Consumers of health care services don't have a clear understanding of just how much medical services really cost.  For many years, health plans insulated members from the true cost of these services by making payments directly to doctors or hospitals. As a result, consumers received medical services for co-pays as low as $10, or some plans provided these services at no cost to the consumer. With the rise in consumer-driven health plans, it’s important for consumers to understand the true cost of medical services, and be knowledgeable about finding the best value before visiting a provider. Here are some interesting facts on what these services really cost.

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.

You’ve heard of the Kelly Blue Book, a trusted resource for looking up new and used car prices. Now there is a Blue Book of health care prices. A new website recently launched to help consumers look-up fair prices for health care services. The website, Healthcare Blue Book is an excellent resource to help consumers make informed choices. If you have ever wondered if you were being overcharged for health care services, or what a specific service might cost - this website can answer those questions. The health care Blue Book fair price is the cash price consumers should pay for a service or product at the time of treatment. It is the payment amount that many high quality health care providers accept from insurance companies as payment in full. Americans can’t control the economy, but they can do a much better job of educating themselves about what they should pay for health care.

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.

Thank you for your interest in our community directory of health care prices --OutofPocket.com.  Over the past several months we have been fine-tuning the OutofPocket server and database to provide consumers with more meaningful price information.  At this time I would like to invite you back to take another look at www.Outofpocket.com.  The directory helps consumers look-up prices for routine health care services by utilizing a custom search engine that collects prices from consumers, providers, Government databases and public websites.
 
Can't find what you're looking for in the OutofPocket.com directory? 
 
We rely on consumers to post/share prices they paid for actual medical services, to share with other consumers.  We also invite providers to list their services/prices in the directory free of charge. The more prices that are added to the directory, the more meaningful the directory will become for everyone. Just imagine how interesting the directory would become if 500,000 consumers posted out-of-pocket prices they paid for actual health care services.
 
Do you have ideas on how we can improve this price transparency tool?   Have any tips to share with us?
 
Send me an email at mona.lori@outofpocket.com.  I'd love to hear from you. 

In this economic downturn, consumers are aggressively looking for ways to cut back on expenses – including health care expenses.  Three and half million people have lost their jobs and their health insurance.  People that have health insurance are paying more for premiums, co-pays and deductibles and employers are passing on more health care costs to their employees.  Health spending is rising faster than wages and many are forgoing medical services in an effort to cut back on health expenses.   People are cancelling gym memberships, eating more unhealthy (comfort) food in these tough economic times, skipping medications to save money, experiencing more stress than ever before, going without health insurance and delaying preventative care.

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.
  

In the Personal Journal section of today’s print version of the Wall Street Journal, Aetna has a full-page ad.  The headline of this ad, “How Aetna can even help you keep your wallet healthy,” caught my attention because the ad promotes a few tips on how consumers can keep health care costs down including:

 

·         Use generic prescriptions rather than brand-name

·         Use mail order service to fill prescriptions

·         Preventative care to keep yourself healthy

·         Stay in network when selecting providers (hospitals, doctors)

 

I have a tip for the health insurer --  why not keep health care costs down by eliminating expensive advertising!  I wonder how much this full-page ad cost Aetna.   With the rise in health care costs, including insurance premiums, cost of service, and administrative fees, I find it disconcerting that health insurers spent so much money on this ad.  If I had my choice, I would prefer my health insurer save me money and reduce my monthly premiums, rather than spend extravagant amounts of money on unnecessary advertising. No offense Aetna, but with health care costs spiraling out of control, consumers are more interested in reducing their out-of-pocket costs.   I’m not sure this ad keeps my wallet healthy.

 

 

Happy New Year!  Spending wisely for health care services is definitely a priority in 2009 and with a little knowledge; you can easily save hundreds –even thousands of dollars.   To get you started, here are some excellent tips on how you can save money on routine health care services. 

 

Affordable Medical Care Services

 

Federally-funded by the Health Resources and Services Administration (HRSA), there are thousands of health centers around the U.S. that provide low-cost health care to people based on financial need. You pay what you can afford, based on your income. For more information visit www.findahealthcenter.hrsa.gov, or you can call (888) 275-4772.

 

Hill-Burton facilities: There are around 200 Hill-Burton health care facilities around the country that offer free or reduced-cost health care for people that cannot afford to pay for services.  To locate a facility or to see if you qualify, visit www.hrsa.gov/hillburton or call 800-638-0742.

