OutofPocket Blog: Reducing out-of-pocket health care costs

The Price Is Right?

2010-02-07T21:28:46.759-05:00

“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.

High Deductible Health Plans are Becoming Popular

2010-02-07T20:54:20.415-05:00

Increasing popularity of high deductible health plans

The most recent National Health Interview Survey (NHIS) from the Center for Disease Control finds that now 22.7% of the under-65 population is in "high deductible" health plans. This is up from 19.4% just one year ago. This includes 6.4% of the population with a Health Savings Account, up from 5.2% last year. It does not separate out HRAs from other people with stand-alone high deductible plans. The report also mentions that fully one-half of the individual market now has high deductible health coverage.

SOURCE: Center for Disease Control

100 Useful tools to help you take more responsibility for your own health

2010-02-04T21:43:45.259-05:00

With health care prices rising, wait lists growing longer, and benefits decreasing, it makes more sense than ever to take more responsibility to help manage you and your family’s health. With the help of the internet, do-it-yourself health is growing at an increasing rate.

If you are ready to take charge of your own health, take a look at these 100 useful tools for mananging your health care. Although they don’t substitute for a live doctor, they can be immensely helpful in getting information, preparing for a visit, and even finding a medical provider. This is a excellent collection of useful resources consumers can use and the 100 tools are organized into several categories:

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

Click here to read Jeanne Peterson’s complete article including a brief description and link to all 100 tools/resources.

How to Save Money on Your Lab Tests

2010-02-01T22:40:29.498-05:00

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”.

How much do they cost and what tests do you really need?

2010-02-01T22:15:58.279-05:00

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.

My New Years Wish -- A Formal Pricing Request

2009-12-29T21:30:10.744-05:00

Today I contacted my health insurer to go over some policy changes they notified me by mail about for the upcoming year. After they answered my policy questions, I took this opportunity to ask them my standard question, “as a member of your health plan, how do I find out what my specific out-of-pocket costs are– before visiting a provider?”

Here is what I learned. This type of information is called a FORMAL PRICING REQUEST and consumers (health plan members) must obtain specific information from the provider and follow the outlined procedures below. Contact your provider’s office and find out:

Provider’s NPI #
The specific diagnosis code(s) for the procedures that will be provided (ICD-9)
The specific CPT code(s) for the services that will be provided
The amount the provider charges for these services
The location (place) of service. This could be lab, outpatient facility, office, hospital)

After the member has all this information from the provider, the member should contact the health plan’s benefits/claims department and be ready to answer all these questions. Within 48-72 hours after the request is made, the insurer will provide the member with a letter identifying the member’s out-of-pocket costs for the services. As a convenience, the insurance plan has offered to read the letter over the phone, rather than mail it out to the member. Contact the Benefits/claims department.

Happy New Year!

Price Disparities Are Common

2009-12-29T21:11:57.01-05:00

NPR ran an interesting story in November 2009 on price disparities in our health care system.

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

The New York Times Advises Consumers to Shop Around for the Best Prices

2009-12-03T15:39:49.599-05:00

An article in the New York Times encourages consumers to shop around to find the best prices for health care services. The article recommends four steps consumers should take to comparison shop for health care:

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

Reducing Healthcare Costs through Medical Negotiation

2009-11-02T10:42:10.157-05:00

This year an estimated 1.5 million Americans will declare bankruptcy, and a study from the American Journal of Medicine suggests that more than 60 percent of people who go bankrupt are actually capsized by medical bills. Most of these medical debtors are well educated, own homes, and have middle-class occupations; three quarters have health insurance. >

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.

Wall Street Journal: Health Care Price Tools

2009-10-29T16:11:32.141-04:00

The Wall Street Journal published a story this week on websites to help patients shop for medical services. The article mentions Outofpocket.com and lists 17 other tools/websites consumers can use to research prices.

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

Medical Tourism is Alive and Well on the Internet

2009-10-22T13:39:22.255-04:00

It's not necessary to get on a plane to India to take advantage of the savings that medical tourism can provide. Patients can realize savings of 25-70% or more just by shopping around via the Internet. Yes a road trip might be necessary, but isn't it worth your time to drive 50 or even 200 miles to save $1000 or more? Maybe the wrong people are reading this, but unless you make over $250,000 per year; a day of work doesn't pay $1000. Saving $1000 on high end diagnostics or an operative procedure is easy.

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.

Best Deal on a Colonoscopy

2009-10-15T19:25:59.609-04:00

A consumer recently contacted me and asked, “I’m due for a colonoscopy. Any idea what is a good deal on a colonoscopy?” Having no idea what a fair price for a colonoscopy would be, I consulted Outofpocket.com to find out. Using the OutofPocket.com search tool, I typed in the search term “colonoscopy” and here’s what I discovered:

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 .

Retail Clinic vs. Office Visit

2009-10-14T09:03:32.055-04:00

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

Hospital Search Engine to Look-up Prices

2009-10-13T13:11:32.367-04:00

Ed Bennet, a hospital web manager, has developed a public hospital search tool using the Google Custom Search engine. The search tool allows you to search more than 2800 hospital websites in a single search query. The hospital websites included in the search results, provide much more information than just prices for services. This tool this can be useful to find/access hospital price data that is hard to find using the standard Google search engine, and elminiates the need to individually search each hospital.

For example, using his hospital search engine, if you type in:

MRI price (results returned = 86)

price x-ray (results returned = 197)

emergency room price (results returned = 91)

Unfortunately, most hospitals publish their “list price” for services, rather than the true out-of-pocket price for their services. The list price often has nothing to do with the actual price you are expected to pay for services. If you pay cash and are uninsured, you should expect (and demand) that you receive a discount from the list price so make sure you inquire about a discounted price. If you are insured, you will pay a lower, contracted rate that your insurer has negotiated with the hospital provider.

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Demystifying the Emergency Room Bill

2009-10-10T17:54:56.289-04:00

I spent two years demystifying my emergency room bill only to uncover that I was being gouged for 800% profit by the hospital. During that time, I learned how to calculate fair and reasonable prices, as determined by the industry standards.

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.

Secret Health Care Prices

2009-09-30T21:27:47.916-04:00

To cut health care costs, let's start by eliminating the secret prices.

With so much discussion on how we need to reduce health care costs, this article written by Dr. Bernadine Healy in the U.S. News and World Report, sheds some light on this issue as Dr. Healy discuses the secrecy of health care prices.

When the price of a colonoscopy ranges from $450 to $10,000, there's room for plenty of savings.
By Bernadine Healy, M.D.

