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. 

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.

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.

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. 

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.

• 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.