges and universities often ask students, staff and teachers to get vaccinated. Students in particular often share living spaces and can easily infect one another. Many colleges and universities require students to carry insurance, which will cover the cost of the flu shot.

More consumers are using the Internet to comparison shop for health care services, according to a new survey.

You shop for purses online, new glasses or sometimes even your groceries. And now, many people are looking for medical services in the same place.

In fact, according to a recent survey by insurance giant UnitedHealthcare, 14 percent of respondents reported using online resources to compare and shop for health care treatments and services.

While that's in contrast to the more than 75 percent who said they use the Internet to shop and compare things like cars and electronics, it does indicate that consumers are moving into Internet health care pricing, UnitedHealthcare found.

In response, UnitedHealthcare is making big improvements to their myHealthcare Cost Estimator, which is an online service that helps consumers find services and compare costs. The new estimator includes mobile versions and the ability to compare quality and cost for more than 574,900 different health care providers and 4,275 hospitals.

But United isn't alone, and many of its competitors are right here in Nashville. MDSave, MedSolutions, Healthcare Blue Book and Change Healthcare, all based in the Nashville area, have services aimed at price transparency.

More Consumers Using the Internet to Comparison Shop for Health Care
By Annie Johnson
Staff Reporter
Nashville Business Journal

Health Bargain Hunters Use Websites to Cut Doctor Bills

By Ryan Flinn

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

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

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

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

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

Travelocity for Health Care

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

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

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

Cheaper Care

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

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

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

High Deductibles

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

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

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

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

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

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

Wide Disparities

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

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

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

Treatment Options

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

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

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

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

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

Making the Effort

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

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

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

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

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

 

This recent article in msn.com discusses the politics involved in the health care price transparency issue.

By Merrill Goozner

The possibility that the Supreme Court will strike down all or part of the Affordable Care Act has given new life to Republican calls to put market mechanisms to work in holding down health care costs. The public is certain to hear lots more about it on the campaign trail later this year.

There's one big problem, though. Markets cannot work when consumers and patients have almost no information about the prices they pay for health care.

Rep. Paul Ryan, R-Wis., chairman of the House Budget Committee, has resuscitated his proposal to turn Medicare over to insurance carriers. Future retirees would be offered financial help to pay for policies sold through public exchanges similar to the ones set up under Obamacare. The subsidy would be limited to the value of the second-lowest cost plan offered on the market. The idea is that over-65 consumers, who would still have the option of remaining in traditional fee-for-service Medicare, would drive down costs by forcing the plans to compete for their business by offering lower-cost alternatives.

Other Republicans and conservative think tanks are touting laws that would allow insurance carriers to sell individuals policies across state lines, which would be coupled with incentives to shift people away from employer-based coverage. Under such plans, individuals could buy catastrophic coverage for expensive hospital stays while using the savings to pay the entire cost of routine health services, just like they pay out-of-pocket now for lawyers, flat-screen TVs or the week's groceries.

Again, the idea is that people putting up their own money will be much more likely to scrutinize the price of tests, drugs and procedures, and choose accordingly. If they comparison shop, they might even visit the provider down the street.

Employers are already moving in the direction of giving consumers "more skin in the game," according to a recent survey by the Employee Benefits Research Institute. One in five Americans are already in high-deductible insurance plans, an all-time high, even though this approach is leading many to skimp on preventive services that could avoid higher health care costs down the road.

Unfortunately for the architects of such proposals, there's a crucial element missing from their proposals, something that is necessary to make any market work: accurate and easily accessible price information for consumers. Have you ever walked into a doctor's office and seen a price posted for all the tests, products or procedures that might be offered during your visit? At the hospital? Ever seen a price list at the local pharmacy?

The problem of price opacity in health care is not easily solved. Health care providers are more like airlines than the local Best Buy or Macy's. They charge different patients different prices depending on who insures them. The uninsured pay the highest prices, the equivalent of a hotel rack rate.

Medicare sets prices. Medicaid patients get the lowest available price. Privately insured patients are offered differing discounts, with larger groups afforded bigger discounts than smaller groups. The prices between the groups vary wildly.

"One specific factor driving the high cost of healthcare is the significant price variation – sometimes more than 100 percent – for the same healthcare services in the same geographic market," said Bobbi Coluni, senior director for consumer innovations at Thomson Reuters, in a recently issued report claiming consumers could reduce health care costs  $36 billion a year with full pricing transparency.

One example offered in the report: a typical Illinois employer could save $29,000 or 33 percent off the cost of knee arthroscopy, and the patient could reduce his or her co-pays by $300, simply by switching from the highest cost to the median cost price offered by different hospitals in that employer's area.