As President Obama said again in his recent address to Congress, an imperative for health reform is containing runaway health costs. But the elephant in the room that is a real driver of costs is something few people are talking about: the variable and hush-hush pricing of medical goods and services, set by the government or negotiated by insurers and largely kept secret from the patients ultimately responsible for their bills.

Look at a colonoscopy: When paid by Medicare, the fee is roughly $450. Insurance companies secretly negotiate a maze of different prices, generally two to five times that. But as the trade group America's Health Insurance Plans recently reported, patients who have to pay their own bill because they are uninsured, are seeking care outside of their insurer's network, or their insurer has denied their claim, can face retail charges as shameless as $10,000. And how can it be that Medicare pays $40,000, prix fixe, for the same heart operation, by the same doctor, at the same hospital, that costs patients paying privately $80,000 to $120,000?
Consumers' ignorance of what services truly cost blurs the connection between their rising insurance premiums and prices, setting the stage for those prices to soar ever higher. Little wonder that the country's total health costs—for public programs like Medicare and Medicaid, private insurance, and out-of-pocket payments—are twice those of other developed countries. Making prices transparent so they can be compared and giving patients the means to shop for insurers that will get them the best deals would put downward pressure on prices and bring sustainable cost savings.

Instead, Americans are led to think that what's mainly to blame for out-of-control costs is their own voracious overconsumption. So cutting down on the quantity of medical services used by the sick and reallocating dollars for wellness and prevention sound like definite cost savers. But that ignores a few facts. Compared with people in other developed countries, Americans see doctors less often and take fewer medications. They also spend the same or fewer number of days in hospitals, and they already lead the world in expenditures per capita on prevention and public health. Yes, more high-tech care may be given to the sick in this country, and yes, that contributes to higher costs. But whether it's low- or high-tech care, what is achingly obvious is that total costs are a function of prices. Ours are the highest.

As a classic 2003 report in the journal Health Affairs put it simply: "It's the Prices, Stupid." In their detailed analysis of health spending in 30 developed countries, leading health economists including Gerard Anderson of Johns Hopkins Bloomberg School of Public Health and Uwe Reinhardt of Princeton University determined that the greater cost of care in the United States was due to much higher prices for virtually all of its medical goods and services.

Our senior citizens must have read that study a few years back when they boarded buses to Canada to buy prescription drugs for half the prices they would pay here. Who stopped their burgeoning tea party? The federal government, citing safety concerns, with heavy pressure from the pharmaceutical interests intent on protecting the higher prices Americans are effectively forced to pay.

We are just beginning to see snippets of such comparative price information become more public in other medical areas, prompted no doubt by the growing out-of-pocket payments besetting insured patients. Just last month, a report initiated by Gov. Tim Pawlenty provided price and quality information on 100 medical services from centers throughout Minnesota. Prices were all over the map. The average for colonoscopies ranged from $325 to $1,354. The price of a simple blood count varied from $13 to $85. The wide variation for these and the other prices disclosed suggests lots of room for competition and cost savings. Another area where scrutiny is needed to understand skyrocketing outpatient bills is that of wildly varying and increasingly common "facility fees." A cardiac stress test, for example, can vary by thousands of dollars depending on the size of this tacked-on fee—a charge for the use of a room needed for less than an hour.

To turn these surprising revelations into useful information that can guide and reward patients for getting the best value for their healthcare dollar, prices have to be widely accessible and easily compared before care is rendered. One way to do this might be to expand the concept of the proposed health insurance exchange, which currently would be restricted to the uninsured. Allow for public and private exchanges, and make them open to all individuals who want to purchase insurance anywhere in the country at the best price. And make exchanges vehicles for price transparency, where consumers could get access to comparative and customary pricing information and then hold insurers' feet to the fire by selecting the company with the best available prices at the places they want to go.

The power of making medical prices transparent to the public has not been lost on the political establishment. Indeed, Sens. Charles Grassley and Arlen Specter have pushed legislation to require price disclosures in the private sector, where secrecy clauses between hospitals and manufacturers have been shown to double or triple the cost of medical devices for some patients. Meanwhile, it may surprise the public to know that the government has gone to great lengths to keep the rock-bottom prices it demands quiet, including entering into contracts with industry that make the prices Medicare and Medicaid pay for prescription drugs, say, inviolable trade secrets.

Why? Congress, as laid out in a 2007 letter from the Congressional Budget Office, recognizes that such disclosures would enable private insurers and their customers to be more insistent about getting similar pricing deals, making their own small discounts, and the government's large ones, converge toward an average. While this would lower costs for people with private insurance, it would make government prices—and costs—a bit higher. Disclosure has still not happened.

But if health reform is supposed to reduce costs, disclosing prices and enabling and incentivizing individuals to seek out the best value to serve their needs is a way to do that as a first step—and before making efforts to restrict or redirect care. I'd estimate a good 10 percent of total costs could be taken out of the system quickly, to the benefit of those in both private and public plans.

--Bernadine Healy, M.D.

How to fight back when your claim is denied

2009-09-25T10:04:23.098-04:00

If your health insurer denies a claim, you have the right to appeal the insurers’ rejection. From 2000 to 2006, the number of consumers appealing claims increased by 34%. Here are some strategies you can follow if you need to appeal a denied claim:

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

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

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

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

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

Nuts for Healthcare

2009-09-21T22:05:59.343-04:00

Jeffrey Seguritan is a twenty-something, enthusiast, blogger and critical mind in all things health care. It’s refreshing to hear Jeff’s opinions and thoughts on our health care system. We so often hear the opinions and stories of elderly Americans and middle aged adults, but here’s the voice of a bright, 25-year old writing about our dysfunctional health care system. His recent blog post, “Healthcare prices – where’s the sticker shock?” discusses the lack of transparency in our healthcare system.

I look forward to reading more of Jeffrey’s posts on the Nuts for Healthcare blog.

How to bargain hunt for health care

2009-09-11T13:03:32.375-04:00

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.

Patients need to act more like customers

2009-09-09T10:45:08.703125-04:00

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.

Price Competition in Minnesota

2009-09-02T12:03:43.512-04:00

Minnesota residents have a new tool to help them comparison shop for health care services. Last week, the state of Minnesota launched the Cost Report tool on the Minnesota HealthScores website. This new tool allows residents to compare prices for health care services and shows the lowest provider cost for a procedure, the highest provider cost, and the average cost per medical group for 103 common medical procedures from 110 providers across the state. This project was a collaborative effort with state health providers collecting the data from health insurance companies.

Doing nothing is no longer an option

2009-08-28T12:53:42.147-04:00

The ongoing health care debate has caused some heated emotions, disagreements, great discussions on very important issues, and plenty of misinformation. Unfortunately, the most important issue of all has gotten lost in all the noise.

