Here are some highlights from this article:

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

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

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

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

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

By Sara McFarland

1. Demand price transparency and turn to transparency tools online
2. Compare competing facilities’ quality and take into account things like; convenience, technology, physician involvement and patient reviews
3. Negotiate pricing when possible
4. Understand that high costs do not always mean better care and bigger does not always mean better.

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

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

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

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

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

Travelocity for Health Care

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

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

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

Cheaper Care

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

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

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

High Deductibles

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

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

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

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

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

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

Wide Disparities

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

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

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

Treatment Options

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

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

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

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

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

Making the Effort

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

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

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

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

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

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

Source: RAND Corp.

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

Source: Aetna

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

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

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

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

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

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

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

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

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

The following guest article was contributed by Angie Hicks, founder of Angie's List.

When I first founded Angie’s List 15 years ago, I tried to help consumers find the best local home and property experts. Before I knew it, Angie’s List was offering consumer reviews in about 350 service categories in every major American city. A few years ago, responding to member demand, we began accepting reports on 150 health and wellness categories, as well.

Most health care consumers are more aware of their actual medical costs these days, thanks to health insurance changes. Angie’s List members, already conditioned to research what others are saying about local contractors before they hire, are applying those same investigative skills to health care providers. And they’re coming around to negotiating health care costs, as well.

Many consumers – including Angie’s List members – don’t know they can negotiate health care costs. More than half of respondents to a recent Angie's List member poll said they’d never tried to negotiate medical bills, but 74 percent of those who did were successful; some ended up paying less than half of the original charge.

This isn't a matter of trying to avoid paying a fair cost for health care. It's making sure you're paying the correct amount and accessing options that are available. Most of our members said they would happily shop around if they knew what to look for. So we partnered with Healthcare Blue Book to make that process easy for them. Knowing what the insurers will pay the doctor is key information to have before starting a negotiation.

Obviously, patients shouldn’t choose a doctor based on price alone. We’re working hard to offer reliable information on local doctors, based on real-life consumer experiences, so that part of the story can be seen as well.

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

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

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

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

• Deaconess offer a low, flat-rate price for three different medical imaging scans, so that consumers and their doctors know in advance the cost of certain tests, including CT Scans, MRI Scans and Diagnostic Ultrasound procedures.

• Deaconess works with the Radiologists, so the price includes both the Hospital and Radiologist fee.  

• One price for each of the three types of scans (regardless of body part), so that our pricing would be both simple and transparent.

• Consumers with high deductible health insurance plans with health savings accounts, consumers who have private health insurance plans with allowable fees above our new prices, as well as consumers who pay directly for their health care, can all save money.

• The new flat prices have reduced the costs for several insurance plans by reducing the mutually agreed upon contractual price.

• Deaconess recognizes that consumers make decisions based on the lowest cost and the highest quality.  Deaconess offers other features and services including the convenience of same day scheduling and a very quick turnaround of results.

• These prices do not apply to consumers with Medicare or Medicaid coverage.  The new prices set by Deaconess are above what the government pays the hospital and the hospital is not allowed to offer price discounts to either of these government plans.

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

First you need the tools to find the real price; the price that you will actually pay, not what a provider charges. Insurance companies and providers have a contractual relationship that disallows most providers from sharing negotiated discounts. If you don't have insurance the process is easier, but either way, you'll need to do your share of the research. The best place to start is the Internet.

Websites like outofpocket.com or your insurance company's site are the best places to start. They'll provide local prices for common procedures. If you don't like what you find there, then use search engines to look for the service you need based on price. Questions like "How much does an MRI cost?" will likely yield the results you need. I mention MRIs because it's something I know a great deal about. I own/run an MRI clinic that offers any MRI for a flat rate of $600 to every patient regardless of how they pay, insurance or not.

