OutofPocket Blog: Reducing out-of-pocket health care costs

When to use a Retail Clinic or Urgent Care Center

2011-12-27T15:34:13.758-05:00

This past year my daughter visited a retail clinic for a strep throat and my husband visited an urgent care center for his stitches. Both of these experiences provided excellent value and I would highly recommend retail clinics and urgent care centers for certain types of conditions. An article written by Misty Williams in the Atlanta Journal Constitution earlier this month discusses when to use a drugstore clinic.

When to use a drugstore clinic

As Americans increasingly pay more out of pocket for their health care, millions are turning to retail clinics -- often located in pharmacies or grocery stores and requiring no appointment -- as a more convenient, cheaper alternative to a primary care doctor.

Typically staffed by nurse practitioners, walk-in clinics are aimed at treating minor ailments such as strep throat or ear infections. They offer weekend and evening hours for people who can’t take off work during the day or face long waits for appointments with their regular doctors.

Retail clinics first began popping up across the country in 2000 and now number roughly 1,200, according to RAND Corp., a nonprofit research group.

The benefit of these walk-in clinics, however, depends on a consumer's situation.

Because they are significantly cheaper, retail clinics often appeal to people who are uninsured and have to pay out of pocket, said RAND researcher Ateev Mehrotra.

The cost of care at walk-in clinics at stores such as CVS, Walgreens and Walmart is on average 30 to 40 percent less expensive than a physician office or urgent care center and roughly 80 percent lower than an ER, a RAND study shows. For consumers, the average cost of an ER visit for strep throat can range from $550 to $750 versus $59 at a retail clinic, data from insurance giant Aetna shows.

“[Patients] really like the predictability of the cost,” Mehrotra said.

Cost is also playing a larger role in people’s decision on where to get care as high-deductible insurance plans that require consumers to pay more out of pocket grow increasingly popular, said David Van Houtte, Aetna senior network manager who negotiates contracts with retail clinics across the country. For people with insurance, who would have the same co-pay as going to a doctor office, retail clinics are more about the convenience, Mehrotra said.

Getting time off from work can be a struggle for many people, he said.

Sujal Patel stopped by a MinuteClinic inside a Virginia-Highland neighborhood CVS on a recent afternoon after battling a nagging sore throat for three days.

Retail clinics are a big convenience, said Patel, who manages pharmacies and swung by on his lunch break.

“If I had gone to a doctor, I would have had to take time off,” he said. “Doctors don’t usually see you right away.”

At the CVS clinic, he was able to get medicines for his respiratory infection and to help him sleep right away without having to drive to a separate pharmacy.

The quality of care at retail clinics is of similar quality to regular doctor offices and other providers, Mehrotra said.

Aetna has a stringent process to credential clinics before contracting with them -- including random site visits to ensure quality is up to standards, Van Houtte said. Each clinic is overseen by physicians, and the staff is required to report back to primary care doctors for patients who have one, he said.

Retail clinics may be one solution to help curb the nation’s increasing health care costs, though they aren’t a magic bullet, Mehrotra said. Roughly 17 percent of visits to ERs could be treated at a retail clinic or urgent care center -- saving up to $4.4 billion annually, according to one RAND study.

“No one should think this is really going to solve the cost spending trends in the United States -- though some would argue every little bit helps,” he said.

Comparing costs

The overall cost of care at retail clinics is substantially less at retail clinics compared with physician offices, urgent care centers and emergency departments, according to a study by RAND Corp., a nonprofit research group. The study looked at the average cost of treating an ear infection, sore throat or urinary tract infection.

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

Source: RAND Corp.

Choosing your care

Not every illness calls for a trip to the ER. Here are a few tips on what level of care makes sense depending on the problem.

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

Source: Aetna

Educating Consumers about Healthcare Price Transparency

2011-12-20T11:42:45.617-05:00

Educating Consumers about Healthcare Price Transparency is the Best Solution to Controlling Costs>

Health reform won’t stop providers from overcharging for care, only consumers can do that. Here’s my story of how I could have paid tens of thousands of dollars more for two minor outpatient surgical procedures, had I not understood how the healthcare system worked. It illustrates just how much we need a healthcare system with price transparency built in – something we will not get under the Affordable Care Act (ACA).

I am a doctor and the father of a 12 year old boy who has cerebral palsy. My son is fortunate to be healthy and active with minor medical needs. But as he has grown, he experienced some issues with contractures in his right lower leg which recently required a minor two hour outpatient surgical procedure.

When my son’s surgery was scheduled, I started getting price estimates from the surgeon, anesthesiologist and the facility, since we have a high deductible insurance plan. The physician’s fees were straight forward and relatively easy to obtain.

Not so with the facility. My son’s surgery was scheduled at the local hospital’s outpatient surgical facility which sent the procedure codes to an external reviewer. Three days later the reviewer came back at $37,000. The hospital referred me to my insurance company. The PPO network said that they could not reveal the prices until after the case was performed.

The hospital said it expected to discount the price, which would be in the range of $15,000 to $25,000. Then I asked my son’s surgeon if he ever operated at any independent Ambulatory Surgical Centers (ASC). One phone call and 10 minutes later, I have the exact price for his surgery: $1,515.

Five years ago, there were virtually no tools that could help consumers figure out what they should pay for a healthcare. Today, with the availability of new technology and new methods to analyze claims data, service providers can develop tools that will help companies examine what different providers in their network charge for tests, procedures, treatments and services in their market. With that knowledge in hand, they can find a fair price for what is needed. The better educated people are about what a fair price should be, the better equipped they are to talk with providers and facilities about fees before a procedure is done.

Customized tools are available for self-funded employer plans, so employees can search provider pricing within their own networks. We have found that even within the same plan the price for a routine test can vary by thousands of dollars.

ACA and Consumerism: No Price Transparency

Even after the Affordable Care Act, large gaps which cost consumers and self-funded employers a lot of money, must be addressed. The ACA does not address the wide disparity in healthcare pricing or encourage, much less mandate, pricing transparency. While my case was an extreme situation of potential overcharge, there is still an enormous amount of price variability in the health care system, even within individual health plans. Employers and their employees will continue to pay way too much for common healthcare services, often as much as five times more than they should.

The ACA will also impact the ability to encourage consumerism in plan design. Some of the provisions may foster consumerism such as the excise tax on rich benefits plans and the increased threshold for medical expense itemized deductions. Other provisions will limit an employer’s ability to foster consumerism, such as the elimination of lifetime limits, the requirement to provide certain services at 100 percent coverage, and the limitations on Flexible Spending Accounts.

The ACA does not help employees or employers learn the real costs of care. The Massachusetts Attorney General report entitled Investigation of Health Care Cost Trends and Cost Drivers from January, 2010, provides a good overview of the wide variation in healthcare pricing and the factors that lead to it. It says price variations are not correlated to quality of care, the sickness of the population being served, volume of Medicare or Medicaid patients, whether a provider offers services at an academic teaching or research facility, or differences in hospital costs of delivering similar services at similar facilities.

The report concluded that price variations are correlated to market leverage, as measured by the relative market position of the hospital or provider group, and then compared with other hospitals or provider groups in the local area.

Congress has considered other legislation (HR 4700, HR 2249, HR 4803) which would have addressed the transparency issue, but these bills did not make significant progress in passage. Employers are left to find their own solutions to these challenges.

Turning Employees into Educated Healthcare Consumers

Most employees don’t realize that if they use in-network providers the cost of their care could vary by over 500 percent depending on which in-network provider they choose. If they need an MRI, they could get it for $500 at one imaging center and pay over $3,000 at another center. Their colonoscopy might cost $950 at one location and over $3,500 at another. The same holds true for almost every service they need.

Why don’t they know? First, they don’t have any idea how much healthcare services should cost or what is the fair price they should pay. Second, they are rarely told how much the service will cost before they get their care, and many times they don’t even realize that they can ask. Finally, many benefit designs with fixed co-payments remove patients need to know or care.

Even when employees have access to insurance company portals, these portals are rarely used and most don’t provide clear pricing information.

When reviewing employee purchasing behavior, it is clear that the current system is not producing favorable results. Most employees pay too much for care. And this occurs regardless of employer location, insurance company or provider network.

Employers are consistently spending 4 to 15 percent more on healthcare than they would if their employees made value based care decisions. It is important to note that this spending is not for higher quality care. Numerous studies have shown that higher healthcare prices do not indicate high quality care. Health reform has the potential to make this situation even worse as the push to create Accountable Care Organizations (ACO) encourages providers to consolidate. Employers will need to carefully consider the value offered by new provider network arrangements, and ensure that they come with transparent offerings with respect to both quality and cost.

Effective Ways to Reduce Costs and Still Deliver Quality Care

Think of it as a cost/value gap. People would never knowingly overpay for a car or home. They would do research ahead of time, find out what current market rates are and approach the buying process as knowledgeable consumers. In healthcare, that’s unusual. Employers and employees can deliver the same value at a lower cost, if they approach the situation as educated consumers.

Employers are the key to solving the cost/value gap in healthcare. Employers make the ultimate decisions regarding benefit designs that encourage consumerism, the networks that direct patients to high value providers, and the education and tools to support employees in selecting healthcare services.

Many employers have implemented wellness and disease management programs often with incentives for participation or even penalties for failure to engage in healthy behaviors. However, when it comes to encouraging employees to make better choices about buying healthcare services, most employers have not supported or encouraged real consumerism. Here are a three methods that can help.

