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It’s the Prices Stupid
Consumer Driven Health Care Revolution
Taking the mystery out of health care prices
Lessons learned from auto insurance
Making the most of your health care dollars
Health Maven!
Personal Responsibility and Financial Incentives
Affordable Prescription Drugs
Make sure you understand the fine print on your health insurance policy
Using Urgent Care Centers instead of Emergency Rooms
Getting Charged for Free Exams
Shopping for radiology tests online
Assistance programs for low-income patients
Resources to help you decipher and negotiate hospital bills
How Much Does It Cost to Have a Baby?
Saving money on out-of-network costs
Affordable Lab Tests
Smile. It's free
Cost of an MRI
What’s my out-of-pocket for this service?
YouTube video on health care system
Free health care services at Take Care Clinics
It’s cheaper to stay healthy
Little known secret about facility fees
Results of Consumer-Driven Health Plans

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February, 2010 (5)
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The opinions expressed herein are my own personal opinions and do not represent my employer's view in any way.

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 Friday, July 03, 2009
It’s the Prices Stupid
Friday, July 03, 2009 9:15:34 AM (Central Standard Time, UTC-06:00) ( Transforming Healthcare | Transparency )

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

 

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

 

Uwe Reinhardt: Plain Talk on Health Reform

 

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

 

By Bernadine Healy, M.D.

 

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

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

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

 Why has President Obama made reform so urgent?

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

 Is it mostly that our prices are too high?

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

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

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

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

 What about reforming health insurance?

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

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

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

 

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 Thursday, July 02, 2009
Consumer Driven Health Care Revolution
Thursday, July 02, 2009 12:12:20 PM (Central Standard Time, UTC-06:00) ( Consumer-driven health care | Transforming Healthcare )

Ten Ways Consumer Driven Health Care is a Proven Success

By Greg Scandlen

 

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

 

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

 

This is a Consumer Driven Health Care Revolution.

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

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

Click here to read the complete article

 

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

 

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 Tuesday, June 23, 2009
Taking the mystery out of health care prices
Tuesday, June 23, 2009 7:43:03 PM (Central Standard Time, UTC-06:00) ( Transparency )
For many of us, the most unbearable part of going to the doctor is when the series of “post-visit” EOBs, bills, statements and paperwork start to arrive in the mail.  Wouldn’t it be nice to know your out-of-pocket costs BEFORE you visit a health care provider? 

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

 

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

 

Tools to look-up prices for health care services

 

Healthcare Blue Book

Leslie’s List

MainStreetMedica

NewChoice Health

OutofPocket

Spectrum Health

USA HealthCare Costs

Vimo

 

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

 

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 Wednesday, June 17, 2009
Lessons learned from auto insurance
Wednesday, June 17, 2009 10:43:20 AM (Central Standard Time, UTC-06:00) ( Consumer-driven health care | Transforming Healthcare )
The auto insurance industry has a rating system that offers safe drivers premium discounts.  What if the health insurance industry implemented a rating system, similar to the auto insurance industry, where “healthy members” get premium discounts when the members demonstrate healthy behaviors?  Some employers have adopted these financial incentives and their results demonstrate reduced employee health care spending after these programs are implemented.   

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

-       Save driver (accident free)    

-       Multi-car policy                     

-       Good grades for teenage drivers in the household

-       Anti-theft device installed in vehicle(s)

-       Air bags installed in vehicle(s)

 

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

-       Taking a health risk assessment

-       Exercising on a daily basis

-       Eating healthy

-       Reducing weight

-       Stop smoking

-       Lowering blood pressure

-       Lowering cholesterol

-       Monitoring and follow-up on chronic diseases 

 

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

 

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Making the most of your health care dollars
Wednesday, June 17, 2009 10:27:52 AM (Central Standard Time, UTC-06:00) ( Consumer-driven health care | Finding the Best Value for Health Care Services | High deductible Health Insurance )

CNNMoney.com published an article, “10 ways to beat the rising cost of health care.” This article includes some excellent tips for consumers.  Here are some great ideas that can help you manage your health care dollars.

 

1.       Before you visit a provider, ask “how much will this cost?”  Negotiating is important if you have a high-deductible plan, are uninsured, or using a provider out-of-network.  The good news --providers are becoming more accustomed to patients asking for discounts.   All you have to do is ask.