We all need to remember that the real crisis is what’s already happening. Today, the average price for health insurance premiums is $13,000 a year. If we do nothing about reforming our health care system, this amount will double over the next decade to $25,000 and many more Americans will be forced to join the uninsured. This is a real crisis.

Many of the discussions about health care reform focus on the 47 million uninsured Americans who do not have health insurance. But remember, health care reform is just as important to the majority of Americans who already have health insurance. Doing nothing results in a crisis that we cannot afford.

Here are the facts:

Rising health care costs are crushing American companies – particularly small businesses
In 1960 U.S. firms spent 1.2% of their payroll on health insurance. In 2006, they spent almost 10%.
Health care costs put U.S. firms at a disadvantage to foreign companies and health care costs destroy U.S. jobs
Escalating health care cost have been passed on to the middle class in the form of higher prices for products/services and flat wages. Money that would have gone to raises has instead been spent on health care premiums that have doubled over the past 9 years.
Small businesses pay 18% more per worker for health care than large firms for the same benefits. They pay more because they have a smaller risk pool and have to absorb higher broker fees and administrative costs per worker.
Businesses that offer employees health insurance:
- Only 49% of firms with 3-9 employees offered health plans in 2008
- 78% of firms with 10-24 employees offered health plan in 2008
- 99% of firms with 200+ employees offered health plans in 2008
This year health care expenditures are expected to account for about 18% of the GDP. Without reform, that number is projected to rise to 28% in 2030, and to 34% in 2040.

We all need to make sure that health care reform gets started this year.

How much will this cost?

2009-08-27T15:26:15.125-04:00

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

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

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

Facts:

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

Engage and Delight Consumers to Get Them to Participate

2009-08-26T12:44:50.485-04:00

The health care industry can learn something from the advertising industry. The key to successful interactive campaigns is to delight and engage consumers so they want to participate. This same rule applies to reforming the health care system. We need to engage and delight consumers to get them to participate.

Regence, a not-for-profit health insurer in the Northwest/Intermountain Region, has been a leader in transforming our health care system. They have created an engaging, interactive presentation to kick off their launch of WhatsTheRealCost.org. It’s a delightful presentation on transforming our health care system. Also, be sure to check out the Regence award winning one-minute video, WhatsTheRealCost.org.

Lowering the cost of health care

2009-08-21T12:00:34.547-04:00

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

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

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

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

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

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

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

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

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

Excessive charges for medical services

2009-08-20T14:25:27.359-04:00

America's Health Insurance Plans (AHIP) just published a report that identifies physician out-of-network charges for 30 states. The report provides a state-by-state snapshot of excessive charges billed by out-of-network physicians, and compares these charges to what Medicare would have paid for these exact same services. This report demonstrates huge disparities in the cost of various medical services that were in some cases tenfold higher than Medicare reimbursements for the same service in the same area.

Here are some examples from the report, of the price disparities for common procedures.

· A patient in Illinois was charged $12,712 for cataract surgery. Medicare pays $675 for the exact same procedure.

· In California, a patient was charged $20,120 for a knee operation that Medicare only pays $584 for.

· A New Jersey patient was charged $72,000 for a spinal fusion procedure that Medicare covers for only $1,629.

What is obviously missing from this report is the insurer’s average contracted price for in-network providers. Wouldn’t it be remarkable to see how prices compare for a specific service side-by-side including:

· List price (the inflated charges)

· Negotiated price (discounted price contracted with in-network providers)

· Government CMS Medicare price (lowest contracted price)

Comparing provider health care prices across different health insurance plans for the exact same service is what we are trying to accomplish with the OutofPocket.com directory. If you want to look up some of these prices, be sure to check out our directory.

The best advice I can share with consumers regarding these “inflated” out of network prices – is to make sure you do your research. If you are uninsured, or if you are insured looking for an out-of-network provider, make sure you don’t pay the inflated charges. Instead you should do your research, understand what the “fair” contracted rates are for this service and know what Medicare reimburses for this service in your area. Then you can confidently ask the provider for a discounted price. On average, Medicare pays about 80 percent of what private insurers pay for the exact same service. If you want to look-up what Medicare pays for specific services -- use the AMA CPT online tool. If you want to find out what the average insurer reimburse for specific services --- use Healthcarebluebook’s tool.

If you are still confused, feel free to contact me and I’d be happy to walk you through these steps to help you become a more informed consumer.

Be sure to read the article that appeared in The New York Times, Survey Finds High Fees Common in Medicare Care that discusses this AHIP report data.

What’ the Real Cost

2009-08-04T15:37:09.370875-04:00

Our health care system is complex, confusing and costly. Fees are mysterious, questions are discouraged, and information is not readily available.

Imagine a reformed health care system where costs are clear, information is simply stated, procedures are openly and honestly evaluated. Where participants share knowledge and information. Where technology drives value. Where all particpatants are informed, engaged and rewarded for smart choices and health behavior.

This is how we need to reform our health care system.

How to Cut Your Doctor Bill

2009-08-01T18:44:21.949-04:00

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

Lowering your health care expenses

2009-07-26T18:22:51.208-04:00

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

Health Care Reform - Understanding the Issues

2009-07-21T15:35:06.117-04:00

Outofpocket.com is not a political blog, but it’s practically impossible these days to read any newspaper, listen to the news or turn on the radio without hearing about health care reform. As informed consumers, it’s important to understand the complicated issues surrounding health care reform since it will affect everyone. The more you understand the problems in our current system, the main points of disagreement, the proposals being presented, the industries that will lose/gain from an overhaul and what impact this will have on your own situation – the more you can make a difference.

In today’s Wall Street Journal, Janet Adamy, Health Care Reporter, wrote an outstanding article that explains the health care reform challenge by answering ten questions:

1. What is the problem with health care? Is it as bad as they say?

2. Can Democrats and Republican agree on anything?

3. What are the main points of disagreement?

4. What would a public plan look like?

5. Why is the total price of the overhaul so expensive, especially considering that it is designed to bring down costs?

6. What are the most likely ways to pay for the overhaul?

7. Which industries are most likely to lose, and which to gain, from any overhaul?

8. I already have insurance through my employer – what happens to me?

9. Politicians have tried for decades to push universal health insurance. Why did they always fail before? Why would this time be any different?

10. What happens if the effort once again fails?

Ten Questions on the Health-Care Overhaul

The Effort to Change the System Enjoys More Support Than Past Attempts, but the Complications Are as Acute as Ever

By JANET ADAMY

It is crunch time for health care. Lawmakers who are trying to fundamentally remake one-sixth of the U.S. economy say this might be the most complicated legislation they have undertaken.

Here are some basics that everyone can grasp -- and probably ought to, because the health bill, if it passes, will affect almost everyone.