1. Put consumerism into all health and wellness programs. Every nurse or member of a call center support staff should have access to pricing and transparency tools needed to fully educate a patient on cost of care. There are tools available that show the range of prices charged by the health plans and providers in their network, so employees can make educated choices about which providers they should use. Why recommend an employee get a colonoscopy but not also suggest where they might get a high quality study at one-third the cost of some locations? Employers could triple their cancer screening rates without spending any additional money if they design their programs correctly.

2. Make sure employers understand their network prices and quality variations. Employers should look at their data. They may be surprised at the variations and opportunities in price. At a minimum, it may affect how benefits are designed. Some employers are even taking additional steps, such as setting up narrower networks to ensure their employees get the best care at the best price.

3. Don’t be satisfied with just a provider directory. Employers may want to rethink the traditional approach of the provider directory that places the providers first and may not even include pricing information. To be effective consumers, employees must first know how much care should cost. Then they must have the ability to find providers who offer fair pricing. Make sure this information isn’t hidden on a little used portal; put it at the employee desktop. Make it available in their hands in the doctor’s office by way of their mobile phones. Make sure every nurse or health coach they talk to can support them.

The Affordable Care Act may not address health transparency issues, but there is no reason why, with t technological tools in hand, employees or medical professionals like myself for that matter, have to overpay for care. Employees that are given the chance to understand healthcare pricing, particularly under Consumer Directed Health Plans (CDHP), are often very appreciative of the results. More importantly, employers can achieve substantial savings that allow for continued health benefits at affordable rates.

About The Author

Dr. Jeffrey Rice is CEO of www.healthcarebluebook.com.

The Healthcare Blue Book provides employers with analytics to help them understand their provider network costs and comprehensive programs to support employees with healthcare consumerism. The Healthcare Blue Book is a leader in supporting employers with high deductible health plans, consumer directed health plans and reference pricing.

Health-care Price Data Can Be Difficult to Obtain

2011-11-03T16:58:12.095-04:00

Why don’t health plans provide their members with useful tools so members can look-up and compare true out-of-pocket prices for health care services --based on their policy, coverage and deductible? If the plans did provide these types of tools, members would be able to compare prices, evaluate costs before visiting the doctor’s office and save money for both the member and the health plan by finding the best value! Sounds too good to be true. Some employers are pushing for transparency and hiring outside vendors to provide solutions for price transparency tools. A few health plans are providing, in my opinion, very limited tools to help member’s look-up costs before visiting a provider.

As more and more people enroll in high-deductible health plans that require consumers to pay for services upfront before their coverage kicks in, the requirement for pricing tools becomes critical.

The challenge with obtaining access to meaningful price information from claims data continues to be a major obstacle. An article written by Anna Wilde Mathews, Push for Health-Cost Data, published last week in the Wall Street Journal is a must read for anyone trying to understand the secrecy behind health care price data.

Haggling with health-care providers may reduce medical bills

2011-10-27T15:50:39.524-04:00

Do you often think that you might be overspending on health care bills? Have you ever been surprised by the amount you owe the provider when the bill arrived in the mail?

Doctors can be helpful if you communicate with them early on to let them know costs are important to you. John Santa, the director of the Consumer Reports Health Ratings Center, offers some practical advice on how consumers should communicate with doctors to negotiate their medical bills. Click here to read the entire article that appeared in the Washington Post last week.

Savings Hundreds of $$$ on Medical Procedures

2011-09-26T11:25:09.561-04:00

As a consumer advocate for health care price transparency, I run across dozens of articles every month that demonstrate every day examples of the disparity in what consumers pay for health care services. The articles all provide specific examples of how prices can vary widely for the exact same service in the same area. This is a wake-up call for consumers. The conclusion is always the same -- consumers can and should shop around to find the best price for routine health care services before visiting a provider.

Saving hundreds of dollars on a medical procedure using a high quality provider is possible and the tools to make comparison shopping practical for consumers are starting to evolve. Before you schedule your next appointment for a lab test, MRI, x-ray, mammogram, colonoscopy, or eye/dental exam, make sure you do a little research and shop around to find the best value.

A Tribune-Review investigation exploring health care costs finds the price for identical medical procedures differs widely across the United States, not only by region, but even within the same hospital or clinic. Cost also depends on who pays -- an insurer, Medicare or the consumer -- and the differences can amount to thousands of dollars. This article reveals the disparity for an MRI ranging in price from as low as $300 in South Florida to $3100 for the exact same MRI in Texas. A routine cholesterol test at a national lab was only $11 and the same lab test at a San Francisco hospital was $150. You do the math.

Do you have a medical bill story to share?

2011-09-06T14:33:53.705-04:00

Do you have a story about a medical bill that was higher than you expected it to be? Or a time when you wanted to know how much a medical test or treatment might cost? How about a time you figured out a way to save money while still delivering high-value care?

As part of our second annual essay contest, Costs of Care, a nonprofit group based in Boston, is offering $4000 in prizes for anecdotes like these that illustrate the importance of cost-awareness in medicine. Judges will include former White House Budget Director Peter Orzsag, former United States Surgeon General C. Everett Koop, Governor Jennifer Granholm, women’s health and cancer research advocate Dr. Susan Love, and Harvard University Provost Dr. Alan Garber.

The mission of Costs of Care is to expand the national discourse on the role of care providers in controlling healthcare costs. The stories we receive as part of our second annual essay contest will provide everyday examples from across the nation that illustrate the power patients and healthcare workers have to curb costs at a grassroots level.

Submissions should be no longer than 750 words and are due by November 15th. For details please visit Costs of Care Essay 2011. Email submissions to contest@costsofcare.org.

You can also read about our winning essays from last year here.

Urgent Care Centers vs. Hospital Emergency Rooms

2011-08-08T09:28:47.458-04:00

Last month my husband was injured while playing basketball and his injury required him to have a number of stitches. With our family high-deductible health plan (HDHP), we realized that a visit to the hospital emergency room was going to be a very expensive option. His injury was serious enough to require a specialized doctor, but definitely not a life threatening situation that required a trip to the emergency room.

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

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

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

Description of Service	Amount Billed	Contracted Amount
Xylocaine 1% 20cc	5.61
TDAP 9.5 ML	112.56
Cefadryxil 500 mg CAP	3.32
Suture pack each	25.00
Suturing Instruments	69.00
Immunization administration fee	17.00
Sim RP face-ears-eye	132.00
LVL 2 treatment fee w/procedure	99.00
Doctor fee level 2 clinic	99.00
Total Amount Billed	$463.49
Total Amount I Paid (contracted rate)		$177.05

How to Reduce Your Drug Costs

2011-07-29T13:02:23.444-04:00

If you are not taking any prescription drugs you can skip this article. But if you are taking prescription drugs, learning how to reduce your drug costs can save you hundreds of dollars a year. A recent article in the U.S. News Money by Philip Moeller includes some excellent advice on how consumers can reduce drug costs. Read the full article.

Highlights from the article.

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

Helping Consumers Get Health Care Costs Under Control

2011-07-25T16:50:03.862-04:00

Simplee is a new Web-based service that can help you get control of your health care costs and expenses. Like Mint.com with your personal finance accounts, Simplee safely and securely links to your health insurance and transforms it into a clean, easy-to-read dashboard for tracking and controlling spending, reducing paperwork, expanding health care options and saving money.

And the best part? It’s free.

Health care in this country has become a confusing mess of bills, deductibles and hidden expenses. Just making sense of it all can be so frustrating and time consuming that we just give up. But the reality is out-of-pocket health care costs are up 50% over the last five years. The average family spends more than $3,000 each year beyond their monthly premiums.

Amid such confusion, it doesn’t help that 80% of all medical bills contain errors and prices for medical procedures and services are almost always inflated before being routinely discounted. The current system is little more than a guessing game, leaving patients in the dark and making it almost impossible to be a well-informed consumer of health care or to know the actual cost of treatment, let alone to shop around for the best possible deal.

Simplee, which went live a few weeks ago, works by connecting to your health insurance accounts and bringing together all of that data in one place, including medical, vision and dental records. Simplee keeps track of your medical expenditures by service, provider and subscriber so you know how much you’ve paid out-of-pocket, your deductible status and total family spending for the last year.

By displaying complicated information in an easy to understand dashboard, Simplee shows you what you’ve already paid so when you get a bill, you’ll know if you’re reconciled it or not. And if you’re charged for a procedure that should be covered, Simplee cross-references your plan information and lets you know how to fix it.

It also reminds you to take advantage of free procedures included in your plan, like dental cleanings, before they expire. Support is provided for nearly 65% of all health insurance plans, including Aetna, Anthem, Blue Cross Blue Shield, Blue Shield California, Cigna, Delta Dental, United Healthcare, Vision Service Plan (VSP) and WellPoint (Empire BCBS). Simplee aims to cover 80% of the entire U.S. market by the end of the year.
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Contributed by Tomer Shoval. Tomer is the CEO and co-founder of Simplee, a free Web-based health care expense management service that allows consumers to easily understand and manage their health care expenses. Formerly the managing director of Shopping.com (eBay) for North America, he has more than 12 years of experience as a business leader in e-commerce and online services.

Pricing Disparities Revealed for Imaging Services

2011-06-30T16:01:37-04:00

Did you know that prices you pay for a CT and PET scan, MRI, ultrasound and mammogram can vary a great deal from provider to provider – for the exact same service? You could be paying almost 700% more than you have to for imaging services simply because you don’t have access to healthcare pricing information that enables you to compare prices and shop around to find the best value. You can save up to $2,000 on just one imaging service by comparing costs across different facilities and selecting the more affordable option.