 

2.       Discounted prescription medications.  Medications can be very expensive.  If you can take advantage of mail-order pharmacies or even retail chains that offer generics for just $4 - you can save a lot of money.  There are hundreds of mail-order pharmacies, and you can find them by doing a Google search.

 

3.       Take advantage of employer sponsored Flexible Spending Accounts (FSAs).   According to Mercer, about 80% of large employers offer FSAs, but only 22% of employees enroll in these plans.  This is tax free dollars that you can set aside for health care expenses.  If you are in the 28% tax bracket, a $1000 FSA may save you about $350. Beware that money FSA dollars that aren’t spent by year-end are lost. 

 

4.       Be sure to look into high-deductible health plans (HDHPs).  We are starting to see a higher rate of adoption for these plans because they encourage personal responsibility, create financial incentives for consumer to make informed choices for staying healthy and are successful at reducing health care expenses! These HDHPs offer lower-monthly premiums and can save you thousands of dollars a year on reduced premiums, but require you to satisfy your deductible before your insurance kicks in.  For many people, saving $5000-7,000/year on premiums and paying a $5000 family deductible is a great deal.  In a healthy year, you might not even have met your deductible!   Do some research to determine if this plan is right for you.

 

5.       Health Savings Accounts (HSAs).  With an HSA you can save pre-tax dollars to pay for health care expenses.   In 2009, a family can contribute $5950 and single person can contribute $3000.  As an extra bonus, American Chartered Bank offers free HSAs.  It’s definitely worth checking into.

 

6.       Walk-in retail clinics are less expensive than office visits for non-emergency, routine medical services.  They post their prices upfront and most now accept insurance.   

 

7.       Stay insured if you lose your job.  A federal subsidy covers qualifying individuals with 65% of the COBRA premiums. 

 

8.       Make healthy life style choices.  Employers are implementing wellness programs where they often reward employees for behavior changes (losing weight or quitting smoking).  The personal benefits of making healthy choices and taking personal responsibility are priceless! 

 

9.       Avoid Medicare mishaps.  Before you sign up for Medicare, or Medicare supplement programs like Medicare Advantage, make sure you understand what is covered and what is not covered. 

 

10.   Adding vision and dental expenses to your health plan can inflate your premiums.  If your health plan does not cover vision and dental, remember vision and dental expenses can be paid for through your FSA or HSA.  If you pay high monthly premiums for dental and vision, be sure to calculate the total cost of coverage vs. your annual expenses.  You might be surprised at the savings if you decide to opt out of dental/vision coverage and pay out-of-pocket.  And be sure to ask your dentist or eye doctor for a discount!

 

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 Tuesday, June 16, 2009
Health Maven!
Tuesday, June 16, 2009 12:10:46 PM (Central Standard Time, UTC-06:00) ( Transforming Healthcare )
outofpocket's on Wellsphere
Wellsphere's Health Maven
Wellsphere - Health Knowledge Made Personal

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

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

 

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Personal Responsibility and Financial Incentives
Tuesday, June 16, 2009 11:44:56 AM (Central Standard Time, UTC-06:00) ( Consumer-driven health care | Transforming Healthcare )
Last year I attended a health care conference in Chicago where Safeway gave a presentation on how they reduced employee health care expenses starting in 2005 by implementing wellness programs and adopting financial incentives.  The secret ingredient for Safeway was rewarding healthy behavior.  This was an outstanding presentation that I remember very well, and the results were so remarkable, I expected just about every corporation at that conference to follow Safeway’s lead. 

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

 

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

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 Monday, June 15, 2009
Affordable Prescription Drugs
Monday, June 15, 2009 11:04:34 AM (Central Standard Time, UTC-06:00) ( Finding the Best Value for Health Care Services )
To reduce health care expenses, consumers have the option of ordering their prescription drugs online.  This not only saves money and provides convenience, but makes health care dollars go a lot further.  One company you should check out is CanUSAmeds.com, a Chicago area-based Canadian online pharmacy with a reputation for outstanding customer service and some of the most affordable pricing for prescription medications. 

 

CanUSAmeds has been in prescription consultation since 2001. Some of the benefits of ordering your prescriptions from CanUSAmeds include:

 

  • Speak directly to owners when you call their toll free number --not a call center
  • Offer very competitive prices, from 30-80% off retail
  • Email prices@canusameds.com or call their toll-free number (877) 469-9616 to ask questions/place an order
  • Located centrally in the Chicagoland area for exceptional customer care
  • Dedicated to providing U.S. consumers with the highest quality and service in the pharmaceutical industry
  • Affiliated with one of the largest fully licensed pharmacies in Canada, to provide you with the highest quality pharmaceutical products
  • Use licensed Canadian Physicians to carefully review your specific prescription needs

Canusameds has many options for you. A very customer –friendly approach is their philosophy. They go the extra mile for you for your choice of options. There is no pressure; they are there to consult with you for no upfront fee. They also can connect with you with low cost lab tests, and imaging.