We have patients travel from out of our area on a regular basis. Recently we had a patient drive all the way from Minneapolis (We're located in Milwaukee). She reports to have saved almost $2500 for her trouble. In the past, patients have flown in from Texas, Colorado and Canada. American patients said that they were able to fly into Milwaukee, rent a car, stay in a hotel, go out for a great meal, and still have money left in their pockets from the savings. Canadian patients were happy to pay the $600 to have their scan months before they would have in Canada. The one thing that all of these patient/consumers have in common is that they found us on the Internet.

MRIs are just one example of a medical product where shopping around can save thousands. Nearly every medical procedure has an enormous range in price. Research is the key to savings, and the Internet makes shopping over a larger geographic area feasible. One word of warning, be certain to confirm any price you find on the Internet for any medical product or procedure, and be certain to verify quality before you travel anywhere (even across the street) in an effort to save money. Low quality medical services are not a value at any price.

Don't forget to buy me a T-shirt if/when you do decide to take advantage of medical tourism, my favorite is the old standby- "My friend went to Milwaukee and all I got was this lousy T-shirt" The savings will be all yours!

-- Contributed by Eric Haberichter

Eric Haberichter is co-founder of Smart Choice MRI , an outpatient health care facility that specializes in MRI services. Eric is passionate about quality and value in healthcare. He enjoys spending time with his family, practicing martial arts and enjoying the outdoors. Be sure to check out Eric’s new blog, The Debunker- Truth in Healthcare .

If you need to have a non-emergency MRI and live within driving distance of Milwaukee, Wisconsin, be sure to contact Eric at Smart Choice MRI. His outpatient facility will only charge you $600 for your MRI, regardless of who is paying the bill.

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

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

Last week I had the opportunity to use my local retail clinic, Take Care Clinic.  It was 5:30 PM when my daughter announced that her sore throat was “really bad.”  Since the pediatrician’s office was closed for the day, we decided to visit the Walgreen’s Take Care Clinic to have a strep throat culture.

When we arrived at the clinic, there were about six people ahead of us, all in line to get their $24.99 flu shots.  The clinic’s semi-automated queue let’s you know how many patients are ahead of you, because it’s first come, first served as you sign-in at the kiosk.   There is no administrative staff available to answer your questions as you wait in the queue to see the Nurse Practitioner (NP), who is busy seeing the patient’s ahead of you.

When our name was called and it was our turn, we were greeted by an assistant that took us into one of the two private rooms where we filled out the typical paper work (insurance card, driver’s license/id, reason for visit, age, birth date, etc.).  We asked for a strep throat culture and they took a brief history, including blood pressure, weight, height , and finally a throat culture…..  After this data was collected we moved into the next private room where we saw the NP.  The NP reviewed the chart and results of the throat culture.  She examined my daughter’s ears and throat.  She used her laptop computer to walk through a protocol (series of questions about my daughter’s health and symptoms).  We received a receipt for services, a prescription for antibiotic (her culture was positive) and were out of there in 45 minutes.  The clinic transmitted the Rx directly to the Walgreen’s pharmacy so all we had to do wait 10 minutes to have the prescription filled.

How do the prices for services compare?  Having never visited a retail clinic before, I had no idea what to expect.  The clinic list prices for their services, but it’s not always obvious what service the patient will need, in addition to a throat culture.  What I do know from past experience is that if we visit our pediatrician for a “sick visit” the pediatrician’s office charges $70 for the visit (this is the BCBS-IL negotiated rate for the service), and a throat culture is an additional charge of $27 at the pediatrician’s office.  If I went to my pediatrician for my daughter’s strep throat, I would pay $97 for this service (see table below.).