According to the Healthcare Transparency Indexfrom change:healthcare, significant pricing disparities exist for the most common imaging services at outpatient facilities, freestanding imaging centers and medical offices both from region to region and within the same region.

Some interesting pricing information revealed in the Healthcare Transparency Index (HCTI):

CT Scans: With more than 70 million CT scans performed each year in the U.S., the Index revealed an average of 40 percent possible savings across all regions for patients receiving the three most frequent CT scans (abdomen without contrast, abdomen with contrast, pelvis with contrast) – just by shopping local facilities. The greatest savings potential existed in the Southwest where a patient could pay up to 683 percent more for the same CT scan. However, patients in the Midwest who saw lower variances still paid an extra $290, or 120 percent.

MRIs: The Index revealed a 25 percent average savings potential across all regions studied for patients receiving the three most frequent MRIs (lower extremity, brain and lumbar spine) by shopping local facilities. Patients receiving the same MRI in the same area of the Southeast could pay a high of $2,500 and a low of $560.

Ultrasound: Shopping local facilities can yield a 28 percent savings for patients receiving the three most frequent ultrasounds (breast, abdomen and transvaginal). The highest price of an ultrasound reported was $700 for an abdominal examination, where the low price in the same area was $120. With an average of three ultrasounds performed per patient just for pregnancy, cost savings to consumers are significant.

PET Scans: Generally one of the priciest items in imaging, the Index found that patients across the U.S. could save an average of 36 percent by comparing prices. The reported cost in the Northeast ranged from $3,500 to $4,500, while patients in the Midwest paid a maximum of only $2,500 and a minimum as low as $1,400.

Mammography: Consumers could save an average of 17 percent on mammography services per year by switching providers. With roughly 37 million mammograms performed each year and this number expected to rise with the aging U.S. population, insight into actual pricing and options for care could ultimately drive down costs for all of these routine services.

About the Healthcare Transparency Index
The Healthcare Transparency Index (HCTI) provides healthcare consumers with ongoing trends data about actual healthcare costs, offering insight into critical opportunities for savings. The data is sourced from change:healthcare’s proprietary, HIPAA-compliant database generated from client activity. This quarter’s Healthcare Transparency Index includes data derived from more than two million medical claims, totaling $340 million and representing more than 152,000 lives across all 50 states over a 12-month period. The report’s pricing and behavioral content is derived from the change:healthcare Cost Transparency Solution.

Sometimes Empowerment Needs a Little Push

2011-06-24T12:36:40.757-04:00

We all complain about the cost of health care and health insurance. Ours is by far the most expensive health care system in the world. And for the money, our health isn’t so hot either. On the world stage, the U.S. ranks 37th in health care efficiency (a measure of health outcomes such as infant mortality, incidence of chronic disease, etc.) as reported by the World Health Organization. America ranks behind virtually every EU country and Canada. What can we do about it? Ration health care? Control doctors?

The answer begins with that which we want to retain. Most Americans enjoy unlimited access to health care. And despite the world rankings, it is generally accepted that the quality of American health care is unsurpassed. Let’s not throw the baby out with the bath water, right? But, if we are going to continue to enjoy our access and quality, then we need more than information and empowerment. We also need a little push.

As in most things, health has interconnected, but contrary forces -- its “yin and yang.” Could it be that wide access to quality care after we get sick may be the culprit creating growing indifference to the consequences of poor health behaviors? It is so easy to rationalize super-sizing our cheeseburger and fries when we have Lipitor, liposuction and a litany of care providers watching our backs. As important as it is that we have convenient and transparent health cost and outcomes information to control health care costs when we need it, I assert that it is equally critical that we avoid poor health in the first place as the ultimate means to reducing the cost of health care.

The crux of the problem is found in our attitudes and values toward health. To reverse high health cost inflation will require us to reverse our attitudes and values first. Incentives as well as information can play a role. Many large employers now provide their employees (and often their spouses) with on-site health management clinics, staffed primarily by nurse practitioners who are generally better trained than doctors to engage patients in health management dialogs. Coordinated with these clinics are health risk assessments in order to identify potential health issues so that individual health management plans can be created. They often include wellness programs and incentives to make behavior changes. Some even include disincentives to motivate participants to change, such as increased deductibles for those who persist in smoking or over-eating.

Driving these employers is sensitivity to the root causes of high health care costs. We hear a lot about the aging of the population, about the contribution to cost by new technologies and drugs, and of course, about defensive medicine and malpractice costs. However, those are just the symptoms. The root causes of high health costs are:
1.   poor health behaviors,
2.   misaligned provider incentives, and
3.   disconnected health information.

Poor health behaviors accounts for about one-half of the $3-trillion we spend on health care annually. Three years ago, in 2008, every annual health insurance premium included an additional $1,405 to compensate for smokers, $1,280 to compensate for lack of exercise and obesity and $1,070 for uncontrolled hypertension and cholesterol. Three years of uncontrolled inflation makes it even worse now.

It would be helpful if doctors took the time while we see them to explore the root causes of our illnesses, to counsel with us about our health behavior choices, to create health management plans and to follow-up with us on our progress. But, don’t count on that in the fee-for-service reimbursement system.   Because the FFS system pays for procedures delivered, it incentivizes physicians to overutilize medical services. It is extraordinarily inflationary as it seemingly justifies overutilization in order to avoid malpractice litigation. It creates an assembly-line culture among providers that results in an average of 7 minute appointments, clearly not enough time to engage in wellness counseling.

Wellness counseling will only occur when providers are incented to do so. But to add more financial incentives on top of FFS is not the answer – it only exasperates the problem. Rather, a system of salaried providers combined with liberal bonuses for improving the health of their patient panels is the ideal solution to refocus practitioners on taking the time to know their patients, to engage them in wellness and to follow-up. Most employer clinics use salaried providers and often feature average appointments of over 25 minutes.

Finally, even those providers who are wellness focused are still ineffective without data, information and health history. Yet, only 20% of hospitals and about 10% of doctors use electronic medical records in their everyday practices. Less than 1% of doctors are interconnected with one another, sharing information about common patients. That leads to errors, misdiagnoses and even deaths. Over 90,000 patients die unnecessarily in hospitals every year according to the Department of Health and Human Services.

As we fight for greater transparency of information, we should also fight for a change from an illness to a wellness model; from FFS to outcomes-based reimbursement; from intuitive medicine to data-based care plans. With that, we also need that push to do better; incentives (and poor health behaviors disincentives) to engage in wellness as vigorously in the future as we do now in poor health behaviors.

By John Kaegi
Chief Strategist
Healthstat Inc.

Saving Money on Dental Service

2011-06-17T12:26:13.944-04:00

Millions of people do not have dental insurance or have a dental policy that is extremely limited. As a result, millions of people end up spending a lot of money on dental services. As one of the millions without dental insurance I often wonder if I am overpaying for my families dental services. I am very happy with our family dentist, but how do I know if I am being overcharged for being a cash paying patient? If you are like me and you don’t have dental insurance ---how do you find the best value for cleanings, crowns, implants, fillings, root canals, and whitening treatments?

About 10 million Americans have lost their dental insurance in the last few years and in 2009 only fifty-four percent of people had some form of dental benefit.

A new start-up called Brighter.com allows consumers to compare dentists by reputation and by price. You can search Brighter.com free and look-up average prices to see what you might be able to save on dental services. I recommend checking out this dental site. Even if you don’t subscribe to Brighter.com, you can look up prices and get an idea of discounts you might be able to negotiate with your family dentist.

Out-of-Pocket Expenditure

2011-05-03T13:11:33.384-04:00

Definitions: Out-of-Pocket Expenditure on Health: The direct outlays of households, including gratuities and in-kind payments made to health practitioners and to suppliers of pharmaceuticals, therapeutic appliances and other goods and services. This includes household direct payments to public and private providers of health care services, non-profit institutions, and non-reimbursable cost sharing, such as deductibles, copayments and fees for services.

Private Health Expenditure: The sum of expenditures on health by prepaid plans and risk-pooling arrangements, firms' expenditure on health, non-profit institutions serving mainly households, and household out-of-pocket spending.

Sources: WHO, World Health Statistics 2010.

Excessive Medical Bills

2011-05-02T17:15:56.212-04:00

An interesting article appeared last month in the Los Angeles Times. The article, written by David Lazarus, sheds some light on why we need price transparency in our health care system. His article reveals true life cases where patients were billed excessively for services – and how much these services were actually discounted. Read the full article.

Case #1
Services: Heart surgery (aortic valve replaced, four nights in the hospital)
Bill: $267,000
Medicare discount: 84%
Final bill to Medicare: $42,000

Case #2
Services: Accident/Injury that required multiple nights in the hospital
Bill: $115,408
Medicare discount: greater than 87%
Final bill to Medicare: $14,405

Case #3
Services: Cancer surgery
Bill: $150,000
Private health insurance discount: 77%
Final bill to private health insurer: $34,500

What Do Hospitals Really Charge? No One Knows, Even With Posted Prices

2011-04-25T17:41:35.39-04:00

An increasing number of hospitals are starting to publish prices for common health care procedures on their websites.

Are these prices helping consumers understand what they might expect to pay for services, or are these published prices just confusing consumers even more? Ken Terry, author of the book Rx for Health Care Reform, wrote a recent article on BNET.com that explores this topic. Read the full article.