 

Here are some examples of the discount prices you will received at CanUSAmeds:

 

Drug

Size

Quantity

Typical Price

www.CanUSAmeds.com

1-877-469-9619

Lipitor

20 mg

90            

$359.97

$102.31    Save 71%

Zetia

10 mg

100

$339.68

$121.30    Save 64%

Prevacid

30mg

90

$477.96

$125.08    Save 73%

Plavix

75mg

100

$477.73

$133.22    Save 72%

Actonel

35mg

12

$291.24

$112.65    Save 61%

Celebrex

200 mg

90

$356.99

$99.89      Save 72%

Advair

250/50

3 Disks

$590.99

$231.04    Save 60%

Singulair

10mg

90

$347.08

$132.18    Save 62%

Topamax

100mg

600

$4286.76

$585.58    Save 86%

Crestor

10mg

90

$338.61

$136.75    Save 60%

Nexium

40mg

90

$469.97

$109.51    Save 76%

Prices were quoted on May 1st, 2009 and are subject to change.  This is only a sample.

 

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 Friday, June 05, 2009
Make sure you understand the fine print on your health insurance policy
Friday, June 05, 2009 11:36:45 AM (Central Standard Time, UTC-06:00) ( Consumer-driven health care )

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

 

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

 

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

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

·         Pay attention to the terms of your deductible

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

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

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

 

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 Thursday, June 04, 2009
Using Urgent Care Centers instead of Emergency Rooms
Thursday, June 04, 2009 9:58:48 AM (Central Standard Time, UTC-06:00) ( Finding the Best Value for Health Care Services )

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

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

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

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

  • Google - search on urgent care and include your city/state
  • Bing - search on urgent care and include your city and state
  • Find Urgent Care - a directory to help consumers find centers in their area
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 Friday, May 29, 2009
Getting Charged for Free Exams
Friday, May 29, 2009 2:33:01 PM (Central Standard Time, UTC-06:00) ( Consumer-driven health care | Transparency )

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

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

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

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 Wednesday, May 20, 2009
Shopping for radiology tests online
Wednesday, May 20, 2009 8:06:47 AM (Central Standard Time, UTC-06:00) ( Finding the Best Value for Health Care Services | High deductible Health Insurance | Transforming Healthcare )
What if consumers could shop for radiology tests (MRI, CT scan, ultrasound, x-ray, mammogram, DEXA, PET, and fluoroscopy), the same way they shop for hotels and airline tickets? 

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

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

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

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

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

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

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

 

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 Tuesday, May 19, 2009
Assistance programs for low-income patients
Tuesday, May 19, 2009 12:55:34 PM (Central Standard Time, UTC-06:00) ( Consumer-driven health care )

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

 

Low-Cost Medicine Programs

 

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

 

Additional Assistance Programs (PAPs)

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

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

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

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

 

Free/Low Cost Clinics

 

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

 

Discount Drug Cards

 

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

 

1.       Drug Company Discount Card

2.       State Discount Cards

3.       NeedyMeds Drug Discount Card

 

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

 

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 Wednesday, May 13, 2009
Resources to help you decipher and negotiate hospital bills
Wednesday, May 13, 2009 8:20:15 AM (Central Standard Time, UTC-06:00) ( Consumer-driven health care | Transparency )
If you have major medical bills and need assistance in making sense of these bills, there are a number of bill review services available that will provide you with advice.  Some of these organizations provide assistance before services are provided, others help review medical bills after the services were provided, to determine if you were overcharged.