Yet employers are powerless to get the price data, many complain. Their insurance carriers frequently refuse to turn over claims data, which would enable them to compare prices between the different local providers and encourage their workers and families to choose the best value.

The insurers cite "proprietary information and preexisting confidentiality agreements with providers," charged Shawn Leavitt, a benefits manager at Minneapolis-based Carlson, which owns and operates nearly 2,000 hotels and restaurants worldwide. "These excuses are a cover for health plans' real concern: to keep health care purchasing decisions as opaque as possible to substantiate excessive administrative costs, and maintain the illusion of well-managed networks and large discounts."

It's not just insurers. Drug companies offer a wide array of discounts to insurers and pharmacy benefit managers. They've even begun offering coupons and discounts directly to consumers to keep them on branded drugs coming off patent, like the discounting recently adopted by Pfizer to keep people on Lipitor instead of switching to generic brands.

Medical device manufacturers that sell implanted heart devices, artificial knees and hips and spinal implants are also heavily into the discount game, which they couple with exorbitantly high rack rates. They negotiate different discounts with different hospitals, and then require each to sign a contract that forbids releasing pricing data to their competitors across town.

Rep. Stephen Kagan, a Democrat from Wisconsin who lost his seat in 2010 to a Tea Party-backed candidate, introduced a simple three-page bill in the last session of Congress that would end pricing secrecy in the medical industry. The "Transparency in All Health Care Pricing Act of 2010" said "any and all individuals or business entities, including hospitals, physicians, nurses, pharmacies, pharmaceutical manufacturers, dentists and the insurance entities . . . shall publicly disclose, on a continuous basis, all prices for products, services or procedures . . . at the point of purchase, in print, and on the Internet."

Though it received one sympathetic hearing, the bill was not included in the Democrats' health care reform legislation after intense opposition surfaced from virtually every health care provider group. No one has reintroduced the bill in the current session of Congress.

"Overly broad proposals that aim to disclose confidential pricing agreements and terms could undermine vigorous competition and have a negative impact on patients," the Pharmaceutical Research and Manufacturers of America said this week in a prepared statement.

A spokeswoman for the American Hospital Association said the group had supported an alternative bill introduced by Rep. Michael Burgess, a Republican from Texas who is also a doctor. That legislation would have had the Agency for Healthcare Research and Quality study the question. It  didn't pass either.

If you are uninsured and have medical bills you cannot afford, you have a few options. If the bills are large enough, you could file for bankruptcy, though that should be a last resort. Another way you can lower your medical bills is ask the hospital finance department if they have a financial assistance program. Normally you would have to be below certain income thresholds to qualify which vary from hospital to hospital. If the first two options do not work, you generally can work out a payment plan with the hospital. This usually helps you avoid interest fees. This is a good option because you will avoid having the bills going into collections. The downside to this is they do not lower the principle.

If you do not qualify for financial aid, and your situation does not merit bankruptcy, medical bill negotiation may be the best option. When you negotiate a medical bill, one important thing to keep in mind is you need to have the money on hand to pay off the bill; otherwise the hospital will not negotiate. You would need to make a payment within ten days via check or credit card. The reason the hospitals are willing to negotiate is because uninsured patients are charged significantly higher prices for hospital visits.

The first step would be to get an itemized copy of the bill, and look over for any errors or gross overcharges. Examples of errors are charges for services not rendered, charged for wrong services and being charged twice for the same service. You would than contact the hospital and ask to have your bill corrected.

If you do not feel you have the knowledge or time to negotiate your medical bill you can hire a medical bill negotiation service, which would negotiate on your behalf. At KL Financial Services, we have experienced negotiators who are knowledgeable in hospital billing practices and can spot errors and overcharges on a large percentage of bills they negotiate. Typically we are able to successfully negotiate bills down 35-40 percent.

If you decide to negotiate on your own or hire a service you should save a significant amount of money on your medical bills.

Contributed by
Adam Luehrs, CEO
KL Financial Services

According to a recent white paper published by Thomson Reuters, $36 billion dollars annually is wasted on health care procedures that are considered shoppable. These procedures are defined as shoppable because they are high-volume, non-urgent procedures and treatments that consumers would plan for and schedule in advance, like a mammogram, colonoscopy or MRI.

Some key findings in this paper include:

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

Both the consumer and the provider are in the dark about health care pricing. If and when the marketplace supports transparency, providers will be able to set their price more rationally and consumers can be better shoppers of health care services.