A Little Effort Goes a Long Way

2011-04-19T12:41:16.968-04:00

The Rauser Agency provides a series of 30 second insurance tips. A recent tip caught my attention because this advice has proven to save consumers hundreds (sometimes thousands) of dollars a year.

Consumers are paying a larger portion of their prescription drug costs in the form of cash/retail, co-pays, co-insurance and deductibles. To make your health care dollars go further, always comparison shop to find the best value. Most important, before you leave the doctor’s office and head off to a pharmacy to fill your next prescription, ask your doctor about generic alternatives.

A Little Effort Goes a Long Way

Should you shop for your next prescription? Here’s an example. A popular brand name statin (cholesterol medication) sells for $147. A generic alternative sells for $7.

In a “traditional” health plan with prescription co-pays, your cost may differ by only $15 or $20.

In an HSA plan, where all claims count towards your deductible, your cost may differ by $140. Every month!

Ask your pharmacist and your doctor about generic alternatives. It is well worth your time.

For more insurance tips from the Rauser Agency, click here.

Health Care Transparency Index

2011-04-06T11:01:20.655-04:00

More than 60 percent of self-insured employers in the U.S. are expected to offer a consumer driven health care plan in 2011 as a way to curb health care costs. Employees and their families will be increasingly accountable for “shopping” and paying for their health care, making it more critical than ever for them to understand the costs involved. Currently, consumers of healthcare have no information and no tool to help them make decisions.

The Healthcare Transparency Index (HCTI) provides health care consumers with ongoing trends data about actual health care costs, offering insight into opportunities for savings.

The data is sourced from change:healthcare’s proprietary, HIPAA-compliant database generated from client activity. The report’s pricing and behavioral content is derived from the change:healthcare Cost Transparency Solution. The Q1 2011 Index reflects information from 1.98 million medical claims, totaling $240 million and representing more than 109,000 lives across all 50 states over a 12-month period.

For more information about the Cost Transparency Solution contact change:healthcare

New Tool to Look-Up OutofPocket Costs

2011-04-05T17:19:06.925-04:00

Consumers have access to a free tool to help estimate how much they will have to pay for medical and dental care outside their insurers' approved providers. This tool is also useful for consumers that pay cash and negotiate a fair price for services, and consumers with high deductible health plans.

Currently, the site is limited to dental services and will be enhanced to include price data for medical and surgical procedures in August 2011. Right now consumers can look up how much a dental service or procedure typically costs in their ZIP code, how much is typically covered by insurance plans, and how much they'll have to pay themselves -- all before they even go to the dentist.

The information is only an estimate, since exact fees and health plan details vary. But it's designed to give consumers a reasonable idea of what the charges could be, based on common criteria. The numbers are based on a collection of data from insurers nationwide.

The free "cost-lookup" service, which resulted from a series of legal settlements by major health insurers to resolve an industry wide investigation in New York, is designed to shine some light on out-of-network costs and reimbursements, an area of health insurance that is little understood by consumers.

Today, consumers never really know how much a procedure will cost them until after they have the procedure done. Free consumer tools such as FairHealth, HealthcareBlueBook and Outofpocket provide consumers with true price information to better understand a fair price for the procedure– before visiting the provider.

The Fair Health site also provides some informational guides that use good old-fashioned “plain speak” to help consumers better understand the healthcare system. Topics include:

What is the difference between an HMO, a PPO, a POS, and an EPO?
What are the differences between in-network and out-of-network care, and how can those differences affect me?
How do health plans typically share costs with their members? (e.g. what are the differences between co-pays, co-insurance, deductibles, and out-of-pocket maximums)?
What is the difference between emergency care and urgent care?
Why is it possible to be billed for an out-of-network provider at an in-network facility?
What are the most common type of dental plans?
What does it mean to use Medicare fees as a basis to determine out-of-network care?

The Next Big Thing

2011-03-14T18:19:24.826-04:00

If you haven’t heard about Castlight Health, you probably haven’t been paying attention to the health care technology news. This health care startup is focusing on bringing transparency to health care, one employer at a time, by casting a light on health care prices. Last week the Wall Street Journal published their annual list of Top 10 Venture-backed Companies, and Castlight was #1 on their list. David Haber’s Blog, Supply Demanded, provides some interesting background information on Castlight Health. I’m sure we will all be reading more about Castlight Health in the very near future.

Price transparency is not going to happen overnight. Every single transparency initiative brings a group of consumer’s one step close to having a better understanding and awareness of the true cost of health care services. These initiatives will eventually create a competitive market place where consumers can shop around for the best value (before visiting a provider), and have a tremendous impact on reducing health care spending overall.

If you have individual health insurance, or if you are uninsured or if you are employed and your employer hasn’t yet purchased Castlight health’s technology – you can always use Outofpocket to look up health care price information.

Need Help with your Prescription Medicines – Learn about Prescription Savings Programs

2011-03-12T12:50:53.217-05:00

Although long-term solutions may be on the horizon with the new health care law, in the interim, more than 50 million Americans are uninsured. With the rising prevalence of chronic diseases, such as diabetes, which has reached epidemic proportions, people without prescription coverage often struggle to afford necessary and life-saving medications and products.

Fortunately, resources, such as prescription savings programs, are available that can help now when people need it most. One such program is Together Rx Access®, which offers eligible individuals and their families meaningful savings on a variety of brand-name prescription medicines and products right at the pharmacy counter. Savings are also available on a wide range of generics. Medicines in the Program include those used to treat high cholesterol, diabetes, depression, asthma, and many other common conditions.

Together Rx Access is committed to collaborating with organizations dedicated to creating awareness about the impact of chronic disease, such as the American Diabetes Association, to inform uninsured individuals with these conditions about options to help them better afford their medicines.

Other savings options are available through the Partnership for Prescription Assistance, which is a clearinghouse of more than 475 public and private assistance programs. Individuals may also qualify for free medicines, or learn about free clinics in their neighborhoods through the Partnership for Prescription Assistance.

Contributed by Roba Whiteley
Executive Director
Together Rx Access

How Much Does It Cost ?

2011-02-07T11:01:44.184-05:00

Here is a provocative video to help consumers understand health care costs. Regence, a health insurer in the Northwest, launched a campaign called What's the Real Cost. This purpose of this initiative is to educate consumers about the real costs of health care, and how the choices they make each day impact those costs.
Click below on the links to watch some short videos that really put things in perspective.

How Much Does it Cost – what if everything worked like health care?

5 Questions - how much does that cost?

Saving Money on Your Medical Bills

2011-02-04T11:17:39.652-05:00

Health care costs continue to rise and consumers need to be well informed so they can make educated choices and find the best value. CBS News provides tips on how consumers can make their health care dollars go further.

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

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

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

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

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

Promoting Price Transparency

2011-01-09T18:27:26.981-05:00

By Iris Kimberg, MS PT, OTR

We continue to transition from a health insurance system funded exclusively by employers to a system where health care insurance expenses are shared between employee and employer.

As we rely less and less on health care insurance policies to pay for many services, including occupational therapy, the movement toward price transparency is gaining momentum and support. While this is customary in other industries, it is nothing short of revolutionary in health care. Slowly but surely, start-up companies, the government and even insurers themselves are seeing that an opportunity to empower the consumer with medical pricing information is a win-win situation for everyone.

An early start-up company, Pricedoc, enables consumers to compare and negotiate pricing on medical procedures in a given location in the United States, while providers receive the benefit of generating patients who are willing to pay directly for their services. Procedures listed include everything from standard preventive medical procedures to laboratory work and physical therapy (can OT be far behind?).

Another company, financed in part by the Cleveland Clinic, is Castlight Health. They too are offering a search engine for health care prices, enabling a health care consumer and employers to search for a provider and find out what his charges will be beforehand. Giovanni Colella, chief executive and a founder of Castlight, says, "Creating the right incentives changes the way people behave, and that's where our company comes in." Safeway grocery chain, with 200,000 employees, has signed on as its first customer.

Thomson Reuters now offers a tool, the Treatment Cost Calculator, that it claims provides highly accurate, real-time estimates of anticipated out-of-pocket costs for services and pricing at the specific provider level.

Insurance companies are jumping on the bandwagon. Aetna now has a tool called the Aetna Navigator for all its members. It helps to estimate the average costs in your area for certain office visits, diagnostic tests, vaccines and procedures, and even estimates the annual average costs in your area for treating specific diseases and conditions. Having cost information before you receive medical care can help you estimate out-of-pocket costs, anticipate possible future expenses, and better manage the funds and accounts that may be part of a health insurance plan, such as a flexible spending or health savings account.

Congratulations to New Hampshire on Healthcost. Developed by the state's insurance department and the commissioner's advisory committee on health insurance, the program provides information on the price of medical care in the Granite State by insurance plan and by procedure. It also provides the estimated price of medical care for the uninsured. This website serves as a resource to help health care consumers in New Hampshire make informed decisions about purchasing health care services and insurance.

We are already health care providers and health care users. More and more, we are becoming health care buyers. There is new fuel for the push for transparency in medical fees. I hope private practitioners will start to participate-for starters, how about posting fees and pricing for OT services on websites and in marketing materials? Instead of worrying about "scaring" away patients, take pride in validating the worth of your services and helping your patients become as fully informed as you would want to be.

Iris Kimberg, MS PT, OTR, has worked in the non-clinical aspect of therapy for the past 30 years. She is the founder of New York Therapy Guide, a site dedicated to the growth, viability and success of therapists in the private sector. Iris now enjoys sharing her expertise with others in the field through workshops, seminars and private consultations. She can be reached at infonytherapy@aol.com.