 

Free clinics: These are privately funded, non-profit, community-based clinics that typically provide care for common illnesses and injuries to those in need, at little or no cost. There are around 1,000 free clinics nationwide. To locate one in your area, call your local hospital or visit www.freemedicalcamps.com for more information.

 

Indian Health Service (IHS): A government agency within the Department of Health and Human Service, IHS provides free medical care to American Indians and Alaska Natives in 35 states. Visit www.ihs.gov for more information.

 

Remote Area Medical: A non-profit, charitable organization that provides free health, dental and eye care to uninsured or underinsured people in remote areas of Tennessee, Kentucky and Virginia but may be expanding to other states in the future. Visit www.ramusa.org or call (865) 579-1530.

 

Affordable Eye Care/Vision Services

 

To locate free or discounted eye care or eye glasses programs in your area, you should contact your local Lions Club. Call 800-747-4448 to get the number to your state Lions Club office, which can refer you to your community representative, or visit www.lionsclubs.org. There are also a variety of national eye care programs that can help you too including:

 

EyeCare America is a public service foundation of the American Academy of Ophthalmology that provides free eye health educational materials and access to medical eye care.  Visit www.eyecareamerica.org or call (800) 222-3937. 

 

Vision USA offers free vision care services to uninsured and low-income workers and their families.  Visit www.aoa.org or call (800) 766-4466.

 

Mission Cataract USA provides free cataract surgery to people who don't have Medicare, Medicaid, private insurance and are low-income. Visit www.missioncataractusa.org or call (800) 343-7265.

 

New Eyes for the Needy is an eyeglass program that accepts donations of used prescription eyeglasses and distributes them to people with limited incomes. Visit www.neweyesfortheneedy.org or call (973) 376-4903.

 

Affordable Dental Care

 

Many people with health insurance do not have dental insurance.  Here are some affordable options, depending on where you live.  Call your state dental association, or local dental society (visit www.ada.org/ada/organizations) to find out if there are any state or local programs, or clinics, that offer discounted dental care to those with limited income. Other sources you should checkout:

 

Health centers: In addition to low-cost health care, many HRSA health centers also offer dental care too. Visit www.findahealthcenter.hrsa.gov or call (888) 275-4772.

 

Dental schools: If you don't mind letting a dental student work on your teeth, dental schools are another source that may offer discounted dental care. Visit www.ada.org - click on “Dental Schools” for a U.S. directory and contact information. 

 

National Foundation of Dentistry for the Handicapped is a service that provides free dental care for elderly and disabled people who can't afford to pay. To learn more or to apply for care in your state, visit www.nfdh.org or call 303-534-5360.

 

Are You Eligible for Medicaid or Assistance Programs?

 

To find out if you're eligible for Medicaid, prescription drug assistance programs, visit www.benefitscheckup.org. Also, see www.needymeds.com, a top resource for finding affordable medicine.

 

Source: These tips were provided by Jim Miller, contributor to the NBC Today show and author of “The Savvy Senior” book.

 

 

Affordable Lab Tests

 

If you need to have blood tests done, you have several options on where you can go to get affordable lab tests. 

 

If you are looking for preventive testing, consider attending health fairs at schools and churches. A company called Life Line Screening offers finger stick blood tests for glucose and lipid panel (total cholesterol, LDL, HDL, triglycerides) for $60. Results are provided on the spot. Go to lifelinescreening.com or call 800-697-9721 to find out when the next local screening is scheduled. 

 

Also be sure to contact community centers, library, and YMCA or village hall.  These organizations often schedule affordable blood screening fairs once or twice a year.  Check with the health services department of your village or township to get more information.

 

If the need for additional tests comes up during a regular checkup, you can start by asking your doctor to cut the cost—to cost. Ask whether you can get involved in a clinical study; that way the blood work might be done for free.

Non-profit hospitals and most other teaching and community hospitals offer a sliding fee scale of discounts for people with no health benefits or insurance, but you have to ask. Call the hospital's financial services office and tell them your situation. Or, offer to pay in cash-- you just might get you a discount.

 

The ambulatory clinics are another option, but you have to make an appointment to see a doctor first. You'll be billed for the tests, but the hospital will help connect you with services you might be eligible for. Also check out community health centers. 

Finally, while it might be hard to discuss, tell the doctor—or office manager—your financial situation and see what he or she recommends.