1. What is the problem with health care, anyway? Is it as bad as they say?

The problem, as advocates for change see it, boils down to two big areas: high costs and lack of coverage. For some households and employers, the cost of care already is out of reach, and many more will struggle to afford it if costs keep escalating. Medicare is eating up a bigger share of government spending, and a growing number of bankruptcies and home foreclosures are linked to medical expenses.

Even though the U.S. spends $2 trillion a year for health care, some 46 million people don't have health coverage. To be sure, that oft-cited number from the Census Bureau is somewhat misleading because it includes illegal immigrants, healthy young adults who don't think they need insurance and poor people who are eligible for Medicaid.

Still, as the recession wears on, the number of uninsured appears to be rising. One study, by the left-leaning Center for American Progress Action Fund, found that as many as 14,000 people are losing their health insurance every day because of job cuts. Families who have insurance pay an additional $1,000 a year in premiums to effectively subsidize all the people who receive care but don't pay for it, according to a separate study by the liberal group Families USA and actuarial consultancy Milliman Inc.

2. Can Democrats and Republicans agree on anything?

Actually, yes. There is broad support for changing the way hospitals and doctors are paid so that they are compensated for the quality of care they provide, not the quantity of procedures they do. Democrats and Republicans also back the idea of creating online marketplaces where consumers and small businesses can comparison-shop for plans.

Both parties want to bar insurance companies from denying coverage to people who are already sick. The insurers are willing to make that concession, as long as lawmakers also require most people to carry insurance, since that would force young, healthy people into the insurance system.

It amounts to a twin mandate -- one on insurers to sell policies, and another on Americans to buy them. Although there are pockets of Republican opposition to the latter idea, both have enough bipartisan support to pass. These steps alone would represent big changes to the status quo.

3. Where are the main points of disagreement?

The sharpest divide between the two parties: Whether to create a government-run insurance plan (otherwise known as a "public plan") that would go up against private plans in online marketplaces. President Barack Obama says a public plan will keep private insurers honest. Republicans say it would give the government too much control over health care.

The other main battle, which doesn't break down as easily along party lines, is how to pay for a plan expected to cost at least $1 trillion over a decade. Many lawmakers think it makes sense to impose a tax on employer-provided health-care benefits, a perk that currently is tax-free.

Then they looked at the poll numbers. Many voters hate the idea of paying taxes on something that right now costs nothing. So Democrats have instead proposed raising taxes on the rich.

Congress also remains divided over whether to make employers (except really small ones) provide insurance. House Democrats propose that if companies don't offer insurance, they should contribute as much as 8% of their payroll spending toward helping workers buy insurance on their own. Republicans argue that companies will make up for it by cutting jobs and lowering wages.

4. What would a public plan look like?

The country already has a huge public plan -- Medicare, which covers the elderly and some other groups. It generally pays doctors and hospitals less than private insurers. Liberal Democrats would like to replicate it in the new marketplaces. They want the government directly to set premiums and services under the plan, perhaps with basic and premium options.

That isn't going to fly in this Congress, despite Democratic control of both chambers. Republicans are more opposed to having a government plan than Democrats are bent on having it. Conservatives figure the government would quickly drive private insurers out of business by undercutting them on price.

Two other scenarios have emerged as compromises. One is to hold off on creating the plan and instead impose heavy regulations on insurance companies aimed at making coverage accessible and affordable. If that doesn't work, then the government insurance plan would kick in after several years. The other idea is to create a batch of regional nonprofit insurance cooperatives to compete with private insurers. But many liberals consider that a far stretch from the original idea, since the government wouldn't run those plans.

One point that gets overlooked in the debate is that most people probably wouldn't even be eligible for the public plan. Only individuals without affordable employer-provided insurance and businesses that aren't big enough to buy reasonably priced plans on their own would qualify.

5. Why is the total price of the overhaul so expensive, especially considering that it is designed to bring down costs?

The cost mostly comes from giving people subsidies to buy insurance, and from expanding Medicaid, the federal-state insurance program for the poor, to cover more low-income Americans.

The theory is that once more Americans carry insurance, the entire health system will spend less money caring for them. Those people will have more access to care that prevents them from getting sick in the first place, and they would rely less on costly forms of treatment such as visiting the emergency room. But it could be years before that really reduces health costs, if it ever does.

President Obama often talks about more fundamental fixes for high costs, like paying for quality and blocking doctors from boosting their income with unnecessary tests. But Congress has limited power to change that.

6. What are the most likely ways to pay for the overhaul?

The White House has proposed about $950 billion in savings over 10 years to pay for the plan that include things like lower reimbursements to hospitals that treat Medicare patients.

The wealthy are a natural target. One proposal is limiting itemized tax deductions for families who earn more than $250,000 annually, a campaign idea of the president. House Democrats want to impose a surtax on wealthy individuals. Less likely are new taxes on soda and sugary drinks, which many lawmakers see as politically unpopular.

7. Which industries are most likely to lose, and which to gain, from any overhaul?

Perhaps no industry stands to gain more from the changes than health insurers, who would get tens of millions of new customers because Americans would be required by law to carry health insurance. Pharmaceutical companies would sell more prescription drugs because more people would have coverage for drugs and access to doctors who prescribe them. Hospitals and doctors wouldn't have to provide as much free care as they do now.

But each of those groups also could take hits, particularly the health insurers if some kind of public option drives down their profit margins. The big losers would be retailers, restaurants and other businesses with low-income workers who provide little or no health insurance, since they would be forced to start paying for it.

Businesses that are too small to afford health insurance but not tiny enough to fall below the proposed $250,000 annual payroll cutoff that exempts them from providing coverage also could get squeezed by the legislation.

8. I already have insurance through my job - what happens to me?

Not too much at first. A handful of tax-free perks for the insured could get axed. For instance, lawmakers want to end the practice of allowing people to put money into so-called flexible spending accounts, which allow them to pay for everything from cosmetic dental work to surgery with tax-free dollars.

Longer term, a lot could change. For instance, your employer could drop coverage, preferring to pay the penalty for doing so and deflecting employees to Uncle Sam's plan. Cost-cutting efforts in other parts of the system could eventually affect employer-provided plans as well.

9. Politicians have tried for decades to push universal health insurance. Why did they always fail before? Why would this time be any different?

These efforts stretch back to the 1930s, when President Franklin Roosevelt proposed creating a compulsory health-insurance system for all Americans, run by the states. Doctors, worried it would hurt their pay, helped kill the measure, buoyed by opposition from business and labor groups. Other major health overhaul attempts, most notably President Bill Clinton's 1993-94 effort, died because powerful interest groups feared their members would either earn less or have to pay more under the new system.