Making Smart Choices with Your High-Deductible Health Plan

2011-01-06T16:53:24.168-05:00

Happy New Year! For those of you that just signed up for a high-deductible health insurance plan (HDHP), welcome to the group of 22 million other people that are already enrolled in these type of plans.

So now that you signed up for a high-deductible health-insurance plan next comes the hard part: making smart decisions about your health care spending since you're now responsible for more upfront out-of-pocket expenses.

High deductible health plans typically have significantly lower premiums, but much higher deductibles, than other plans. For 2011, high-deductible plans will have a minimum annual deductible of $1,200 for an individual and $2,400 for a family, according to the Internal Revenue Service. The maximum out-of-pocket limits for an individual in network is $5,950 and $11,900 for a family.

The good news is that under the new health-care law, many more high-deductible plans now cover preventive care, such as annual checkups and recommended immunizations, as well as typical tests including mammograms and colon-cancer screenings. The best way to maximize your dollars using a high-deductible health plan is to fully understand what's covered by the plan and what is applied to your high deductible.

As far as expenses that are out-of-pocket, there are a number of ways to maximize your money. Of course, the obvious one is to take better control of your health by eating well and exercising so you end up having to go to the doctor less often. Here are some useful tips to help you make your health care dollars go further.

Consider using a cheaper, generic version of a brand-name drug when appropriate. Be sure to talk with your doctor about less expensive generic alternatives that provide you with the same results.
Talk to your doctor about the costs of a recommended treatment and any alternatives. Sometimes there are cheaper alternatives that that doctors don’t always bring up because they think your health plan covers all the costs.
One of the biggest savings can come from using the health savings accounts offered with many high-deductible plans. You contribute to these accounts with pretax dollars and use the money, tax-free, to pay for out-of-pocket medical expenses. Unused money can be carried over into future years.
If possible try to use urgent care centers rather than Emergency Rooms. This can save you hundreds and possibly thousands of dollars.
Try to stay in-network. Providers in-network can be a lot less expensive. If you go out of network sometimes you can offer to pay cash for services and receive up to 50% discount. Be aware that if you choose to pay cash, this medical expense will not be applied to your deductible.
Compare prices for health care services before visiting a provider. The Wall Street Journal published a directory consumers can use to look up prices, or you can view a list of public websites that provide health care pricing.

Online Drug Savings Tool

2010-12-06T12:35:47.583-05:00

More and more of today’s health care costs are being passed along to the consumer in the form of higher deductibles, more expensive co-pays,and double-digit increase in premiums. With these higher out-of-pocket expenses consumers need to be savvy, cost conscious and shop around for the best value by comparing prices and value.

Many doctors write out prescriptions for expensive brand name drugs. You need to know that there are less expensive options than what the doctor orders on the prescription pad. Patients need to ask their doctors and pharmacists about these options. Unfortunately, some patients never ask.

What you need to do is research drug savings options. You can check for yourself to find lower cost alternatives with the help of a new online drug savings tool that provides drug costs on hundreds of prescriptions and over-the-counter medication products.

This tool is a joint project between the publishers of Consumer Reports Health and AARP, and gives you access to Consumer Reports research on costs, how the drug works, side effects of the drug, precautions to discuss with your doctor and drug interactions you might not be aware of.

This is a great way to get answers about hundreds of the most common medications on the market. This tool enables you to have more informed conversations about medicine with your physician, as well as the pharmacists who fill your prescriptions.

Just be aware that this tool focuses on the most popular drugs and does not include every drug. And as always, be sure to consult with your doctor before you change medication or add new medications to what you're already taking.

Negotiating Your Health Care Bills

2010-11-28T06:13:32.329-05:00

Today more and more consumers have high deductible health plans, higher out-of-pocket costs, and are paying cash for services. It would never occur to most people to negotiate prices with their doctors for health care services but it turns out that doctors, hospitals and labs are willing to negotiate. Only 30 percent of people negotiate health care prices and these people are successful 70 percent of the time. Listen to an NPR podcast of real patients talking about their personal experiences and success stories in negotiating with providers for a fair price.

The next time you need to have a routine non-emergency procedure done, here are some simple tips to keep in mind.

Be aware that there is a huge price variation for the exact same procedure. If you are not careful you can end up paying up to 300-500% more for services.

Do your homework before you visit your provider. Find out a fair price for the health care procedure using tools like HealthCareBlueBook.

Have a good conversation with your doctor before you have the procedure done to negotiate a fair price upfront for services.

Angie’s List Helps Consumers Manage Health Care Costs

2010-11-06T17:39:40.308-04:00

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

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

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

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

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

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

Comparison Shopping for Health Care Prices is not Easy

2010-10-13T11:45:44.184-04:00

Kara McGuire recently wrote an article in the Minneapolis Star Tribune about how difficult it is to comparison shop for prices when you are shopping for health care services.

Nine months into her high-deductible health plan, she was ready to apply cost-conscious consumerism tactics to determine how to find the best price. Click here to read the full story.

How do you find the best health care provider?

2010-10-08T16:21:14.378-04:00

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

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

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

Virginia Publishes Health Care Prices

2010-09-30T19:26:58.019125-04:00

Virginia Health Information published a report listing price information for health care services. This information is available on their website and provides consumers with access to information on what health care procedures cost in Virginia--- before they receive medical care. The report shows the average amounts that health insurers in Virginia pay for 31 procedures that including preventive, emergency, outpatient and hospital inpatient care and they have future plans to expand this list of procedures. This information was designed for:

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

"Virginia is one of a few states with health care pricing information," says Michael T. Lundberg, VHI's Executive Director. VHI worked together with representatives from the Virginia Association of Health Plans, the Medical Society of Virginia, the Virginia Hospital and Healthcare Association and the Virginia Department of Health to produce the information.

"There are few things, if any, that rival the importance of our health care," said Dr. Bill Hazel, Virginia's Secretary of Health & Human Resources. He continued: "Patients deserve to be able to evaluate the cost and quality of their health care options, and have a reliable resource for these comparisons in VHI." Delegate John O'Bannon, himself a physician and sponsor of the legislation agreed, saying: "This is a great first step in empowering citizens to be educated consumers of health care."

To access this health care price guide, visit: http://www.vhi.org/transparency

Costs of Care Essay Contest

2010-09-13T17:56:50.716-04:00

Everyone has a health care story and here’s a chance to tell your story.

Do you have a story to tell about a medical bill that was higher than you expected it to be? Or a time when you wanted to know how much a medical test or treatment might cost and couldn’t find out?

Costs of Care, a nonprofit group based in Boston, is offering $1000 for anecdotes like these that illustrate the importance of cost-awareness in medicine. Judges will include former U.S. Health and Human Services Secretary Michael Leavitt, Boston surgeon and New Yorker writer Atul Gawande, and former Massachusetts Governor and Democratic Presidential Candidate Michael Dukakis. According to Dr. Neel Shah, who is directing the contest, "Using everyday examples from across the country, these stories will highlight the need to make healthcare prices more transparent."

Submissions should be no longer than 750 words and are due by November 1st. More details are available here.

Applying Out-of-pocket expenses to my deductible

2010-08-24T17:26:31.532-04:00

My family has a high deductible health plan with a $5,200 annual deductible and a Health Savings Account (HSA). I really like our health plan because it provides my family with great coverage in case of any major medical events, and our monthly premiums are considerably lower. In a typical year, we never meet this deductible.

This calendar year my family has accumulated some medical expenses and it looks like we might be meeting our deductible by the end of the year. I have a number of prescriptions filled at our local Walgreens Pharmacy so I joined the Walgreens prescription savings club to save 25% on all my prescriptions. This is a huge savings for my family. Almost a month ago I realized my prescription out-of-pocket spending was not being applied towards my annual deductible and since this was almost $2000 in Rx expenses – I was concerned.

It turns out that if you join the Walgreens savings club and use your savings club discount when you pay for prescriptions, Walgreens does not submit these drug claims to your health insurance plan. In order for these expenses to be applied to my deductible, I am required to submit these receipts myself. Why Walgreens cannot forward these claims is a mystery. But now that I know, I will make sure these drug expenses get applied to my deductible.

Websites help patients compare prices for health care

2010-08-11T03:35:40.924-04:00

This article by Jillian Berman, was published in the July 30, 2010 issue of USA TODAY.

As Alan Grunberg neared 50, he knew he was going to need a colonoscopy, so the Chicago-based Realtor began shopping around to try and find the best place to get the procedure done.

"I couldn't get anybody to give me information on how much it was going to cost," he says, adding that his insurance wouldn't cover the procedure.

Grunberg eventually found PriceDoc.com and received multiple quotes. "The price was outstanding," he says. "I jumped on it."

PriceDoc is one of several sites that give consumers the ability to shop for procedures ranging from a colonoscopy to teeth whitening. In some cases, the sites allow consumers to negotiate with providers.

Steven Findlay, health analyst for Consumers Union, says sites listing prices for procedures can be helpful, but consumers shouldn't settle for the first price offered. Unlike traditional retailers, health providers don't usually advertise sales, he says.

Patrick Bradley, PriceDoc's co-founder, says his goal is to help consumers find a low price for services their insurers won't cover. Patients search by ZIP code for a list of doctors and their prices.

Some of the doctors listed on the site prefer to negotiate and include the "make me an offer" button on their profile, while others just list their lowest price, Bradley says.

"We've created a free, market-based competitive field if you're paying with cash," he says.