This past year my daughter visited a retail clinic for a strep throat and my husband visited an urgent care center for his stitches.  Both of these experiences provided excellent value and I would highly recommend retail clinics and urgent care centers for certain types of conditions.  An article written by Misty Williams in the Atlanta Journal Constitution earlier this month discusses when to use a drugstore clinic.

When to use a drugstore clinic

As Americans increasingly pay more out of pocket for their health care, millions are turning to retail clinics -- often located in pharmacies or grocery stores and requiring no appointment -- as a more convenient, cheaper alternative to a primary care doctor.

Typically staffed by nurse practitioners, walk-in clinics are aimed at treating minor ailments such as strep throat or ear infections. They offer weekend and evening hours for people who can’t take off work during the day or face long waits for appointments with their regular doctors.

Retail clinics first began popping up across the country in 2000 and now number roughly 1,200, according to RAND Corp., a nonprofit research group.

The benefit of these walk-in clinics, however, depends on a consumer's situation.

Because they are significantly cheaper, retail clinics often appeal to people who are uninsured and have to pay out of pocket, said RAND researcher Ateev Mehrotra.

The cost of care at walk-in clinics at stores such as CVS, Walgreens and Walmart is on average 30 to 40 percent less expensive than a physician office or urgent care center and roughly 80 percent lower than an ER, a RAND study shows. For consumers, the average cost of an ER visit for strep throat can range from $550 to $750 versus $59 at a retail clinic, data from insurance giant Aetna shows.

“[Patients] really like the predictability of the cost,” Mehrotra said.
 
Cost is also playing a larger role in people’s decision on where to get care as high-deductible insurance plans that require consumers to pay more out of pocket grow increasingly popular, said David Van Houtte, Aetna senior network manager who negotiates contracts with retail clinics across the country. For people with insurance, who would have the same co-pay as going to a doctor office, retail clinics are more about the convenience, Mehrotra said.

Getting time off from work can be a struggle for many people, he said.
 
Sujal Patel stopped by a MinuteClinic inside a Virginia-Highland neighborhood CVS on a recent afternoon after battling a nagging sore throat for three days.

Retail clinics are a big convenience, said Patel, who manages pharmacies and swung by on his lunch break.

“If I had gone to a doctor, I would have had to take time off,” he said. “Doctors don’t usually see you right away.”

At the CVS clinic, he was able to get medicines for his respiratory infection and to help him sleep right away without having to drive to a separate pharmacy.

The quality of care at retail clinics is of similar quality to regular doctor offices and other providers, Mehrotra said.

Aetna has a stringent process to credential clinics before contracting with them -- including random site visits to ensure quality is up to standards, Van Houtte said. Each clinic is overseen by physicians, and the staff is required to report back to primary care doctors for patients who have one, he said.

Retail clinics may be one solution to help curb the nation’s increasing health care costs, though they aren’t a magic bullet, Mehrotra said. Roughly 17 percent of visits to ERs could be treated at a retail clinic or urgent care center -- saving up to $4.4 billion annually, according to one RAND study.

“No one should think this is really going to solve the cost spending trends in the United States -- though some would argue every little bit helps,” he said.

Comparing costs

The overall cost of care at retail clinics is substantially less at retail clinics compared with physician offices, urgent care centers and emergency departments, according to a study by RAND Corp., a nonprofit research group. The study looked at the average cost of treating an ear infection, sore throat or urinary tract infection.

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

Source: RAND Corp.

Choosing your care

Not every illness calls for a trip to the ER. Here are a few tips on what level of care makes sense depending on the problem.

• 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

Do you often think that you might be overspending on health care bills? Have you ever been surprised by the amount you owe the provider when the bill arrived in the mail?

Doctors can be helpful if you communicate with them early on to let them know costs are important to you. John Santa, the director of the Consumer Reports Health Ratings Center, offers some practical advice on how consumers should communicate with doctors to negotiate their medical bills. Click here to read the entire article that appeared in the Washington Post last week.

 

Last month my husband was injured while playing basketball and his injury required him to have a number of stitches.  With our family high-deductible health plan (HDHP), we realized that a visit to the hospital emergency room was going to be a very expensive option.  His injury was serious enough to require a specialized doctor, but definitely not a life threatening situation that required  a trip to the emergency room. 

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.

Description of Service	Amount Billed	Contracted Amount
Xylocaine 1% 20cc	5.61
TDAP 9.5 ML	112.56
Cefadryxil 500 mg CAP	3.32
Suture pack each	25.00
Suturing Instruments	69.00
Immunization administration fee	17.00
Sim RP face-ears-eye	132.00
LVL 2 treatment fee w/procedure	99.00
Doctor fee level 2 clinic	99.00
Total Amount Billed	$463.49
Total Amount I Paid (contracted rate)		$177.05

 

 

 

Simplee is a new Web-based service that can help you get control of your health care costs and expenses. Like Mint.com with your personal finance accounts, Simplee safely and securely links to your health insurance and transforms it into a clean, easy-to-read dashboard for tracking and controlling spending, reducing paperwork, expanding health care options and saving money.

