OutofPocket Blog

What You Need to Know to Find Affordable Health Care Services

Admin — Mon, 17 Nov 2008 19:45:28 GMT

How much does an MRI of the brain cost? What would I pay for a CT-scan? What provider offers the best price for an ultrasound?

Every week you shop for goods/services, and make choices based on what is a “good value.” When you make these purchase decisions, you use the skills you have (without even thinking about it) to find the best value. The same rules apply when you are trying to make the most of your healthcare dollars. It doesn’t matter if you are shopping for prescription medications, durable medical equipment, providers, diagnostic tests or vaccinations. Obviously in an emergency situation these rules do not apply, but for routine service you need to put on your consumer hat and apply some simple rules. If you do not follow these rules, you will end up overpaying for services. Our healthcare system charges consumers up to 300% more for the exact same service and if you aren’t informed there’s a good change you will overpay. Would you rather spend less on healthcare and more on family vacations?

Three things you need to remember when shopping for health care services:

Shop around. Apply your consumer-savvy skills to comparison shop and find out what other consumers paid for similar services. Providers charge hundreds of different prices for the exact same service. Make sure you find the best price and get the best value. Talk to other consumers and find out where people went for services and what they thought of the provider. Were the prices fair?

Ask lots of questions. Don’t be afraid to ask providers and your insurance plan questions like “how much will this service cost me? “ Ask friends, family, community groups where they would go to get the best value for a specific service/treatment. Information can be powerful.

Use resources available. Make the most of tools available to you via websites, insurance plans, health content sites, community sites and blogs. If your health insurance plan provides cost estimator tools, be sure to check these out. They are not always meaningful, but worth looking into. The more you know, the better informed you will be. For me the most effective way to get actual prices is to call the insurance plan and the provider directly and ask them how much this service will cost me. You can also use websites that provide pricing to understand what others paid for similar services. Most importantly, don’t be afraid to ask for a price and if necessary, as for a discount.

The Boston Globe Spotlight Team reported on a story about pricing discrepancies in our healthcare system. They obtained actual private insurance data in their research to analyze provider prices for the exact same service and compared these prices with providers in Massachusetts. Here’s a summary of what they found:

InPatient Services	Coronary Bypass	Hip Replacement	Pneumonia
Average price in Massachusetts	$43,514	$19,256	$5,695
Massachusetts General Hospital	$51,522	$23,197	$6,789
Brighan and Women's Hospital	$47,138	$24,552	$7,936
Tufts Medical Center	$40,486	n/a	n/a
Boston Medical Center	$33,988	n/a	n/a
Beth Israel Deaconess Medical Center	$43,514	$21,627	$6,389
Lahey Clinic	$43,857	$20,175	$6,127
Northeast Health System, Beverly Hospital	n/a	$18,299	$5,695
South Shore Hospital	n/a	n/a	$6,311
Brockton Hospital	n/a	n/a	$5,052
Winchester Hospital	n/a	n/a	$4,814

OutPatient Services	MRI of Brain	CT Scan of Chest	Ultrasound, 1st trimester
Average price in Massachusetts	$693	$482	$129
Massachusetts General Hospital	$1,153	$838	n/a
Brighan and Women's Hospital	$1,118	$838	$263
Tufts Medical Center	$638	$478	$117
Boston Medical Center	$557	$418	$86
Beth Israel Deaconess Medical Center	$855	$642	$201
Lahey Clinic	$704	$513	n/a
Northeast Health System, Beverly Hospital	n/a	$504	$148
South Shore Hospital	$835	$519	$163
Brockton Hospital	$590	$443	$139
Winchester Hospital	$716	$537	$168

How do you search for health care prices?

Admin — Fri, 31 Oct 2008 21:05:17 GMT

If you have a health insurance deductible to satisfy, or if you are enrolled in a consumer driven healthcare plan, or if you have out-of-pocket costs that add up to more than $25/visit, I am sure you try to make the most of your health care dollars by finding low-cost providers that offer the best value. How do you find these low-cost providers?

Starting November 1^st, I am polling the community to find out how you search for health care prices. I am interested in understanding how different consumers search for low-cost healthcare prices. What tools do you use to compare prices for health care services? What “search terms” do you type in Google to find prices for health care services?

Let’s assume you visited your doctor and you need to have a non-emergency test or procedure performed. How do you go about your search to compare prices for services like MRIs, x-rays, mammograms, vaccinations, lab tests, or a colonoscopy? Do you ask your doctor for estimated prices? Do you call the hospital or facility and ask for prices? Do you ask your family, friends or neighbor to compare what they paid? Do you call your health insurance hot-line for prices and recommendation on where to get the best value for this service? Do you use Google to search? If so, what search terms do you use?

Send me an email to let me know what search terms you would use (or have used) to look-up and compare health care prices for specific services. The first 1,000 people to respond will be entered in a drawing for a chance to win a $50 Amazon.com gift certificate. Email entries will be accepted through November 30, 2008.