One drawback is that for some locations and procedures, the choices are limited. When Grunberg tried to use PriceDoc again to search for a dermatologist, he couldn't find any providers in his area. "I'm not going to travel 500 miles to have something done unless I need to do it," he says.

Bradley says most of the consumers using his site are looking for dental, vision, cosmetic and dermatology procedures. Many have individual insurance policies, which typically have high deductibles, or are paying for care out of a health savings account.

Mona Lori, founder of OutOfPocket.com, says her customers are primarily interested in prices for dental and vision procedures. Lori created the site, which offers a price-based directory of health care services, in 2007 after unsuccessfully trying to get providers to give her prices for various procedures.

Findlay says providers are gradually becoming more transparent with prices.

Brian Douglas, co-founder of New Choice Health, says that should be the goal. Douglas says he started NewChoiceHealth.com, which lists price ranges for procedures at various facilities, to "help educate the consumer that health care is retail.

High Quality Medical Imaging Pricing – at a Lower Cost

2010-07-26T12:15:48.186-04:00

Deaconess Hospital Medical Imaging, located in Cincinnati, Ohio, is focused on providing patients with the same superior, high quality imaging services -- but at a lower cost. Deaconess has recently announced new, flat pricing for MRI, CT Scans and Diagnostic Ultrasounds, whether you are a self-pay or have private insurance. Here are some of the details on their new pricing.

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

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

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

          o All MRI Scans $795
          o All CT Scans $565
          o All Diagnostic Ultrasounds $200

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

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

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

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

For more information about Deaconess Hospital Medical Imaging services, please visit www.DHMedicalimaging.com or contact Sarah Lewis slewis@deaconess-cinti.com.

Upfront, transparent pricing for your surgery

2010-06-12T21:00:23.187-04:00

The Surgery Center of Oklahoma is a 32,535 square foot, state-of-the-art multispecialty facility in Oklahoma City, owned and operated by approximately 40 of the top surgeons and anesthesiologists in central Oklahoma. The facility has been accredited by the AAAHC since 1998 without interruption and has annually provided care to thousands of patients.

If you have a high deductible or are part of a self-insured plan at a large company, you owe it to yourself or your business to take a look at our facility and pricing which is listed on our website. If you are considering a trip to a foreign country to have your surgery, you should look here first. Finally, if you have no insurance at all, this facility will provide quality and pricing that we believe are unmatched.

It is no secret to anyone that the pricing of surgical services is at the top of the list of problems in our dysfunctional healthcare system. Bureaucracy at the insurance and hospital levels, cost shifting and the absence of free market principles are among the culprits for what has caused surgical care in the United States to be cost prohibitive. As more and more patients find themselves paying more and more out of pocket, it is clear that something must change. We believe that a very different approach is necessary, one involving transparent and direct pricing.

Transparent, direct, package pricing means the patient knows exactly what the cost of the service will be upfront. Fees for the surgeon, anesthesiologist and facility are all included in one low price. There are no hidden costs, charges or costs.

The pricing outlined on our website is not a teaser, nor is it a bait-and-switch ploy. It is the actual price you will pay. We can offer these prices because we are completely physician-owned and managed. We control every aspect of the facility from real estate costs, to the most efficient use of staff, to the elimination of wasteful operating room practices that non-profit hospitals have no incentive to curb. We are truly committed to providing the best quality care at the lowest possible price.

G. Keith Smith, M.D.
ksmith@surgerycenterok.com
The Surgery Center of Oklahoma

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How Much Will Your Surgery Cost? Hospitals Can't Tell You

2010-04-18T15:20:36.738-04:00

A new research paper from The Healthcare Blue Book entitled Surgery Pricing Secrets: The Challenges Patients Face, shows that it is almost impossible to get prices ahead of time if a patient plans to have surgery in a hospital.

Healthcare Blue Book researchers found that:

§ It took three times as many phone calls and four times as long to get pricing information from a hospital.

§ Hospitals would not provide guaranteed prices and price ranges often varied by more than 100%.

§ ASCs were more likely to discount prices for cash customers; regardless of the patient’s financial status.

§ Facility fees are 3-4 times higher in a hospital than in an ASC.

Healthcare Blue Book researchers contacted hospitals and ambulatory care centers (ASCs) in three markets: Raleigh-Durham , NC ; Denver , CO ; and Portland , OR . Hospitals and ASCs were asked to provide the costs of an anterior cruciate ligament surgery of the knee for a patient without health insurance.

Queries were primarily about facility fees, but researchers also asked respondents about other fees associated with the surgery.

It’s almost certain health care expenditures, which totaled about $2.5 trillion in 2009, will continue to climb by at least 6% a year. Hospital costs are 31% of the total according to the Centers for Medicare and Medicaid Services. So what are health care consumers going to do?

The Healthcare Blue Book, an Internet content provider, offers a free consumer guide to fair pricing for healthcare treatments and services for local markets.

“One of the main tenets of successful healthcare reform will be patients taking more responsibility for finding out what their care costs as they make treatment decisions,” said Dr. Jeffrey Rice, Healthcare Blue Book CEO, and white paper author. “But until hospitals are able to provide exact pricing, managing out of pocket costs for both insured and self-pay patients is almost impossible.”

Click here or a free copy Surgery Pricing Secrets: The Challenges Patients Face.

The Price Is Right?

2010-02-07T21:28:46.759-05:00

“Come on down!” Those are awfully familiar words to any “Price is Right” guru. Ever notice how the items being bid on are all brand names? It’s part of “branding,” and it works well if you’re targeting a fan of the CBS hit television show, even post-Bob Barker!

There’s a time and a place for brand names. I choose Kraft Macaroni and Cheese over the store brand, it’s my personal preference. Why? In my opinion, Kraft has a better product, and the difference is definitely noticeable. (Yes, it is the cheesiest!) I could save about $25 a year by choosing the store brand, which adds up to about $1,250 over my lifetime.

Now, this is crazy. The average person has one prescription per month, and the cost of the brand name prescription, on average, is $100.00. Let’s say from age 45 to age 68, a person spends this amount per month on the same brand name prescription. That’s $27,600! What? $27,600! Sorry, it was just SO worth repeating!

Now, let’s take this same person and factor in medtipster.com, where the same prescription is available in a generic form (which is an exact replica of the brand name) for only $4.00 per month. Now we’re talking! That’s just $1,104.00 over 23 years. While I’m sure you can do the math, basically the difference is, well, a new Honda Civic Hybrid, or two Kia Rios!

So you see, we’re not talking mac’n cheese any more. While “The Price is Right” for some purchases, it’s better to “come on down” on prescription drug spending.

Guest post by Tylar Masters, Marketing & Communications, Medtipster.com

About Medtipster: Medtipster provides consumers with a solution to the rising cost of health care. Using Medtipster’s proprietary technology, consumers simply type in their drug name, dosage and zip code, and instantly find their prescription drugs available on discount generic programs, located right in their own neighborhoods. Many of these drugs are available for $4 or less.

High Deductible Health Plans are Becoming Popular

2010-02-07T20:54:20.415-05:00

Increasing popularity of high deductible health plans

The most recent National Health Interview Survey (NHIS) from the Center for Disease Control finds that now 22.7% of the under-65 population is in "high deductible" health plans. This is up from 19.4% just one year ago. This includes 6.4% of the population with a Health Savings Account, up from 5.2% last year. It does not separate out HRAs from other people with stand-alone high deductible plans. The report also mentions that fully one-half of the individual market now has high deductible health coverage.

SOURCE: Center for Disease Control

100 Useful tools to help you take more responsibility for your own health

2010-02-04T21:43:45.259-05:00

With health care prices rising, wait lists growing longer, and benefits decreasing, it makes more sense than ever to take more responsibility to help manage you and your family’s health. With the help of the internet, do-it-yourself health is growing at an increasing rate.

If you are ready to take charge of your own health, take a look at these 100 useful tools for mananging your health care. Although they don’t substitute for a live doctor, they can be immensely helpful in getting information, preparing for a visit, and even finding a medical provider. This is a excellent collection of useful resources consumers can use and the 100 tools are organized into several categories:

Information on alternative and traditional health care treatment options
Useful information on supplements
Symptom checkers and online quizzes to point you in the right direction
First-aid and safety tools
Consumer quizzes on health related topics
Personal health record resources and tools
Drug information tools Resources to learn more about health care
Tools to find a doctor, specialist or hospital

Click here to read Jeanne Peterson’s complete article including a brief description and link to all 100 tools/resources.

How to Save Money on Your Lab Tests

2010-02-01T22:40:29.498-05:00

We love sharing tips on how consumers can save money on health care costs. When it comes to lab tests, most consumers have their lab tests done through their doctors. For consumers that want to save money and time, online lab testing is an affordable way to have your lab tests done. Consumer online lab tests can be a convenient and cost-effective way to have the same lab tests done that your doctor orders --- while saving money on these tests. To use these online lab websites, consumers select a specific test(s), enter their zip code to locate a blood draw center in their neighborhood, and order the test online using their credit card. Depending on the consumer’s health plan, consumers might be reimbursed for this service. Be sure to check with your health plan for specific details. I’d like to introduce you to Personalabs.com, a direct-to-consumer lab test website.

PERSONALABS™ was founded in Aug 2006 to provide consumers with direct access to the same blood tests available from their doctor. No office visit is required, there is no medical record and their tests are offered at a lower cost. Their focus is to empower consumers by giving them the tools to make informed decisions about their health and wellness. They provide the same blood tests that are available through your doctor, including STD tests, health tests and drug tests, without waiting for a doctors' appointment and without the high costs. Online lab test sites make it very easy for consumers to get tested for a variety of health concerns.