What is different now is that major health and other interest groups are on board with the idea. Many insurers, hospitals, doctors and drug companies agree that the system is so flawed it isn't sustainable, and they see a bill as a chance to push through improvements like adopting electronic health records, broadening the use of data to show which treatments work best and reducing the threat of malpractice lawsuits. Employers see it as a chance to curb the sharply rising price of covering their workers. Almost no one is arguing that the system is fine the way it is. Mr. Obama's high popularity, coupled with wide Democratic margins in Congress, also grease the wheels for passing a bill.

10. What happens if the effort once again fails?

Lawmakers would likely scale back their plans and try to at least pass a measure that partially expands insurance coverage or helps stall the increase in health costs. But so many parts of the legislation are intertwined that they will be less effective, and perhaps impossible to achieve, if done piecemeal. Lawmakers might be reluctant to take up the controversial legislation ahead of congressional elections next year. So it would probably be several years before lawmakers tried again.

Another Successful Triathlon

2009-07-15T12:01:54.953-04:00

As an accomplished triathlete, I have been honored to be involved in helping coach women train and prepare for their first triathlon. The women I train are in their 20s through 60s, and after an 8-week training program, everyone successfully completed the TrekWomen’s triathlon this past Sunday in Wisconsin. It’s a truly rewarding experience for me to see all these women reach their goal of finishing their first triathlon. Everyone established their individual fitness goals, whether it was is to exercise on a daily basis, to increase their level of fitness, to eat healthier in order to perform better, to feel better, get fit and to lose weight. After finishing their first triathlon, many of the participants now have “triathlon fever” and plan to do another triathlon next year to improve their time.

What's remarkable is that these women are actively participating in wellness, improving their health and the quality of their lives. As these women continue to maintain healthy lives, down the road, I am certain that health care expenses will be lower for these women due to their focus on wellness and improving their health.

Congrats to all the women athletes and I look forward to training with next year’s team!

Knee Surgery Out-of-pocket Expenses

2009-07-10T19:06:16.641-04:00

New hope for damaged knees. After more than twenty years of competitive running, the cartilage on my knee was destroyed and I could no longer run. My determination to run again and to continue being active for many more years to come led me to Dr. Brian Cole, head of the Cartilage Restoration Center at Rush University Medical Center. Dr. Cole has been performing the osteochondral allograft transplant procedure on athletes for 12 years and his outcomes are very successful. This type of procedure offers an alternative to total joint replacement and enables patients to maintain an active life 12 months after the surgery.

In November 2008, a donor match was identified and I had elective knee surgery to repair my damaged cartilage. Prior to the surgery, this procedure was preapproved by my health insurance plan and I was fortunate enough to have very good insurance to help cover most of the costs of this expensive procedure. I have a high deductible health plan, along with a health savings account so I am required to pay $5,000 out-of-pocket before my insurance kicks in. I knew this much going into surgery, but had no idea what my specific out-of-pocket costs were going to be after the surgery.

During my preparation for surgery and my long rehab following surgery, I maintained a list of all my out of pocket expenses related to this procedure. Below is a breakdown of these expenses including the provider’s list price, insurance plan’s contracted price, and my out-of-pocket expense.

(1) Total LIST price $ 71,138.21

(2) Total INSURANCE CONTRACTED price $ 20,187.03

(3) My total OUT-OF-POCKET expenses $ 7,093.87

Item	List Price	Insurance Contracted Price	My Outofpocket Price	Notes
Office Visit	$162.00	$70.00	$70.00	Dr. referred me to specialist
X-rays	$136.00	$50.00	$50.00	x-rays to diagnosis injury
MRI knee	$1,116.00	$706.00	$706.00	MRI to diagnosis injury
Office Visit - specialist	$198.00	$116.00	$116.00	Office visit w/specialist
Office Visit - specialit	$109.00	$70.00	$70.00	follow-up office visit
X-rays	$153.00	$50.00	$50.00	diagnostic x-rays
Blood/urine lab tests	$193.78	$50.00	$50.00	blood tests for pre-surgery
X-rays	$125.00	$39.00	$39.00	x-rays post surgery
Surgery anesthesia	$1,440.00	$576.00	$576.00	anesthesia for surgery
Surgery Physician's fee	$22,676.06	$3,221.50	$1,845.00	partial applied to my deductible
Surgery Surgical Assistants	$5,668.00	$547.65	$109.51	paid 20% of contract price (met deductible)
Surgery Facility Fees	$32,444.37	$11,160.88	$2,232.16	paid 20% of contract price (met deductible)
DME - Knee Brace	$897.00	$603.00	$118.80	paid 20% of contract price (met deductible)
DME - CPM machine	$3,225.00	$972.00	$194.40	paid 20% of contract price (met deductible)
DME - Ice, Compression Unit	$595.00	$595.00	$595.00	not covered under insurance plan
Physical therapy (10 sessions)	$2,000.00	$1,360.00	$272.00	paid 20% of contract price (met deductible)
TOTALs	$71,138.21	$20,187.03	$7,093.87

Teaching Consumers How to Price Shop

2009-07-08T13:49:33.701-04:00

Americans cannot control the economy, but they can do a much better job of educating themselves about what they should pay for health care services. Healthcarebluebook is a national website that provides free pricing data to consumers. The purpose of healthcarebluebook is to give consumers the information they need to pay fair prices for health care services.

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

It’s the Prices Stupid

2009-07-03T11:15:34.185-04:00

If you have ever had the opportunity to comparison shop for health care services, you would agree that pricing for medical services in the U.S. health care system is ridiculous. There is a huge disparity of prices for the exact same service and these prices are kept secret. For many years health insurers have been able to get away with secret pricing simply by explaining “their prices are proprietary.” Health insurers negotiate contracted prices with providers and these prices are a tightly guarded secret. In fact, the secret pricing makes it impossible for patients to shop around and find the best value because prices are not easily disclosed to patients before services are provided. Not only do insurers keep prices a secret, but even health care providers are seldom willing/able to share prices because (1) providers are reimbursed different prices from different health insurance plans. As a result, providers sometimes charge 50 different prices for the exact same service, depending on the health insurance plan and policy of the patient. So it’s not surprising that providers themselves are confused about their pricing, and (2) Due to the contracts with insurers, providers are afraid of the legal consequences they will face if they disclose these negotiated prices.

In a recent article in U.S. News, Uwe Reinhardt was interviewed about health care costs. Dr. Reinhardt is a prominent health economist who is not afraid to say it like it is. Below is the original article that was published in U.S. News.

Uwe Reinhardt: Plain Talk on Health Reform

A prominent health economist talks about high prices, medical insurance, and rationing

By Bernadine Healy, M.D.