 

Be sure to check out some of the online lab ordering websites including DirectLabs, LabSafe, MedLabUSA, MyMedLab and PrivateMDLabs. These lab sites offer large discounts and have drawing centers located in many different neighborhoods.

 

Source: These tips were provided by Julie Deardorff in her Health column in the Chicago Tribune.

 

 

Wishing you a happy, healthy New Year!

 

Mona

 

 

You might have noticed that a lot of prices are missing from our OutofPocket.com directory.  OutofPocket is currently under construction and we appreciate your patience.  We are making some enhancements to the site and in this process; the majority of our price data is temporarily not searchable.  During the construction phase, what you will see when searching for prices on OutofPocket is a link to websites that publish health care prices.  Please be patient and check back in a few weeks.  In the meantime, I would like to encourage as many consumers as possible to post/share prices you paid for actual services, contact us about a great site to add to the directory or link to, or if you are a provider – send us your prices so we can include them in the directory.

Making Sense Out of Existing Data

Did you know that health care price data exists today --it's just not available to the public. I am passionate about bringing consumerism to health care, and dedicated to promoting price transparency.  My goal is to make sense of the existing price data to help consumers make informed choices. 

For CONSUMERS

• Hunting down true out-of-pocket expenses for health care services – in advance, can be frustrating.  Unless you are an experienced data minter, this type of hunting can be intimidating and time-consuming.  If you are uninsured, under-insured, looking for an out-of-network provider, or have a high-deductible health plan, you are probably trying to make cost-effective choices before purchasing health care services.  And you are probably interested in knowing your true out of pocket cost for the services BEFORE you visit the provider.    That’s just being a good consumer.  You need useful and relevant tools to help you make good choices.

For INSURERS

• You are the keeper of all the claims data for your members.  You know exactly the negotiated (contracted) price for every provider, for every service, for every different insurance plan you offer.  You also know how much of a member’s deductible has been met.  You have databases of prices paid for every service for every member and could make life a lot easier for your members and possibly change health care if you agreed to share this data to make it publically available.  Yet you insist on keeping this data a secret. 

For OUTOFPOCKET.COM

• I am inviting consumers to post/share prices they paid in the directory.   Everyone wants to look up prices, but very few are willing to take a minute to post/share their prices.  We could wait years for legislation to pass, insurers to agree to make prices public, or we could do something today.  Consumers are invited (and encouraged!) to collaborate and share prices they paid on OutofPocket.com.  If enough consumers participate and share prices, consumers collectively will create a very powerful directory of true out-of-pocket prices.

For PROVIDERS

• You have an opportunity to transform health care as we know it today.  You can help promote transparency by publishing your prices for services.   Why not let consumers know up front what your services will cost them?  OutofPocket.com invites you to include your prices/services in the directory - free of charge.  This not only promotes your practice, but also helps consumers understand what they will be required to pay for services at your facility.

Imagine how easy it would be to comparison shop for health care services if relevant data was available. If consumers had access to true healthcare price data, comparison shopping for health care services could be a lot like your experience shopping for a book on Amazon.com, booking a vacation on Travelocity.com or purchasing an item on eBay.com. 

Tell a friend about OutofPocket.com and be sure to add prices you paid for health care services to this directory.   Not only will you be sharing data, but you will be contributing to a powerful directory of prices that will help promote more affordable health care services.

Are these tools useful?

Doctor Review Websites

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

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

Price Transparency Tools

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

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

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

Doctor Ratings

 

I love the idea of empowering consumers to exercise choice, encouraging them to become an active participant in making decisions about their health care, and incenting them to find the best value before seeking health care services.  It’s important to note that value is about quality and price so if you end up finding the lowest-cost provider, but the quality of service is less than desirable – you have not found a good value.  I often use recommendations from family, friends and community members when researching a new doctor, facility or hospital.  Asking consumer’s questions like, “what did you think of that doctor? Would you recommend their services? What didn’t you like about the facility?”  These are all very helpful questions for you to ask when trying to learn about a new provider.   

 

If you’d rather use online tools to lookup recommendations and ratings of doctors, there are a number of sources available.  For additional information, you can read a white paper on MD Rating Websites: Current State of the Space and Future Prospects.  Ruth Given has written a 39-page analysis that takes a comprehensive look at many of the doctor rating sites that exist today.

 

Here’s a list of doctor rating websites to get you started.