 

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

 

Claims Assistance Professionals

HealthCare mediation LLC

Health Proponent

Health Champion

Hospital Bill Review

ICS Healthcare (Ingenix)

Medical Cost Advocate

INSNet

Patient Advocate Foundation

Patientcare

 

 

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 Monday, May 11, 2009
How Much Does It Cost to Have a Baby?
Monday, May 11, 2009 5:56:44 PM (Central Standard Time, UTC-06:00) ( Consumer-driven health care | Transparency )

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

 

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

 

ITEM

CHARGE

Total delivery charge for three days in the hospital

$ 36,625

Aetna’s negotiated (discounted)  total

$ 17,300

2006 average nationwide negotiated total

$   6,898

 

Miscellaneous items and charges on the hospital bill:

 

ITEM

CHARGE

Epidural anesthetic injection

$    530

Hospital’s resources for providing the epidural     

$ 2,152

Anesthesiologist’s fee

$ 1,530

90 minutes in recovery after delivery

$ 2,382

 

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

 

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

 

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 Wednesday, May 06, 2009
Saving money on out-of-network costs
Wednesday, May 06, 2009 7:16:09 AM (Central Standard Time, UTC-06:00) ( Finding the Best Value for Health Care Services )
If you are insured, selecting a health care provider that is not in your network can cost you more out of pocket.  Network providers in your health plan have discounted rates for their services.  Non-network providers do not provide this discount and you’ll end up paying more for their services.  Sometimes the specialist, or provider that came so highly recommended with the highest quality ratings, is not in your network.  How should you approach this to make the most of your health care dollars?  Here are things to consider when deciding to use in-network versus out-of-network providers.

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

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

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

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

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

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 Monday, May 04, 2009
Affordable Lab Tests
Monday, May 04, 2009 7:40:04 AM (Central Standard Time, UTC-06:00) ( Consumer-driven health care | Finding the Best Value for Health Care Services )
Millions of people every day struggle to contain their health care costs. The National Center for Health Care Statistics reports 43 million people under the age of 65 do not have health insurance.

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

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

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

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

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

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

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

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

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

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

Take control of your health care costs today!

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 Thursday, April 30, 2009
Smile. It's free
Thursday, April 30, 2009 1:24:55 PM (Central Standard Time, UTC-06:00) ( Transforming Healthcare )

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

 

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

 

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

 

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

 

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

 

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 Monday, April 27, 2009
Cost of an MRI
Monday, April 27, 2009 8:55:26 AM (Central Standard Time, UTC-06:00) ( Finding the Best Value for Health Care Services )
How much does an MRI cost?  What is a fair price to pay for an MRI?  How do you know if you are being overcharged for an MRI?  Where should you go to find the best value?   

 

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

 

(1) How much does an MRI cost? 

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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 Tuesday, April 21, 2009
What’s my out-of-pocket for this service?
Tuesday, April 21, 2009 4:35:37 PM (Central Standard Time, UTC-06:00) ( Consumer-driven health care | Transparency )
COPAYs, co-insurance, deductibles, list price, discounted price, contracted rate, negotiated price, cash price.  Do you know in advance what amount you will be charged for health care services?

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

 

Bargaining down those medical bills

 

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

 

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

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

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

 

Conclusion

 

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

 

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 Thursday, April 16, 2009
YouTube video on health care system
Thursday, April 16, 2009 8:46:12 PM (Central Standard Time, UTC-06:00) ( )
A picture is worth a thousand words.  Using a whiteboard to explain complicated issues surrounding our health care system, Humana has created a three minute video on YouTube that does a great job explaining why we need health care reform. The video explains in simple terms what's wrong with our currently health care system and presents some ideas and proposals that are being considered. 

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

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 Tuesday, April 14, 2009
Free health care services at Take Care Clinics
Tuesday, April 14, 2009 2:08:39 PM (Central Standard Time, UTC-06:00) ( Finding the Best Value for Health Care Services )
Walgreens recently announced that they are offering free health care services at their retail clinics for all current and future Take Care Clinic patients and their families that experienced a job loss after March 31, 2009 and are uninsured.   They call it the Take Care Recovery Plan.

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

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

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 Monday, April 13, 2009
It’s cheaper to stay healthy
Monday, April 13, 2009 3:02:08 PM (Central Standard Time, UTC-06:00) ( Consumer-driven health care )

It’s easier and much less expensive to stay healthy.  In today’s tough economic times, it has never been more important for people to really take control of their health and prevent unnecessary health emergencies.  Even though at times it seems like an awful lot of trouble to stay fit, exercise, eat healthy foods and take good care of yourself by having regular checkups and screenings – this behavior is actually a great return on your investment.  When you get sick, things can get very expensive. Many employers reward this type of healthy behavior and insurance premiums are sometimes reduced if you take good care of yourself.   So why wouldn’t you choose to stay healthy? 