Here are the details to be included in the drawing for the $50 Amazon gift card. Send an email to info@OutofPocket.com and in your email message be sure to include:

(1) What specific resources you would use (search engines, websites, online tools)

(2) What search terms you would use to find prices for health care services

(3) An email address where we can contact you, to notify you if you win the drawing

Good luck and thanks for sharing your search tips with us.

How Much Does an Appendectomy Cost?

Admin — Fri, 31 Oct 2008 01:54:06 GMT

Here's the scoop on the true price of an appendectomy.

If you are wondering what the true cost of an appendectomy is, keep reading.... Jaz-Michael King’s blog, A Scanner Brightly, provides the most thorough detail I have ever read on a patient’s charges for an appendectomy. He wrote this blog earlier this year, and itemized the specific charges related to his appendectomy procedure. A huge thank you to Jaz-Michael for sharing this detail with everyone to help us become better health care consumers. I am glad everything turned out fine for Jaz-Michael and I would like to encourage him to keep up the great blog. The data he shares is a wealth of information for consumers.

You definitely should read his blog entry, Hospital Bill: Appendix Ultimatum - it includes his comments and other useful information on the breakdown of costs for this procedure.

Here are the itemized charges for an emergency appendectomy.

Appendectomy -- Itemized Charges	Charges	Actual Negotiated Price
Emergency Room:	$1,185.00	$419.68
Emergency Room Physician:	$1,461	$460.60
Cat Scan:	$2,015.00	$713.64
Operating Room:	$3,250.00	1,151.03
Surgeon:	$1,740.00	$626.81
Anesthetist:	$1,601.00	$787.50
Recovery Room:	$3,100.00	$1,097.91
Pathologist:	$35.00	$35.00
Semi-Private Ward:	$5,000.00	$1,770.81
X-Ray:	$127.00	$44.98
Per Diems:	$5,850.70	$5,850.70
Labs, Supplies, Medical Services	$1,627.04	$652.65

New York State Service Charge	$523.64	$523.64

Total Hospital Charges:	$22,718.70
Total Paid:	$12,078.38


The hospital visit was reimbursed at 53.2% of charges
Insurance: CIGNA

How Much Does a CT Scan Cost?

Admin — Tue, 28 Oct 2008 15:14:08 GMT

Are you shopping around for a CT scan but have no idea how much your out-of-pocket costs will be? You are not alone. A new type of CT scan, called “virtual colonoscopy”, offers a noninvasive and less expensive alternative than the traditional CAT scan.

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

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

Hospital or Clinic	Location	Price
Invision Sally Jobe	Denver , CO	$800
Johns Hopkins Hospital	Baltimore , MD	$1,000
M.D. Anderson Cancer Center	Houston , TX	$1,500
Virginia Commonwealth University Medical Center	Richmond , VA	$750
Mayo Clinic	Rochester , NY Scottsdale , AZ	$1,400-$1,500
Ronald Regan UCLA Hospital	Los Angeles , CA	$505
University of Chicago Hospital	Chicago , Il	$1,153
University of Wisconsin Hospital	Madison , WI	$1,200
Beth Israel Deaconess Medical Center	Boston , MA	$1,017

Finding Affordable and Low-Cost Prescription Drugs

Admin — Sun, 26 Oct 2008 23:40:34 GMT

As the economy weakens, more people are looking for help from Prescription Drug Assistance Programs to pay for their medications . These programs are sponsored by pharmaceutical manufacturers and provide consumers with billions of dollars a year in free or low-cost drugs. In order to quality for this program, patients must meet very strict financial requirements. Here are some online resources where you can get help.

FINDING & NAVIGATING PATIENT-ASSISTANCE PROGRAMS

NeedyMeds.org online resource to find help with the cost of medicine Partnership for Prescription Assistance helps match patients to more than 475 private and public programs. This resource includes information on other types of assistance programs.

Partnership for Prescription Assistance helps match patients to more than 475 private and public programs. This resource includes information on other types of assistance programs.

RxAssist.org allows patients to search a database of patient-assistant programs by medication. Provides tips on free and low-cost medications.

DISCOUNT DRUG CARDS

Together Rx Access – sponsored by nine major drug companies, this free card offers 20% to 40% discounts on retail prices for more than 300 drugs.

Merck & Pfizer offer separate discount cards for many of their medications. Discounts range from 15% to 50%.

OBTAINING LOW-COST GENERIC DRUGS

Rx Outreach offers more than 350 generic medications at a cost of $20-$95 for 180-day supplies. Xubex Pharmaceutical Services offer more than 250 generic medications at a cost of $20-$30 for most 90-day supplies.

Walmart, Target and Safeway and other retail chains offer many generic drugs at $4 for a 30-day supply with no eligibility restrictions. Some retain chains have recently lowered prices on 90-day supplies to $10-$15.