 

alijor.com

angieslist.com

bookofdoctors.com

careseek.com

checkMD.com

doctorfeedback.com

doctorscorecard.com

drscore.com

findadoc.com

healthcare.com

healthgrades.com

healthworldweb.com

kudzu.com

mdnationwide.org

mydochub.com

ratemds.com

remarkabledocs.org

revolutionhealth.com

suggestadoctor.com

thehealthcarescoop.com

vimo.com

vitals.com

wellness.com

whitecollarfinder.com

zocdoc.com

 

Do you know how to find affordable lab tests?

 

Fortunately I have good health insurance.  Four years ago I signed up for a high-deductible health plan for my family in order to keep our premiums down.  My deductible is $5,200 and as a result, I am getting really good at shopping around for the best value, negotiating cash prices with providers, calling around to get prices and using available tools/resources to comparison shop/understand fair prices.  The more money I am able to save on finding affordable health care, the more money I have to spend on family vacations.  That’s enough incentive for me.

 

My health insurer has negotiated special deals (discounts) with providers in my network.   When I use these network providers, I am charged the discounted rate for services.  This carefully guarded rate is difficult to find out until after services are provided because health insurers keep negotiated prices a secret.  That’s why I encourage consumers to post/share rates they paid for actual services in OutofPocket.com directory, to share with other consumers.  If insurers and providers will not reveal these prices, consumers should!

 

I recently had a series of blood tests done that were required for my upcoming surgery.  I realized if I went to my doctors office to have these blood tests taken, my out-of-pocket costs would be much higher, so I selected a stand-alone lab testing facility that offers affordable lab tests.  I went online to find Quest Diagnostics and scheduled my appointment.  I just received my EOB and here’s what I discovered

 

Prices For My Lab Tests for Comprehensive Blood Test

Total Quest Labs billed to my insurance plan      $ 193.78

Total discounted by my insurance plan                 $ 143.78

Amount of my out-of-pocket for my lab tests         $   50.00

 

If I wasn’t careful, I could have easily ended up paying a lot more for my lab tests.  If I did not have insurance, I would have negotiated a cash discount with the lab when I scheduled the service, to make sure I get a fair price.  Because of my cost-effective choices, I saved about $144.

 

Here are some resources you can use to find affordable lab tests in your area.

 

www.PrivateMDLabs.com

www.MedLabUSA.com

www.DirectLabs.com

www.LabSafe.com

www.MyMedLab.com

www.QuestDiagnostics.com

 

 

A recent blog post on Health as Human Capital Foundation shares an interesting research summary on hidden health care prices. The research focuses on an employer that analyzed their employee health care costs and spending patterns for MRIs of the knee. They analyzed MRI costs from six local facilities in one metropolitan area and here’s what was identified:

• Amounts paid by the employers two health insurance companies for MRIs ranged from below $700 to more than $2,400
• Amount billed to the employer’s insurance companies (before discounts were applied) ranged from $1,100 to over $4,000
• Approximately 300 MRIs were done annually in this population. If employees were to choose the lowest-cost provider for an MRI instead of the highest-cost provider, it would save the employer about a half a million dollars per year for just one type of diagnostic procedure
• If an individual consumer shops around for the best price for an MRI, they can save themselves hundreds of dollars on this diagnostic test. If all employers/employees in one city shopped around for the best value, imagine how many hundreds of millions of dollars per year could be saved on health care costs just by choosing the lowest-cost providers?
• Why don’t employers simply require their employees go to the lowest-cost provider? The employees don’t know who the lowest-cost provider is. This information is not available. Health plans carefully guard ‘secret’ payment information because they have different negotiated prices with different providers. They don’t want one provider to discover that another provider is being reimbursed more for the exact same procedures. So when an employer chooses a health plan for its employees, the negotiated prices for services are already set. Services provided will be reimbursed at the plan’s negotiated amount (whatever that is).

Other interesting facts

• The rate of MRIs has tripled over the past ten years
• One-third of the MRIs provided are considered unnecessary
• MRIs generate significant revenue for health care facilities. Often there are financial incentives encouraging their use
• Studies indicate that radiology costs (includes x-rays, MRIs, CT scans) have risen faster than any other category of health care costs

Consumers --- do your homework and research prices BEFORE visiting a provider. Use available tools, make phone calls and compare prices and quality before you decide on a provider. You can save yourself hundreds, and possibly thousands of dollars annually.

Employers -- provide comparison shopping tools for your employees to use to help them make informed choices. Employers can also encourage and incent employees to make cost-effective choices. This not only reduces health care expenses for employees, but also reduces employer health care costs. A win-win situation.