Conclusion

My visit to the Take Care Clinic was surprisingly expensive.  I was charged $108 for a new patient, comprehensive office visit and $17 for a rapid strep culture.  Total charges for this visit were $125.  I don’t think the “comprehensive office visit” was necessary. The clinic submitted the bill directly to my insurance company, and my health plan offered slight discounts (see table below.)  The convenience of visiting the clinic immediately, rather than wait to see the pediatrician the following day, was a great service.   The following day a staff member from the Take Care Clinic did a follow up call to our house to see how my daughter was feeling and asked if we had any questions --that’s good customer service.  After this visit I researched and discovered that I could have just had the rapid strep throat culture done, without the added cost of an office visit at the clinic.  It appears that they over treated my daughter at the clinic.  All we asked for and all she needed was a rapid strep throat culture, but they unnecessarily did a full office visit.  Had I know this when I went in, I would have demanded a “strep throat culture” only.  Next time I will know better and hopefully, you’ll learn from my mistake.

Out-of-pocket expenses

Here’s what I learned:  the two most blatant culprits of the overcharges were due to Secret Prices and Coding Errors/use of an Internal Coding System…I’m sure that’s no surprise for OutOfPocket Blog readers.

A little background

It was suggested that I go to the Emergency Room by my doctor who had prescribed a course of oral antibiotics for an infection. I then came down with a stomach virus and was unable to keep down the medication.  My infection progressed, so my doctor instructed me to go to the ER for IV antibiotics.  I went, received excellent care, stabilized within six hours, went home and had a full recovery.

Then I received my first billing statement.  Those antibiotics and basic blood tests cost $7,051.  Then my PPO policy negotiated it down to $3,525, with no explanation.  These prices seemed so arbitrary to me, I just wanted to know they were fair and reasonable, as determined by industry standards. 

By working with a patient advocate at Southwest Bill Review, I learned that up to 90% of all hospital bills are coded incorrectly.  My patient advocate told me that there is supposed to be transparency in the billing system – and that there are definitive coding guidelines that apply to each hospital.  However, this hospital administers their own coding system – making it impossible to determine exactly what is being charged.    I learned that this is very common.

I then developed a 10-step-process to hospital negotiation. My hope is that this information will help people navigate through the current medical billing system.

The 10-step-process can be found at my blog, Hospital Overcharges 101. Also be sure to check out the Youtube video of my experience.

Free Medical Cost Savings Tips For All

I can be followed on Twitter at: MedOvercharg101 and the Facebook Fan Page, Medical Overcharges 101 – when the 140 characters on Twitter just isn’t enough. 

--By Lynn Jordan

Lynn Jordan is an award winning freelance producer and writer having worked in the television and live event production industries.  This is her first time with the hospital billing system and her hope is that what she has learned will help other people confront their medical bills.

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

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.

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. 

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!

• Children's Dental Clinic, 2100 Ridge Ave., Evanston. Call the clinic at 847-866-2953.
• Cook County Department of Public Health Dental Clinic, Suite 250, 2121 E. Euclid Ave., Rolling Meadows, Illinois.  Patients must live in Cook County and meet income guidelines. The clinic, in the Rolling Meadows branch of Circuit Court, accepts patients by appointment. Call the clinic at 847-470-7398.
• Northwest Community Hospital, Mobile Dental Clinic, 800 W. Central Rd., Arlington Heights, Illinois. The clinic accepts Public Aid and Kid Care.  Fees are charged according to sliding scale. All patients must be screened before receiving treatment. Call the clinic at 847-618-5573.
• Waukegan-Belvidere Medical Clinic, 2400 Belvidere Rd., Waukegan, Illinois. The clinic offers dental care for ages 3 and older. Patients must reside in Lake County. It accepts Public Aid and Kid Care and charges fees on a sliding scale. Call the clinic at 847-360-6525.

If you know of other clinics that offer affordable dental, vision or medical services, please send us an email so we can share this information on our blog with other consumers.

Mona Lori
info@outofpocket.com

Ask the provider upfront (before services are delivered) for a price break. Each provider has their own rules about negotiating bills, and you should always ask. Explain your circumstances and offer to pay cash at time of service or develop a payment plan.