The next time you need a routine lab test, I strongly recommend you consider online lab test sites. Consumers are invited to visit Personalabs.com and save 5% on their lab tests by using discount code “AD2009”.

How much do they cost and what tests do you really need?

2010-02-01T22:15:58.279-05:00

An article in today’s CBS Moneywatch.com reviews diagnostics tests, their costs, purpose, concerns and if then test is worth getting. If you are considering getting a non-emergency MRI, mammogram, CT scan, or nuclear scan, be sure to read this article. If you want to learn more about prices for these diagnostic tests, you can search the Outofpocket.com directory to find true prices for these services.

From MRIs to Mammograms: Which Tests Do You Really Need?

Chalk it up as one more symptom of our broken health-care system: Americans waste more than $250 billion per year on unnecessary medical tests and treatments, according to a Thomson Reuters health-care analytics report. Often, doctors order expensive, high-tech tests to rule out unlikely possibilities, reassure worried patients, or as a CYA strategy against a possible lawsuit. An American Journal of Preventive Medicine study found that in 43 percent of cases where healthy people went in for routine checkups, doctors ordered an X-ray, electrocardiogram, or urinalysis. So how can you be sure you’re not wasting your money on medical tests you don’t really need?

Unnecessary medical tests don’t just take money out of your pocket. They can expose you to radiation, cause mental stress, and kill a day or more. Not to mention their cumulative effect: ever-climbing insurance premiums.

MoneyWatch wanted to find out whether five commonly prescribed tests are worth getting: mammograms, CT scans, PSA prostate screening tests, nuclear heart scans and MRIs for lower back pain. So we talked to experts in preventative and family medicine and pored through the latest research about the risks and benefits of these tests, which can cost up to $2,000 or more a pop. What we found may surprise you.

Of course decisions about medical care are intensely personal, and everyone’s circumstances are slightly different. If there’s a key takeaway it’s this: Medical tests are not analogous to checking your car’s tire pressure. Sure there may be benefits, but there can also be negative consequences. Be sure to educate yourself on the downside.

CT Scan

Purpose: Non-invasive and painless, doctors use them to get detailed images of everything from cancerous tumors to signs of heart disease to bone injuries. You lie on an exam table that slides in and out of a machine. More than 70 million CT scans are done annually; 23 times the number in 1980, according to the Radiological Society of North America.
Cost: Varies widely; average price is $1,150 for a brain CT scan, $1,800 for a chest CT scan and $2,175 for an abdominal CT Scan
Concerns: Researchers are increasingly fearful that the scans’ radiation could lead to increased cancer risk and say that safer tests such as an ultrasound can sometimes do the job. Then, there’s the danger of medical error. Last August, 206 patients at Cedars-Sinai Medical Center in Los Angeles accidentally received eight times the normal amount of radiation during their CT scans. “A single CT scan for an isolated problem I’m not so concerned about. It’s when patients keep coming back for repeated exams that cumulative radiation starts to add up,” says Dr. Aaron Sodickson, assistant professor of radiology at Harvard Medical School.
Worth getting? If your doctor orders a non-emergency CT scan and you’ve already had at least one previously, “ask your doctor if there are alternative tests that can be done,” says Greg Morrison, chief operating officer of the American Society of Radiologic Technologists. If you will undergo the test, first ensure that the facility is accredited by the American College of Radiology and that technicians follow the ALARA (As Low as Reasonably Achievable) protocol, so you’ll receive the lowest possible dose of radiation.

PSA Prostate Cancer Test

Purpose: Doctors encourage men to get this simple blood lab test every year to help them avoid the second leading cause of death among U.S. males. But the PSA, or prostate specific antigen test, may do more harm than good.
Cost: About $45; up to $1,500 if the test leads to a biopsy
Concerns: The American Cancer Society does not support routine testing for prostate cancer, because of the risk of over diagnosis and overtreatment. Studies recently published in the New England Journal of Medicine found that PSA screening does find more prostate cancer, but the early detection does not translate into lives saved. For every man whose life is saved by early detection of prostate cancer, 48 others will undergo unnecessary treatment with possible side effects including impotence and incontinence.
Worth getting? Discuss your options with your doctor. Some men opt for regular PSA screenings, but not to have surgery or radiation therapy unless an aggressive cancer is detected.

Nuclear Heart Scan

Purpose: Doctors usually order these two- to four-hour tests after patients have had unexplained chest pain or pain brought on by exercise. The scans are designed to help detect narrowing of the arteries, damaged heart muscle, or to evaluate how well your heart is pumping blood. After a radioactive ‘tracer’ is injected into your veins, you take a stress test, walking on a treadmill or riding a stationary bike at increasing speeds. Then photographs are taken, showing your heart after strenuous exercise.
Cost: About $2,000
Concerns: Although this type of imaging can be useful for diagnosing heart disease, it’s overused. A pilot study of 3,035 scans for the American College of Cardiology (funded by insurers and cardiology groups) found that about 18 percent of the nuclear heart scans were done unnecessarily; another 16 percent were ambiguous.
Worth getting? Ask your doctor whether an alternative test is available, such as a stress echocardiogram, which does not involve exposure to radiation and costs about $1,000. Discuss the amount of radiation you’ve been exposed to in the past to determine whether you may want to avoid future radiation, when possible.

Lower-Back MRI

Purpose: A spinal magnetic resonance imaging (MRI) test can find changes in the spine and other tissues, infections, herniated discs, and tumors without using radiation. You typically lie on a moveable table that slides into a tube surrounded by a magnet. Newer standing, or open, MRI machines are also available.
Cost: About $2,000
Concerns: MRIs can show every bump and lump, which may lead to procedures causing more harm than good. The Health Affairs journal found that the increasing availability of MRI is linked to an increase in surgery for lower back pain even though symptoms for most back pain sufferers often resolve themselves without invasive surgery. The researchers theorized that doctors ordering the MRIs have a tendency to find something to blame in the resulting images.
Worth getting? Experts say that if you have lower back pain, wait at least a month before submitting to an MRI. “The main reason you’d have an MRI of your lower back is if you’re going to have surgery,” says Dr. Daniel Merenstein, Assistant Professor and Director of Research in Family Medicine at Georgetown University Medical Center. “But for routine low back pain, surgery has not been shown to be any better than Motrin or other non-steroidal anti-inflammatory drugs or acupuncture.”

Mammogram

Purpose: The 10-minute X-ray procedure can be done for breast-cancer screening purposes in the absence of symptoms or for diagnosis purposes after a doctor detects a change in a woman’s breast.
Cost: About $125
Concerns: For years, women were advised to have routine screening mammograms every year or two starting at age 40. Last fall, the U.S. Preventative Services Task Force recommended less routine screening, concerned that mammograms on women in their 40s yield a high number of false positives. For women without risk factors, such as a history of breast cancer among close relatives, the panel now recommends biennial screenings starting at 50 and until age 74.
Worth getting? Although the panel advises women in their 40s without significant risk factors to discuss the usefulness of a mammogram with their doctors, leading breast cancer experts, including American Cancer Society and Susan G. Komen for the Cure, still strongly recommend women get screening mammograms beginning in their 40s. “The American Cancer Society acknowledges the limitations of mammography [but] overwhelmingly believe[s] the benefits of screening women 40 to 49 outweigh its limitations,” Dr. Otis Brawley, chief medical officer of the American Cancer Society said, in a statement. “We believe the evidence does show there is survival benefit for women who get screening in their 40s, although we acknowledge that benefit is not great,” says Susan Brown, director of health education for Susan G. Komen for the Cure. So until the medical community reaches a consensus, it seems best to get the mammogram.

My New Years Wish -- A Formal Pricing Request

2009-12-29T21:30:10.744-05:00

Today I contacted my health insurer to go over some policy changes they notified me by mail about for the upcoming year. After they answered my policy questions, I took this opportunity to ask them my standard question, “as a member of your health plan, how do I find out what my specific out-of-pocket costs are– before visiting a provider?”

Here is what I learned. This type of information is called a FORMAL PRICING REQUEST and consumers (health plan members) must obtain specific information from the provider and follow the outlined procedures below. Contact your provider’s office and find out:

Provider’s NPI #
The specific diagnosis code(s) for the procedures that will be provided (ICD-9)
The specific CPT code(s) for the services that will be provided
The amount the provider charges for these services
The location (place) of service. This could be lab, outpatient facility, office, hospital)

After the member has all this information from the provider, the member should contact the health plan’s benefits/claims department and be ready to answer all these questions. Within 48-72 hours after the request is made, the insurer will provide the member with a letter identifying the member’s out-of-pocket costs for the services. As a convenience, the insurance plan has offered to read the letter over the phone, rather than mail it out to the member. Contact the Benefits/claims department.

Happy New Year!

Price Disparities Are Common

2009-12-29T21:11:57.01-05:00

NPR ran an interesting story in November 2009 on price disparities in our health care system.

When it comes to our health care system, the basic economic rules do not apply. Prices for identical goods and services are usually the same or very close at competing businesses. That's not the case when it comes to health care — not by a long shot. In Pensacola, Florida there are huge price disparities for MRI tests. It's not a matter of greed or poor decision-making by MRI providers or a lack of consumer awareness. For better or worse, it's the way our insurance-based health care system works. Read the full story .