Today there are about 46 million uninsured Americans and this number continues to increase as the recently unemployed lose their jobs and join the uninsured.   In these tough economic times, you have to ask yourself “how do all these uninsured consumers shop for affordable health care services when they need medical attention?”  Regardless if you are uninsured or insured, how much more can you afford to spend on out-of-pocket costs?  Many of us are living on very tight budgets and need to make the most of our health care dollars.  Protecting ourselves from being overcharged for medical costs and finding affordable health care service is more important today than ever before.

 

With the holidays approaching in this economic downturn, consumers are responding by tightening their budgets, becoming more cost conscious and relying more heavily on comparison shopping engines to help them shop around for the best value.  The same behavior applies to shopping for health care services.  Unfortunately most consumers have no idea how to comparison shop for health care services.

 

A new start-up, Out-of-Pocket Protector, works with consumers to protect them from inflated costs and billing errors.  If you have read my earlier posts you already know that I strongly encourage consumers to do research upfront --before you even visit a provider, to make sure you negotiate a fair price for service.  If for some reason you skip the research step and find yourself needing a second opinion to review your medical bills for errors, and possible overcharges, there are a number of services to help you through this process.  Ideally, consumers would take charge of this on their own, but if you feel intimated by the whole process, you can take comfort in knowing that services are available to help you.  These services often charge membership fees or charge you a percentage of the money they are able to save you.  One such service is called Out-of-Pocket Protector (no relation to OutofPocket.com).  According to Out-of-Pocket Protector, what sets them apart from competitors is their “focus on the whole process, from finding and negotiating affordable care upfront, to offering consumers a second opinion on their medical bills after they receive care.  The vast majority of consumers want to promptly pay a fair price for the health care they receive.  With help, that’s just what our members are able to do.” Membership for this service is $14.95/month or $165/year.  If you would like more information on this service visit www.outofpocketprotector.com.

 

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

 

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

 

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

 

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

 

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

 

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

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

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

 

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

 

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

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

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.

Finding the best value for health care is not just about finding the lowest cost provider.  Value has everything to do with price and quality.  Today it’s very difficult for consumers to find useful and meaningful information on doctors.  To help you make informed health care choices, I’ve identified four online tools to help you do your homework ---before choosing a hospital or medical professional for your surgery, procedure or treatment.

 

Quality Check

 

This tool provides hospital performance reports with information by medical specialty. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) obtains information about accredited organizations not only through direct observations by its employees, but also through direct communications from those accredited organizations and from measurement companies hired by accredited organizations and accepted by The Joint Commission as sources for performance measure data. 

 

Hospital Compare

 

This Government online tool on the U.S. Department of Health & Human Services website provides information on how well hospitals care for patients with certain medical conditions or surgical procedures, and the results from a survey of patients about the quality of care patients received during a recent hospital stay.  This information can help you compare the quality of care hospitals provide. 

 

American Nurses Credentialing Center

 

This online directory is provided by the American Nurses Credentialing Center (ANC).  The directory identifies hospitals and health care organizations that are part of the Magnet Recognition Program, which identifies centers of nursing excellence.  This designation is considered to be the gold standard and many hospitals don’t make the cut.

 

Board Certified

 

This helpful online tool on the ABMS website allows you to confirm if your physician is board certified in his specialty.

 

Doctor Information

 

The Federation of State Medical Boards (FSMB) online tool provides professional information on physicians and physician assistances licensed in the U.S., and includes information on disciplinary sanctions, education , medical specialty, license history and locations. 

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

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

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

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

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

MyHealthScore online tool to look up fees for specific procedures

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

VIMO search tool to compare medical procedure prices at hospitals

How to find a low-cost MRI

 

Everyone is talking about “consumer driven health care” and “price transparency”.   What does this really mean and how does this benefit you?  Recently, there have been a number of unrelated blogs written by consumers describing their experience shopping around for the best price for an MRI.  The fact that consumers are shopping around to find the best price for health care services, calling providers and facilities -is a positive statement about consumers taking more control of their own health care and making smarter decisions.   This is what consumer driven health care is all about.

 

To provide you with some background, an MRI is a diagnostic test that can cost consumers anywhere from $400-$3500, depending on where you go for the test, and what insurance you have (or don’t have).  There is a huge disparity in MRI prices so it definitely pays to shop around to get the best deal.  Consumers can save hundreds of dollars if they comparison shop before scheduling an appointment for their MRI because stand-alone diagnostic facilities offer more competitive prices than hospitals. 