Bill review. Be sure to review your medical bills for possible errors. I can’t tell you how many times I found small errors on my medical bills just by casually browsing through the detail. As soon as the bill arrives, read through all the line items and make sure that you are being charged the correct price and charged only for services you received. Medical billing errors occur all the time. Why pay more than you have to? I am assuming you already review many of your household bills (cell phone, utilities, cable, appliances, groceries, auto insurance) for accuracy. Treat your medical bills with the same level of scrutiny.

Compare prices using online tools. Insurers sometimes provide their members with tools to look up out-of-pocket costs for a specific plan. Other online tools are available to give you an idea of a fair or estimated price for a specific service. The more you know about fair pricing, the better price you will be able to negotiate. In addition to outofpocket.com be sure to check out healthcarebluebook.com , AMA CPT online, and costhelper.com to look up prices for services. For a more complete list of price tools, refer to the this list of price transparency tools. Remember also that where you go to receive care can also make a big difference in your costs. Emergency-room visits tend to cost $300 to $1000, compared with $150 at an urgent-care center, $65 to $75 at a doctor’s office, and $35 to $45 at a convenience-care clinic. For non-emergencies, it pays to call your insurer’s 24-hour advice hotline for guidance on where to go for care. Make sure the facility and provider are in your health plan’s network. In fact, don’t wait for an emergency to find the nearest ER or urgent care center in your network. Look it up now and keep this information handy so you can easily refer to it in case of an emergency, when it is often difficult to make cost effective decisions.

Discounts can make a big difference. You should make the most of discounts that are available to you from your insurer, dental/vision programs, prescription medications, and incentives from your employer. All these discounts help reduce your medical bills. Many insurers offer discounts on services to promote healthy lifestyles, including gym memberships, smoking-cessation and weight loss programs, chiropractic service and acupuncture. Ask your insurer or employer about these programs. Providers also offer discounts for paying in cash, or paying at time of service.

Did you know:

• The national average cost of an MRI is nearly $2,000
• Heart bypass surgery costs about $57,000
• The average cost of a 30-day prescription of one name brand drug is $71 compared to $22 for the generic equivalent
• National healthcare expenditures are expected to nearly double over the next 10 years

Knowing what you're spending and keeping an eye on health care costs are important parts of keeping health care affordable for all of us. Here are some things we can all do to make a difference:

• Ask for FDA-approved generic drugs instead of more expensive name brands
• Make sure you're getting the right treatment, and always ask your doctor any questions you may have
• Review all explanation of benefits for accuracy, and ask about any costs that you don't recognize or understand.
• Understand what your out-of-pocket costs will be before you receive medical services. Online tools are available for consumers to look-up average prices if your insurer or provider cannot answer this question.

Price variations for healthcare services, even within the same market and provider network, may be thousands of dollars. So knowing what the fair price is can help consumers better manage the cost of their health care. Unlike many other health care price tools, Healthcare Blue Book is very easy to use.  Type in the kind of healthcare service needed plus a zip code and the Healthcare Blue Book pulls up the fair price based on fees paid by Preferred Provider Organizations (PPO) to doctors for services in that market. Consumers can then use the suggested Healthcare Blue Book price to discuss prices for services and treatments with their doctors and other healthcare providers.

Americans do price/value comparisons for their homes, cars, vacations and the majority of goods and services they buy. “Why not healthcare?” asks Dr. Jeff Rice, Healthcarebluebook.com founder. The former CEO of CareSteps, Rice has a long history in the healthcare industry of developing innovative products for consumers.

“Patients should not assume that a high price means good quality,” says Rice. “It is up to patients to ask about the cost of services and to learn about the quality of their providers. Doctors and hospitals that charge a fair price, often provide the best value. Healthcarebluebook.com can help consumers figure out what they should pay.” Consumers need better education about the healthcare services they purchase and 2009 is a good year for them to start. Using the Healthcare Blue Book can help people learn how to obtain fair prices for their healthcare.