And the best part? It’s free.

Health care in this country has become a confusing mess of bills, deductibles and hidden expenses. Just making sense of it all can be so frustrating and time consuming that we just give up. But the reality is out-of-pocket health care costs are up 50% over the last five years. The average family spends more than $3,000 each year beyond their monthly premiums.

Amid such confusion, it doesn’t help that 80% of all medical bills contain errors and prices for medical procedures and services are almost always inflated before being routinely discounted.  The current system is little more than a guessing game, leaving patients in the dark and making it almost impossible to be a well-informed consumer of health care or to know the actual cost of treatment, let alone to shop around for the best possible deal.

Simplee, which went live a few weeks ago, works by connecting to your health insurance accounts and bringing together all of that data in one place, including medical, vision and dental records. Simplee keeps track of your medical expenditures by service, provider and subscriber so you know how much you’ve paid out-of-pocket, your deductible status and total family spending for the last year.

By displaying complicated information in an easy to understand dashboard, Simplee shows you what you’ve already paid so when you get a bill, you’ll know if you’re reconciled it or not. And if you’re charged for a procedure that should be covered, Simplee cross-references your plan information and lets you know how to fix it.

It also reminds you to take advantage of free procedures included in your plan, like dental cleanings, before they expire. Support is provided for nearly 65% of all health insurance plans, including Aetna, Anthem, Blue Cross Blue Shield, Blue Shield California, Cigna, Delta Dental, United Healthcare, Vision Service Plan (VSP) and WellPoint (Empire BCBS). Simplee aims to cover 80% of the entire U.S. market by the end of the year.
____________

Contributed by Tomer Shoval.  Tomer is the CEO and co-founder of Simplee, a free Web-based health care expense management service that allows consumers to easily understand and manage their health care expenses. Formerly the managing director of Shopping.com (eBay) for North America, he has more than 12 years of experience as a business leader in e-commerce and online services.

Health care costs continue to rise and consumers need to be well informed so they can make educated choices and find the best value.   CBS News provides tips on how consumers can make their health care dollars go further.

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.

Happy New Year! For those of you that just signed up for a high-deductible health insurance plan (HDHP), welcome to the group of 22 million other people that are already enrolled in these type of plans.

So now that you signed up for a high-deductible health-insurance plan next comes the hard part: making smart decisions about your health care spending since you're now responsible for more upfront out-of-pocket expenses.

High deductible health plans typically have significantly lower premiums, but much higher deductibles, than other plans. For 2011, high-deductible plans will have a minimum annual deductible of $1,200 for an individual and $2,400 for a family, according to the Internal Revenue Service. The maximum out-of-pocket limits for an individual in network is $5,950 and $11,900 for a family.

The good news is that under the new health-care law, many more high-deductible plans now cover preventive care, such as annual checkups and recommended immunizations, as well as typical tests including mammograms and colon-cancer screenings. The best way to maximize your dollars using a high-deductible health plan is to fully understand what's covered by the plan and what is applied to your high deductible.

As far as expenses that are out-of-pocket, there are a number of ways to maximize your money. Of course, the obvious one is to take better control of your health by eating well and exercising so you end up having to go to the doctor less often. Here are some useful tips to help you make your health care dollars go further.

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

Today more and more consumers have high deductible health plans, higher out-of-pocket costs, and are paying cash for services. It would never occur to most people to negotiate prices with their doctors for health care services but it turns out that doctors, hospitals and labs are willing to negotiate. Only 30 percent of people negotiate health care prices and these people are successful 70 percent of the time. Listen to an NPR podcast of real patients talking about their personal experiences and success stories in negotiating with providers for a fair price.

The next time you need to have a routine non-emergency procedure done, here are some simple tips to keep in mind.

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

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

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

Kara McGuire recently wrote an article in the Minneapolis Star Tribune about how difficult it is to comparison shop for prices when you are shopping for health care services.

Nine months into her high-deductible health plan, she was ready to apply cost-conscious consumerism tactics to determine how to find the best price. Click here to read the full story.

