The Wall Street Journal published a story this week on websites to help patients shop for medical services.  The article mentions Outofpocket.com and lists 17 other tools/websites consumers can use to research prices.

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

It's not necessary to get on a plane to India to take advantage of the savings that medical tourism can provide. Patients can realize savings of 25-70% or more just by shopping around via the Internet. Yes a road trip might be necessary, but isn't it worth your time to drive 50 or even 200 miles to save $1000 or more? Maybe the wrong people are reading this, but unless you make over $250,000 per year; a day of work doesn't pay $1000. Saving $1000 on high end diagnostics or an operative procedure is easy.

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

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

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

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

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

-- Contributed by Eric Haberichter

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

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

A consumer recently contacted me and asked, “I’m due for a colonoscopy.  Any idea what is a good deal on a colonoscopy?”  Having no idea what a fair price for a colonoscopy would be, I consulted Outofpocket.com to find out.  Using the OutofPocket.com search tool, I typed in the search term “colonoscopy” and here’s what I discovered:

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

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

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

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

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

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

Conclusion

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

Out-of-pocket expenses

 

Ed Bennet, a hospital web manager, has developed a public hospital search tool using the Google Custom Search engine.  The search tool allows you to search more than 2800 hospital websites in a single search query.  The hospital websites included in the search results, provide much more information than just prices for services.  This tool this can be useful to find/access hospital price data that is hard to find using the standard Google search engine, and elminiates the need to individually search each hospital.  

For example, using his hospital search engine, if you type in:

 

MRI price (results returned = 86)

price x-ray  (results returned = 197)

emergency room price (results returned = 91)

 

Unfortunately, most hospitals publish their “list price” for services, rather than the true out-of-pocket price for their services.  The list price often has nothing to do with the actual price you are expected to pay for services.  If you pay cash and are uninsured, you should expect (and demand) that you receive a discount from the list price so make sure you inquire about a discounted price.  If you are insured, you will pay a lower, contracted rate that your insurer has negotiated with the hospital provider.

 

 

I spent two years demystifying my emergency room bill only to uncover that I was being gouged for 800% profit by the hospital.  During that time, I learned how to calculate fair and reasonable prices, as determined by the industry standards.

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

A little background

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

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

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

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

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

Free Medical Cost Savings Tips For All

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

--By Lynn Jordan

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