In addition to fair pricing, the website provides information on useful resources for patients including a list of websites by state that provide health care pricing.

An article in the Los Angeles Times Health Section, Cut health costs, not your care,  provides some valuable tips and techniques to help you reduce your health care costs  - while you continue to take care of your health. Here are some of the highlights:

Saving Money on Prescription Medications

• Compare drug prices before making a purchase by using tools like destinationrx.com and drugstore.com
• Save up to 80% by selecting generic rather than brand-name drugs
• Consider purchasing your medications in bulk to save money
• Do your research to find drug companies offering discounts on brand-name drugs
• Consider purchasing medications online (be sure to visit the U.S. FDA site for consumer information)
• Look for discounts on brand-name drugs by searching for coupons at www.internetdrugcoupons.com

Save Money on Doctor Visits

• Stay proactive about your health.  A doctor visit is a lot less expensive than an emergency room visit.
• Use network providers whenever you can.  Ask network providers for referrals from your network if you need to see a specialist.
• Consider bartering to help pay doctor fees. 
• Utilize retail clinics for non-emergency medical services
• Utilize urgent care centers rather than emergency rooms for conditions that are not life threatening
• Visit community health centers to locate medical help at low cost.
• Use resources like public libraries to find affordable medical services in your area.
• Contact disease/condition foundations for additional resources and options on affordable screenings.
• Negotiate a price for services if you are paying cash to save 50% or more off the list price.
  

Doctor Review Websites

The November 28 edition of Slate.com included an interesting article by Dr. Kent Sepkowitz.  His article sheds some light on all the doctor rating websites available today.  Dr. Sepkowitz spent many hours reviewing doctor rating tools, including free sites and sites that require subscriptions or fees to obtain this information.  His conclusion:  the online doctor rating tools are very lean, content-free and lack any useful information. 

Last month I posted a blog about finding the best value (understanding the quality side of health care in addition to finding the best cost) and listed 25 different websites that offer doctor ratings.  I neglected to mention that I never use these doctor rating sites because they are not useful.   They lack meaningful data.  All of them.  Instead, I ask my doctors, family, friends, and community for their personal recommendations.  Then I go online and start to research the doctor’s certifications in more detail using many websites, tools and blogs to read other patient’s comments and experiences.  Since this is user generated content, you need to be able to read between the lines.  Sometimes people just have a bad day and they should skip writing reviews online until they have 24 hours to think about what they want to write and their mood stabilizes.

Price Transparency Tools

I am dedicated to promoting price transparency in health care.  This is what I do and that’s why I launched OutofPocket.com almost two years ago.  If I can help consumers make more informed and cost-effective choices before visiting a provider, then I have accomplished my mission.   When consumers start making more informed choices, become active participants in their own health care and demand greater transparency  --- good things result including lower costs, more innovation, more choices and improved access to medical care.
 
OutofPocket.com is not the only price transparency tool available.  Dozens of others are out there and I research all the new tools to evaluate their usefulness so I can talk about these tools in my next presentation.  Unfortunately, the price transparency tools seem to have the same disease as the doctor rating tools.  Each has some amount of data, but not enough to be meaningful and comprehensive.  Wouldn’t it be interesting if these tools collaborated and consolidated their data to produce a robust tool where shopping for routine health care servcies would be comparable to the experience of shopping for items using eBay or Amazon.com, where you can easily compare quality, prices and recommendations?

Here is the short list of 20 price transparency tools.  If you would like my comprehensive list and review of each tool, please send me a note and I’d be happy to forward this information to you.

Alijor
AMA CPT Lookup Tool
Carol
CostHelper
DoctorPricing
HealthcareBlueBook
HealthPricer
HospitalVictims
MainStreet Medica
MedcareCompare
MyHealthScore
MyMedical Costs
MyRegence
OutofPocket
PatientCare
RemakeHealth
Spectrum Health
UCompreHealthCare
USA Healthcare Costs
Vimo