 

Two years ago I began my quest for the true price for an MRI.  Since my experience,many other consumers have been blogging about their own experience and how they shopped around to find the best value.  Here are a few blog entries from consumers that I thought were worth sharing.  After reading these stories, you will have a better understanding of the problem with our current health care system and how you can be a smarter health care consumer.

 

The Cost of a Hospital is Difficult to Pin Down

How Much Does an MRI Cost?

An MRI from Wake Forest

Shopping for an MRI

Quest for the True Price for an MRI

The Priceless MRI

 

If you would like to learn about some of the price transparency tools available today, download my research here.

 

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

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

Beware of out-of-pocket costs

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

Quest for the true price of an MRI

Why would a consumer overpay for any health care service?  This happens all the time because consumers have no idea what they are being charged for a service, and they have no idea what the fair price is for this service.  Since our health care system doesn't provide consumers with meaningful tools like Amazon.com, Expedia.com or Travelocity.com to research and compare prices/services --consumers are basically on their own to determine the best value.

I just read about a consumer that paid $1900 for an MRI at Wake Forest Baptist Medical Center.  The consumer has BCBS health insurance so we are not talking about an inflated price for someone that is uninsured.  About six months ago I conducted research on "the quest for the true price for an MRI".  I ended up researching 50+ tools available to consumers to help determine the price of an MRI at many providers around the country.  The results:  an MRI (in this example for a knee) can cost a consumer anywhere from $600 (in Milwaukee at SmartChoice MRI) to $3500 (Dartmouth Hitchcock Medical Center in New Hampshire) - for the exact same diagnostic test. An MRI is an MRI is an MRI.  Isn't it?  So why the huge variance in price?  In fact, if you are charged more than $1000 for an MRI I would suggest you negotiate down the price, offer to pay cash at time of service and start negotiating with the price that Medicare reimburses providers for an MRI- which is $463.  You can download a copy of my research here.

To help you make the most of your health care dollars and find the best value for routine services like MRIs, x-rays, mammograms, vaccinations, office visits, lab tests, vision and dental services, I suggest you use OutofPocket.com to compare and share prices of health care services so you know what others are paying for similar type of services.  Information can be powerful.  

Consumers are starting to find more cost-effective options for elective surgery by traveling to foreign countries where they have the procedure done and save themselves tens of thousands of dollars. A Wall Street Journal story in late September reported that an open heart surgery in the U.S. can cost about $100,000 and can be done an at internationally accredited hospital in India for only $8,500. A hip replacement surgery in the U.S. averages $45,000-$50,000 but can be performed for $12,000 in Singapore.

According to the Deloitte Center for Health Solutions, 750,000 patients traveled abroad in 2007 for in-patient and outpatient procedures. A private health-care provider in Singapore says the number of U.S. patients they treated in 2007 doubled from a year earlier.

What’s interesting is a growing number of insurers are starting to realize the cost-savings of medical tourism. Not only does the insurer save money, but the employer and the employee also benefit from the reduced costs. For the complete story on Paying Workers to Go Abroad for Health Care, be sure to read the article in the Wall Street Journal

When it comes to saving money and shopping around for the best value when purchasing groceries, books, electronics, clothing, automobiles, and vacations - you have the tools you need to help you find the best value. You know how to compare costs, clip coupons, look up prices and research recommendations to determine value. But do you know how to save money on your prescription drugs, contact lenses, dental care and doctors visits?  CNN.com recently published an article to help you save money on drugs and doctors. The article covers tips on:

Dental Care: Have you considered using dental schools for your next dental check-up? These schools charge a lot less than regular dentists. The American Dental Association publishes a list of accredited dental schools you can review.

Contact Lenses: Why pay more than you have to for contact lens? You can purchase your next pair of contact lenses online and save yourself up to 50% of what your eye doctor charges for the exact same contacts. Here is one of many online shopping sites to compare costs.

Prescription Drugs: If you don’t have a sufficient prescription plan, why pay more than you have to when you fill your prescriptions? The Consumer Reports Best Buy Drugs website tells you if there is a less expensive drug that could work the same as the one you’ve been prescribed.

Hospital Bills: It is common knowledge that hospitals often make billing errors. You should always review the detailed charges on your bill, and expect to find errors. The Patient Advocate Foundation will help you review your medical bill for no charge.