In Colorado, a non-profit organization called 9Health Fair promotes health awareness and encourages individuals to assume responsibility for their own health by providing consumers with 20 free and 4 low-cost health screenings.  The low-cost screenings include:

 

·       Prostate Specific Antigen (PSA) screening; identifies a man’s risk for prostate cancer, for $25

·       Blood Count screening; identifies a person’s ability to fight infection, risk for anemia and blood-clotting abilities by checking white and red blood cells, hematocrit and hemoglobin levels for $15

·       Blood Chemistry screening, which tests 28 separate things including cholesterol, blood glucose, liver, kidneys, thyroid and more, for $30

·       Colon Cancer Screening Kit; this take-home/mail-in kit checks for human blood in the stool which can lead colon cancer for $20

 

Wouldn’t it be nice if everyone had access to affordable screening programs like this?  If you know of any programs like9Health Fair that we should tell others about, be sure to let me know and I’ll post it on the OutofPocket.com website, to share with others.

 

If you are uninsured, under-insured, or have a high-deductible health plan, don’t skip taking care of yourself.  In fact, I encourage you to use this information about low-cost prices 9Health Fair offers for screening tests to your advantage.   Call a provider and see if they will match these prices, or at least offer you a discount.

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 Thursday, April 09, 2009
Little known secret about facility fees
Thursday, April 09, 2009 4:00:50 PM (Central Standard Time, UTC-06:00) ( Consumer-driven health care | Transparency )

Wondering why your medical bills are so high?  New Hampshire Public Radio’s health reporter, Elaine Grant, revealed some interesting information about hidden facility fees in an interview last week with New Hampshire State Senator Jackie Cilley, Joe Loring, Executive at St. Joseph Hospital and James Unland, President, The Health Capital Group.  Click here for the full transcript.

 

Let’s face it, health care has a lot of “secret pricing”, but state lawmakers are starting to tackle one of the best kept secrets in health care – facility fees.  These facility fees can add hundreds and even thousands of dollars to your medical bill.  Hospitals say the fees are essential to their bottom line, but critics point to these fees as a major contributor to the high cost of health care.   

 

When you are paying out-of-pocket costs for health care services, these prices can make a huge difference.  For consumers that are uninsured or that have high-deductible plans, knowing the difference between an independent practice lab or one owned by a hospital can save you hundreds and possibly thousands of dollars.  When consumers go to a hospital-owned practice or facility, their bill includes the cost of the hospital’s overhead – aka “facility fee.”  This explains why hospital outpatient services usually cost more than the exact same services offered by an independent  stand-alone facility.  For example, an independent diagnostic facility charges $65 for an x-ray, while the hospital charges more than $260 for the exact same service.  The average consumer has no idea these fees even exist.   In many cases, the facility fee is simply included in the total cost of the visit, making it impossible to see.  Many consumers are not even aware that the provider they’re visiting is owned by or affiliated with a hospital.   So be sure to call and ask before you make an appointment at a facility.

 

In 2006 facility fees made national headlines when patients brought two class action lawsuits against Seattle hospitals.  One of the patients had a five-minute procedure performed at a clinic owned by the University of Washington Medical Center and was billed more than $8000.  Nearly $7000 of this bill was for the facility fee.  The medical center settled the case and agreed to disclose its prices.   Interestingly, once the prices were made public, the hospital could no longer justify the unreasonably high prices so they discounted their fees by 40% for about 1400 outpatient procedures.  Here is a link to the hospital’s public prices.

 

Let this be a lesson for all:  you can save a lot of money by asking providers what a procedure will cost – beforehand. 

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 Tuesday, April 07, 2009
Results of Consumer-Driven Health Plans
Tuesday, April 07, 2009 6:08:03 PM (Central Standard Time, UTC-06:00) ( Consumer-driven health care )

One out of every ten patients now has a consumer-driven health plan, so hospitals are starting to become proactive bill collectors.  An article in the Minneapolis Star-Tribune discusses how hospitals in the Twin Cities are starting to telephone patients before their scheduled procedure to review how much they will owe out-of-pocket.  As strange as this seems, it’s really a step in the right direction for our health care system.  Patients (consumers) are becoming more aware of the true prices for health care services.  This behavior encourages consumers to comparison shop to find the best value and make the most of their health care dollars.  If patients continue to pressure providers for true prices, we will start to see health care prices become publically available, resulting in competitive pricing, innovative services and improved  patient care. 

 

This is very good news for health care consumers.

 

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