If there were a Straight Talk Express for health economists, Princeton professor Uwe Reinhardt would be the engineer. Born in Germany and raised in Canada, Professor Reinhardt has personally experienced medical systems in different countries. Over the past 25 years, he has become a critical voice in the debate about reforming America's healthcare system. He spoke with Dr. Bernadine Healy about today's healthcare costs and efforts to overhaul the system. Excerpts:

Uwe, you're hard to pigeonhole on health reform.

This drives my students nuts. They say, "Are you a Republican or a Democrat?" I say, "Should that matter?" I'm partly libertarian, but I do come out for universal coverage.

Why has President Obama made reform so urgent?

Obama said what the cost of healthcare did to GM it could do to the nation. This was hyperbolic, of course, but with the GDP down 6 percent in the first quarter and flat economic growth ahead, healthcare can't go marching on as if nothing has happened. It is now 18 percent of the shrinking GDP and projected to be 40 percent by 2050, according to the White House. If the increase gobbles up SUVs and fast foods, that might not be too bad. But if it displaces money to educate children, that's a real trade-off. Human capital is what has made America great.

Is it mostly that our prices are too high?

A bunch of us wrote a paper a few years ago called "It's the Prices, Stupid." Europe has a lot more physicians and hospitalizations per capita and takes more medicine. But our prices are much, much higher for the same things. The good side is that high prices have allowed incredible innovation because medical technology and delivery systems have been able to slosh around in money. The bad side is that in 10 years, Americans on the bottom half of the income ladder won't be able to afford healthcare.

One thing that is really puzzling is that for Medicare patients we spend twice the money in Miami and McCallum, Texas, as we do in San Francisco. This geographic variation has been known for about 25 years, but Congress has never appropriated the research budget to figure out what's really going on. Obviously, if you compare area averages, that's pretty crude science. You really want to go down to the individual level and see if these patients are different. They might be. But you need very good data on individual patients, even social factors and religion. Now the White House is saying that it is going to slam down on these high cost areas, but you don't really know enough yet.

Why don't individual healthcare consumers bargain for better prices?

My wife, May, called up the Princeton hospital and asked what a normal delivery would cost. She got nowhere. I called about a colonoscopy and got the same runaround. So I asked a guy at New Jersey Blue Cross. He just roared. "Are you serious? We pay 50 prices. We pay every hospital a different price. We pay the same hospital five different prices." I asked, "Are they public? Can I look them up?" The answer was, "No. That's proprietary." Imagine if a bunch of people were blindfolded, shoved into Macy's, and told to shop prudently. For years, I've argued hospitals should post their fees relative to Medicare. I've put it to the White House, the Senate. People look at me: "Are you serious? Transparency?"

What about reforming health insurance?

The insurance market is chaotic. We need to have one basic, standard package that is respectable. Hairpieces don't have to be covered, but in connection with cancer, I could see why they should be. The Dutch had a national debate whether they should socialize the cost of fertility treatments. Making such choices has always made Americans gun-shy.

That does bring up the "R" word. Won't health reform mean rationing hip replacements or end-of-life care?

How much could you really save on end-of-life care? For now, we have more than enough inefficiencies not to have to make those harsh decisions. My feeling is our kids will be the ones who have to figure this part out. Our generation did civil rights and women's liberation. Let them do this. They will face millions of baby boomers with zero net worth. I say to my students, "You will have to take care of them somehow. You cannot put them on an ice floe—especially with global warming."

Consumer Driven Health Care Revolution

2009-07-02T14:12:20.814-04:00

Ten Ways Consumer Driven Health Care is a Proven Success

By Greg Scandlen

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

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

This is a Consumer Driven Health Care Revolution.

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

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

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

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

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

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

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

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

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

Click here to read the complete article

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

Taking the mystery out of health care prices

2009-06-23T21:43:03.693-04:00

For many of us, the most unbearable part of going to the doctor is when the series of “post-visit” EOBs, bills, statements and paperwork start to arrive in the mail. Wouldn’t it be nice to know your out-of-pocket costs BEFORE you visit a health care provider?

In order for consumers to make informed choices, we need tools that provide accurate price and quality information. Unfortunately, our current health care system lacks transparency and waiting around for health insurers or health care providers to solve this problem could take a long time. In the meantime, we are starting to see some new tools that consumers can use to look-up price estimates for health care services and get an idea of a fair price for service. The tools are not perfect, but it’s better than not knowing at all how much things cost. In fact, whether you are insured or uninsured, it would be helpful to know up front what your out-of-pocket expenses will be --- before you visit the doctor!

So the next time you need to have an MRI, x-ray, mammogram, CT scan, colonoscopy, dental exam, eye exam, lab test or office visit, ---be sure to take a few minutes to visit some of these free websites so you have a better idea of fair prices for specific services. You might even be able to use this information to negotiate a discount with your health care provider.

Tools to look-up prices for health care services

An article in CNNMoney, Biggest Medical Mystery: The Bill, discusses obstacles and price transparency.

Lessons learned from auto insurance

2009-06-17T12:43:20.961-04:00

The auto insurance industry has a rating system that offers safe drivers premium discounts. What if the health insurance industry implemented a rating system, similar to the auto insurance industry, where “healthy members” get premium discounts when the members demonstrate healthy behaviors? Some employers have adopted these financial incentives and their results demonstrate reduced employee health care spending after these programs are implemented.

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

- Save driver (accident free)

- Multi-car policy

- Good grades for teenage drivers in the household

- Anti-theft device installed in vehicle(s)

- Air bags installed in vehicle(s)

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

- Taking a health risk assessment

- Exercising on a daily basis

- Eating healthy

- Reducing weight

- Stop smoking

- Lowering blood pressure

- Lowering cholesterol

- Monitoring and follow-up on chronic diseases

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

Making the most of your health care dollars

2009-06-17T12:27:52.32-04:00

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!

Health Maven!

2009-06-16T14:10:46.508-04:00

I recently received recognition from Wellsphere that the OutofPocket.com blog has been designated as a Health Maven! I joined forces with an amazing group of health care bloggers on Wellsphere to participate in a community of writers that share expert advice on a variety of health care topics. Wellsphere’s mission is to help millions of people live healthier, happier lives by connecting them with the knowledge, people and tools they need to manage and improve their health.

If you haven't visited Wellsphere.com yet, you should definitely check it out.

Personal Responsibility and Financial Incentives

2009-06-16T13:44:56.773-04:00

Last year I attended a health care conference in Chicago where Safeway gave a presentation on how they reduced employee health care expenses starting in 2005 by implementing wellness programs and adopting financial incentives. The secret ingredient for Safeway was rewarding healthy behavior. This was an outstanding presentation that I remember very well, and the results were so remarkable, I expected just about every corporation at that conference to follow Safeway’s lead.