Virginia Health Information published a report listing price information for health care services. This information is available on their website and provides consumers with access to information on what health care procedures cost in Virginia--- before they receive medical care. The report shows the average amounts that health insurers in Virginia pay for 31 procedures that including preventive, emergency, outpatient and hospital inpatient care and they have future plans to expand this list of procedures. This information was designed for:

• 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

"Virginia is one of a few states with health care pricing information," says Michael T. Lundberg, VHI's Executive Director. VHI worked together with representatives from the Virginia Association of Health Plans, the Medical Society of Virginia, the Virginia Hospital and Healthcare Association and the Virginia Department of Health to produce the information.

"There are few things, if any, that rival the importance of our health care," said Dr. Bill Hazel, Virginia's Secretary of Health & Human Resources. He continued: "Patients deserve to be able to evaluate the cost and quality of their health care options, and have a reliable resource for these comparisons in VHI." Delegate John O'Bannon, himself a physician and sponsor of the legislation agreed, saying: "This is a great first step in empowering citizens to be educated consumers of health care."

To access this health care price guide, visit: http://www.vhi.org/transparency

Everyone has a health care story and here’s a chance to tell your story.

Do you have a story to tell about a medical bill that was higher than you expected it to be? Or a time when you wanted to know how much a medical test or treatment might cost and couldn’t find out?

Costs of Care, a nonprofit group based in Boston, is offering $1000 for anecdotes like these that illustrate the importance of cost-awareness in medicine. Judges will include former U.S. Health and Human Services Secretary Michael Leavitt, Boston surgeon and New Yorker writer Atul Gawande, and former Massachusetts Governor and Democratic Presidential Candidate Michael Dukakis. According to Dr. Neel Shah, who is directing the contest, "Using everyday examples from across the country, these stories will highlight the need to make healthcare prices more transparent."

Submissions should be no longer than 750 words and are due by November 1st. More details are available here.

 “Come on down!” Those are awfully familiar words to any “Price is Right” guru. Ever notice how the items being bid on are all brand names? It’s part of “branding,” and it works well if you’re targeting a fan of the CBS hit television show, even post-Bob Barker!

There’s a time and a place for brand names. I choose Kraft Macaroni and Cheese over the store brand, it’s my personal preference. Why? In my opinion, Kraft has a better product, and the difference is definitely noticeable. (Yes, it is the cheesiest!) I could save about $25 a year by choosing the store brand, which adds up to about $1,250 over my lifetime.

Now, this is crazy. The average person has one prescription per month, and the cost of the brand name prescription, on average, is $100.00. Let’s say from age 45 to age 68, a person spends this amount per month on the same brand name prescription. That’s $27,600! What? $27,600! Sorry, it was just SO worth repeating!

Now, let’s take this same person and factor in medtipster.com, where the same prescription is available in a generic form (which is an exact replica of the brand name) for only $4.00 per month. Now we’re talking! That’s just $1,104.00 over 23 years. While I’m sure you can do the math, basically the difference is, well, a new Honda Civic Hybrid, or two Kia Rios!

So you see, we’re not talking mac’n cheese any more. While “The Price is Right” for some purchases, it’s better to “come on down” on prescription drug spending.

Guest post by Tylar Masters, Marketing & Communications, Medtipster.com

About Medtipster: Medtipster provides consumers with a solution to the rising cost of health  care. Using Medtipster’s proprietary technology, consumers simply type in their drug name, dosage and zip code, and instantly find their prescription drugs available on discount generic programs, located right in their own neighborhoods. Many of these drugs are available for $4 or less.

 

We love sharing tips on how consumers can save money on health care costs.   When it comes to lab tests, most consumers have their lab tests done through their doctors. For consumers that want to save money and time, online lab testing is an affordable way to have your lab tests done. Consumer online lab tests can be a convenient and cost-effective way to have the same lab tests done that your doctor orders --- while saving money on these tests. To use these online lab websites, consumers select a specific test(s), enter their zip code to locate a blood draw center in their neighborhood, and order the test online using their credit card. Depending on the consumer’s health plan, consumers might be reimbursed for this service. Be sure to check with your health plan for specific details. I’d like to introduce you to Personalabs.com, a direct-to-consumer lab test website.

PERSONALABS™ was founded in Aug 2006 to provide consumers with direct access to the same blood tests available from their doctor. No office visit is required, there is no medical record and their tests are offered at a lower cost. Their focus is to empower consumers by giving them the tools to make informed decisions about their health and wellness. They provide the same blood tests that are available through your doctor, including STD tests, health tests and drug tests, without waiting for a doctors' appointment and without the high costs. Online lab test sites make it very easy for consumers to get tested for a variety of health concerns.

The next time you need a routine lab test, I strongly recommend you consider online lab test sites. Consumers are invited to visit Personalabs.com and save 5% on their lab tests by using discount code “AD2009”.