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

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

Affordable Prescription Drugs

2009-06-15T13:04:34.164-04:00

To reduce health care expenses, consumers have the option of ordering their prescription drugs online. This not only saves money and provides convenience, but makes health care dollars go a lot further. One company you should check out is CanUSAmeds.com, a Chicago area-based Canadian online pharmacy with a reputation for outstanding customer service and some of the most affordable pricing for prescription medications.

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:

Drug	Size	Quantity	Typical Price	www.CanUSAmeds.com 1-877-469-9619
Lipitor	20 mg	90	$359.97	$102.31 Save 71%
Zetia	10 mg	100	$339.68	$121.30 Save 64%
Prevacid	30mg	90	$477.96	$125.08 Save 73%
Plavix	75mg	100	$477.73	$133.22 Save 72%
Actonel	35mg	12	$291.24	$112.65 Save 61%
Celebrex	200 mg	90	$356.99	$99.89 Save 72%
Advair	250/50	3 Disks	$590.99	$231.04 Save 60%
Singulair	10mg	90	$347.08	$132.18 Save 62%
Topamax	100mg	600	$4286.76	$585.58 Save 86%
Crestor	10mg	90	$338.61	$136.75 Save 60%
Nexium	40mg	90	$469.97	$109.51 Save 76%
Prices were quoted on May 1st, 2009 and are subject to change. This is only a sample.

Make sure you understand the fine print on your health insurance policy

2009-06-05T13:36:45.202-04:00

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

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

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

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

· Pay attention to the terms of your deductible

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

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

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

Using Urgent Care Centers instead of Emergency Rooms

2009-06-04T11:58:48.299-04:00

Urgent care centers are an affordable option for patients needing non-critical medical care. At urgent care centers, patients are treated by highly trained staff of physicians, nurses and health care technicians for many non-critical medical problems. If you haven’t heard of urgent care centers, perhaps you are more familiar with some of the other names they are called:

Immediate Care
Convenient Care Clinic
Express Care Center
After-hours Facility
Minor Illness & Injury Center
On-call Doctor/ Physician
Quick Care Center
Now Care Facility
Prompt Care Clinic

The centers are typically open late nights; require no appointments, accept insurance or cash payment and walk-ins are welcome. The centers usually guarantee you will receive medical care in less than 30 minutes and their services cost considerably less than visiting an emergency room.

To find an urgent care center near you, you can use search engines:

Google - search on urgent care and include your city/state
Bing - search on urgent care and include your city and state
Find Urgent Care - a directory to help consumers find centers in their area

Getting Charged for Free Exams

2009-05-29T16:33:01.102-04:00

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

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

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

Shopping for radiology tests online

2009-05-20T10:06:47.173-04:00

What if consumers could shop for radiology tests (MRI, CT scan, ultrasound, x-ray, mammogram, DEXA, PET, and fluoroscopy), the same way they shop for hotels and airline tickets?

Radiology tests like MRI and CT scans have become key tools for physicians to help diagnose and monitor disease. It's no surprise that diagnostic imaging has become one of the fastest growing segments of healthcare, consuming billions of dollars per year. In fact we will spend over $20 billion in 2009 just on MRI scans alone.

Many consumers are increasingly forced to burden the costs of these high-tech medical tests through high deductible plans, often paying hundreds of dollars out of pocket for a scan. And uninsured consumers are faced with costs that can easily run into the thousands of dollars. For example, a Lumbar Spine MRI scan performed at a hospital can cost an uninsured consumer $3,000.

Healthcare is still mired in complex and opaque pricing strategies that make it difficult, if not impossible, for uninsured consumers to discover the real costs of Radiology tests and receive the same prices that health insurance companies enjoy. Fortunately there are technology companies, like RemakeHealth, that are building online resources to help healthcare consumers.

RemakeHealth recently launched its Radiology shopping website which lets consumers look up prices for nearly any outpatient Radiology test, find a local certified imaging center and purchase the test with a credit card. Radiology tests featured include X-rays, MRI scans, CT scans, Ultrasounds and more. All the imaging center providers on the website are certified by the American College of Radiology and staffed by American Board of Radiology certified Radiologists.

RemakeHealth acts like a travel agent and has negotiated prices for uninsured consumers in advance. When consumers purchase a test they receive concierge like services which include a personal phone call to set up the appointment and answer any questions about the test.

RemakeHealth is also working to eliminate confusing healthcare pricing schemes. For example a Brain MRI usually has 3 different prices: without dye, with dye, with and without dye. They have simplified this by offering one price and not charging extra for dye injections. Consumers are also often unaware of large price variations that occur between facilities in the same town. RemakeHealth has addressed this by creating one price for each type of test in each of their local service areas.

The company was founded by Dr. Ravi Sohal, who is a Radiologist, and its cofounders are from the Radiology industry as well. The founders have dedicated themselves to helping uninsured consumers make informed decisions by building healthcare shopping tools similar to the ones we all enjoy when looking to buy nearly everything else online. They have always been amazed that you can shop for an airline ticket and hotel room but not for an X-ray and MRI scan, until now.

Assistance programs for low-income patients

2009-05-19T14:55:34.204-04:00

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

Low-Cost Medicine Programs

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

Additional Assistance Programs (PAPs)

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

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

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

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

Free/Low Cost Clinics

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

Discount Drug Cards

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

1. Drug Company Discount Card

2. State Discount Cards

3. NeedyMeds Drug Discount Card

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

Resources to help you decipher and negotiate hospital bills

2009-05-13T10:20:15.963-04:00

If you have major medical bills and need assistance in making sense of these bills, there are a number of bill review services available that will provide you with advice. Some of these organizations provide assistance before services are provided, others help review medical bills after the services were provided, to determine if you were overcharged.

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

Claims Assistance Professionals

HealthCare mediation LLC

Health Proponent

Health Champion

Hospital Bill Review

ICS Healthcare (Ingenix)

Medical Cost Advocate

INSNet

Patient Advocate Foundation

Patientcare

How Much Does It Cost to Have a Baby?

2009-05-11T19:56:44.463-04:00

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

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

ITEM	CHARGE
Total delivery charge for three days in the hospital	$ 36,625
Aetna’s negotiated (discounted) total	$ 17,300
2006 average nationwide negotiated total	$ 6,898

Miscellaneous items and charges on the hospital bill:

ITEM	CHARGE
Epidural anesthetic injection	$ 530
Hospital’s resources for providing the epidural	$ 2,152
Anesthesiologist’s fee	$ 1,530
90 minutes in recovery after delivery	$ 2,382

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

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

Saving money on out-of-network costs

2009-05-06T09:16:09.164-04:00

If you are insured, selecting a health care provider that is not in your network can cost you more out of pocket. Network providers in your health plan have discounted rates for their services. Non-network providers do not provide this discount and you’ll end up paying more for their services. Sometimes the specialist, or provider that came so highly recommended with the highest quality ratings, is not in your network. How should you approach this to make the most of your health care dollars? Here are things to consider when deciding to use in-network versus out-of-network providers.

Quality is very important. You want to find the highest quality provider that offers the best value.

Get cost estimates from the hospital and the physicians, and try to find out if there are any supplemental fees you can avoid.

Research what portion your insurance will cover. Know that most plans will only cover a percentage of charges they consider "reasonable and customary." This may be a lot less than what the hospital and doctors charge, and you'll be responsible for the difference. Find out if your insurance company will pay the entire "reasonable and customary" portion, or if you'll be responsible for some of it due to deductibles or co-insurance.

Ask providers if they are willing to accept your insurance company's payment for their services as payment in full, especially if they work in a hospital that's covered by your plan. Make sure you take care of this before services are provided.

Negotiate with the provider and even offer to pay cash at time of service for special discounts. Know what payment amount Medicare allows for this service. If you need help finding out this information, send me an email and I will walk you through the steps on how to find this information. Know what payment amount your health plan allows for an in-network provider for this same service. Information can be powerful.

Affordable Lab Tests

2009-05-04T09:40:04.117-04:00

Millions of people every day struggle to contain their health care costs. The National Center for Health Care Statistics reports 43 million people under the age of 65 do not have health insurance.

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

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

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

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

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

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

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

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

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

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

Take control of your health care costs today!

Smile. It's free

2009-04-30T15:24:55.956-04:00

Every so often you run across a touching story about people who really make a difference in improving the lives of others. This is one of them.

Dentistry From The Heart (DFTH) is a dental program that provides free dental care to those who need it. Since 2005, this non-profit organization has provided free dental services at more than 50 locations across 29 states. Founded in Tampa, Florida in 2001, Dentistry From The Heart started as Dr. VincentMonticciolo’s way of giving back to his community and providing aid to the growing number of Americans without dental insurance. Over the past eight years, more than 4,000 patients from across the state have traveled to attend Dr. Monticciolo’s DFTH events to receive a free filling, extraction, or cleaning.

After realizing the potential impact DFTH could make across the country, Dr. Monticciolo registered DFTH as a national non-profit organization and created all the tools needed for dental practices to host DFTH events in their community.

“With the number of Americans living without dental insurance on the rise, my desire is for more dentists to look to Dentistry From The Heart as a way to directly impact lives and provide invaluable services to their community,” said Dr. Vincent Monticciolo.

Since 2005, Dr. Monticciolo has enlisted more than 60 dental practices across the United States to host their own events. With their help, Dentistry From The Heart has now served more than 10,000 people and given away more than $2.5 million in free dental work. Dentistry From The Heart is a registered non-profit organization that provides free dental work for people who need it. Dr. Vincent Monticciolo founded the organization as a means to give back to the community and address the growing number of people without dental insurance. In the past eight years, Dentistry From The Heart events have contributed more than $2.5 million in free dentistry and helped more than 10,000 patients across the country.

Cost of an MRI

2009-04-27T10:55:26.159-04:00

How much does an MRI cost? What is a fair price to pay for an MRI? How do you know if you are being overcharged for an MRI? Where should you go to find the best value?

With so many consumers now paying cash for health care services or using their high-deductible health plans to pay out of pocket, these questions become more and more common. Consumers are becoming more savvy about purchasing health care services, and need to know up front how much things cost.

(1) How much does an MRI cost?

Prices vary a great deal. Research indicates that prices for MRI services can range anywhere from $450-$3500, depending on where you go to have the MRI performed. If you visit a hospital facility for your MRI, you will end up paying a lot more for this diagnostic test that if you visit a stand-alone facility not affiliated with a hospital. If you offer to pay cash up front at time of service, the provider will most likely offer you an attractive discount. Three independent outpatient facilities, one in Milwaukee Wisconsin, one in Lawton, Oklahoma, and the other in Indianapolis, IN offer one price for an MRI. No matter what insurance you have or don’t have. No matter what type of MRI you need. They have taken the mystery out of MRI pricing. Here’s the scoop.

· DoctorsMRI a diagnostic facility in Lawton, Oklahoma charges patients $599 for an MRI. No hidden fees. No surprises. All MRIs are one price = $599

· SmartChoiceMRI in Milwaukee, Wisconsin offers patients MRIs for $600. No hidden fees. No surprises. All MRIs are one price = $600

· MRI Solutions in Indianapolis, Indiana offers patients MRIs for $450. One flat fee. They do not accept health insurnace. All MRIs are one price = $450

(2) What is a fair price to pay for an MRI?

Based on the fact that two facilities in the country are offering one standard price for all MRIs, I would conclude that if you are paying much more than $600 for an MRI – you are probably paying too much. Try to negotiate with your provider to see if they are willing to reduce the price now that you know how much other facilities are charging for the same service.

Be sure to check out HealthcareBlueBook, a website that helps determine “fair” prices for health care services.

(3) How do you know if you are being overcharged for an MRI?

Be sure to ask the health care provider’s office staff questions before services are provided. Use my list of available tools to comparison shop for an MRI. If you know what other facilities charge for the same service, this information can be powerful. Remember, higher prices do not necessarily translate to higher quality.

What’s my out-of-pocket for this service?

2009-04-21T18:35:37-04:00

COPAYs, co-insurance, deductibles, list price, discounted price, contracted rate, negotiated price, cash price. Do you know in advance what amount you will be charged for health care services?

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

Bargaining down those medical bills

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

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

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

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

Conclusion

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

YouTube video on health care system

2009-04-16T22:46:12.274-04:00

A picture is worth a thousand words. Using a whiteboard to explain complicated issues surrounding our health care system, Humana has created a three minute video on YouTube that does a great job explaining why we need health care reform. The video explains in simple terms what's wrong with our currently health care system and presents some ideas and proposals that are being considered.

If you haven’t seen this video, you should definitely check it out.

Free health care services at Take Care Clinics

2009-04-14T16:08:39.055-04:00

Walgreens recently announced that they are offering free health care services at their retail clinics for all current and future Take Care Clinic patients and their families that experienced a job loss after March 31, 2009 and are uninsured. They call it the Take Care Recovery Plan.

To learn more about this program you can call 1-866-Take-Care (1-866-825-3227) and press 3 for Take Care Recovery Plan information.

Or you can visit their website to learn more about the Take Care Recovery Plan.