The New York Times Advises Consumers to Shop Around for the Best Prices

2009-12-03T15:39:49.599-05:00

An article in the New York Times encourages consumers to shop around to find the best prices for health care services. The article recommends four steps consumers should take to comparison shop for health care:

Check to find out if your health insurer offers tools for members
Use tools like PriceDoc.com, HealthcareBlueBook.com and Outofpocket.com to look-up prices
Research state transparency initiatives to look-up hospital prices in your state
Call the provider to find out specific price information

Reducing Healthcare Costs through Medical Negotiation

2009-11-02T10:42:10.157-05:00

This year an estimated 1.5 million Americans will declare bankruptcy, and a study from the American Journal of Medicine suggests that more than 60 percent of people who go bankrupt are actually capsized by medical bills. Most of these medical debtors are well educated, own homes, and have middle-class occupations; three quarters have health insurance. >

However, medical negotiation, the practice of reviewing and negotiating payment of your medical bills and procedures, is providing individuals the opportunity to prevent medical bills from spiraling out of control.

“Many people don't think of medical negotiating as a practical option to reduce their medical costs; though they anticipate negotiating when purchasing a home or pricing a car,” says Derek Fitteron, CEO of Medical Cost Advocate (MCA), an expert medical cost reduction company.

MCA uses health care pricing information along with data showing the cost of typical medical and surgical procedures, and works with medical providers to negotiate costs on behalf of the consumer. MCA will negotiate any medical bills including those not fully covered by insurance like surgery, hospital and professional charges and those not covered at all including cosmetic, bariatric and dental. This can be done prior to the procedure (negotiating a set price) or after it occurs to help arrive at a reduced price for the consumer.

“While individuals can negotiate bills themselves, they often don’t have the skills, knowledge or time necessary to achieve success,” says Fitteron. “MCA negotiators include attorneys and former healthcare billing professionals that know how to negotiate bills and have industry data to leverage. All negotiations are conducted tactfully with utmost respect for the patient provider relationship.”

With an 80% success rate of reducing bills ranging from $250 - $250,000 by 20-50 percent, MCA follows a no-risk negotiation policy for consumers; if they don’t save the customer money, the customer doesn’t pay.

“Consumers should make a habit of medical bill negotiation,” says Fitteron. “Actively participating in the billing process both before and after a procedure or treatment provides consumers with an opportunity to get their debt under control. In todays increasingly consumer directed health care environment many families need a trusted cost advocate on their side.”

Fitteron also offers the following five money-saving tips to help consumers save money on their medical bills:

1. Be sure that you understand your insurance coverage. Review and understand your insurance summary/declaration sheet and know in-network and out-of-network provisions. Have a firm understanding of your co-payments, deductibles and co-insurance rates and when they apply.

2. Research before buying. If you plan to use or go out-of-network, do extensive research on a doctor’s capability and costs. A professional like Medical Cost Advocate can help you in this process and can help you negotiate a rate or payment plan before your procedure.

3. Take advantage of health savings accounts and other tax advantaged products to reimburse medical expenses like HSAs, HRAs, and FSAs which are frequently available from employers or directly.

4. Ask for details about your procedure charges including an itemized bill with procedure costs. Be sure to wait for an Explanation of Benefits (EOB) from your insurer, and always review both items to make sure you received what you thought you were getting.

5. Find a trusted medical cost negotiator, like Medical Cost Advocate, to help reduce bills. As most people lack the time, expertise or desire to negotiate their medical bills, they should hire an expert (that works on a pay-for-performance basis) to negotiate bills on their behalf.

About Medical Cost Advocate

Medical Cost Advocate (MCA) is a medical cost reduction company that lowers consumers’ medical bills before or after treatment through the power of professional negotiation. Serving consumers, their employers, benefits consultants and financial institutions, MCA leverages industry experience and proprietary data to regularly save consumers between twenty and fifty percent on their medical bills. MCA can negotiate any medical, surgical or dental bill for insured and underinsured consumers. With out-of-pocket healthcare costs steadily increasing, MCA provides the professional advocacy every consumer needs to realize savings without risk.

Wall Street Journal: Health Care Price Tools

2009-10-29T16:11:32.141-04:00

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.

Medical Tourism is Alive and Well on the Internet

2009-10-22T13:39:22.255-04:00

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.

Best Deal on a Colonoscopy

2009-10-15T19:25:59.609-04:00

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 .

Retail Clinic vs. Office Visit

2009-10-14T09:03:32.055-04:00

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

Hospital Search Engine to Look-up Prices

2009-10-13T13:11:32.367-04:00

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.

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Demystifying the Emergency Room Bill

2009-10-10T17:54:56.289-04:00

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.

Secret Health Care Prices

2009-09-30T21:27:47.916-04:00

To cut health care costs, let's start by eliminating the secret prices.

With so much discussion on how we need to reduce health care costs, this article written by Dr. Bernadine Healy in the U.S. News and World Report, sheds some light on this issue as Dr. Healy discuses the secrecy of health care prices.

When the price of a colonoscopy ranges from $450 to $10,000, there's room for plenty of savings.
By Bernadine Healy, M.D.

As President Obama said again in his recent address to Congress, an imperative for health reform is containing runaway health costs. But the elephant in the room that is a real driver of costs is something few people are talking about: the variable and hush-hush pricing of medical goods and services, set by the government or negotiated by insurers and largely kept secret from the patients ultimately responsible for their bills.

Look at a colonoscopy: When paid by Medicare, the fee is roughly $450. Insurance companies secretly negotiate a maze of different prices, generally two to five times that. But as the trade group America's Health Insurance Plans recently reported, patients who have to pay their own bill because they are uninsured, are seeking care outside of their insurer's network, or their insurer has denied their claim, can face retail charges as shameless as $10,000. And how can it be that Medicare pays $40,000, prix fixe, for the same heart operation, by the same doctor, at the same hospital, that costs patients paying privately $80,000 to $120,000?
Consumers' ignorance of what services truly cost blurs the connection between their rising insurance premiums and prices, setting the stage for those prices to soar ever higher. Little wonder that the country's total health costs—for public programs like Medicare and Medicaid, private insurance, and out-of-pocket payments—are twice those of other developed countries. Making prices transparent so they can be compared and giving patients the means to shop for insurers that will get them the best deals would put downward pressure on prices and bring sustainable cost savings.

Instead, Americans are led to think that what's mainly to blame for out-of-control costs is their own voracious overconsumption. So cutting down on the quantity of medical services used by the sick and reallocating dollars for wellness and prevention sound like definite cost savers. But that ignores a few facts. Compared with people in other developed countries, Americans see doctors less often and take fewer medications. They also spend the same or fewer number of days in hospitals, and they already lead the world in expenditures per capita on prevention and public health. Yes, more high-tech care may be given to the sick in this country, and yes, that contributes to higher costs. But whether it's low- or high-tech care, what is achingly obvious is that total costs are a function of prices. Ours are the highest.

As a classic 2003 report in the journal Health Affairs put it simply: "It's the Prices, Stupid." In their detailed analysis of health spending in 30 developed countries, leading health economists including Gerard Anderson of Johns Hopkins Bloomberg School of Public Health and Uwe Reinhardt of Princeton University determined that the greater cost of care in the United States was due to much higher prices for virtually all of its medical goods and services.

Our senior citizens must have read that study a few years back when they boarded buses to Canada to buy prescription drugs for half the prices they would pay here. Who stopped their burgeoning tea party? The federal government, citing safety concerns, with heavy pressure from the pharmaceutical interests intent on protecting the higher prices Americans are effectively forced to pay.

We are just beginning to see snippets of such comparative price information become more public in other medical areas, prompted no doubt by the growing out-of-pocket payments besetting insured patients. Just last month, a report initiated by Gov. Tim Pawlenty provided price and quality information on 100 medical services from centers throughout Minnesota. Prices were all over the map. The average for colonoscopies ranged from $325 to $1,354. The price of a simple blood count varied from $13 to $85. The wide variation for these and the other prices disclosed suggests lots of room for competition and cost savings. Another area where scrutiny is needed to understand skyrocketing outpatient bills is that of wildly varying and increasingly common "facility fees." A cardiac stress test, for example, can vary by thousands of dollars depending on the size of this tacked-on fee—a charge for the use of a room needed for less than an hour.

To turn these surprising revelations into useful information that can guide and reward patients for getting the best value for their healthcare dollar, prices have to be widely accessible and easily compared before care is rendered. One way to do this might be to expand the concept of the proposed health insurance exchange, which currently would be restricted to the uninsured. Allow for public and private exchanges, and make them open to all individuals who want to purchase insurance anywhere in the country at the best price. And make exchanges vehicles for price transparency, where consumers could get access to comparative and customary pricing information and then hold insurers' feet to the fire by selecting the company with the best available prices at the places they want to go.

The power of making medical prices transparent to the public has not been lost on the political establishment. Indeed, Sens. Charles Grassley and Arlen Specter have pushed legislation to require price disclosures in the private sector, where secrecy clauses between hospitals and manufacturers have been shown to double or triple the cost of medical devices for some patients. Meanwhile, it may surprise the public to know that the government has gone to great lengths to keep the rock-bottom prices it demands quiet, including entering into contracts with industry that make the prices Medicare and Medicaid pay for prescription drugs, say, inviolable trade secrets.

Why? Congress, as laid out in a 2007 letter from the Congressional Budget Office, recognizes that such disclosures would enable private insurers and their customers to be more insistent about getting similar pricing deals, making their own small discounts, and the government's large ones, converge toward an average. While this would lower costs for people with private insurance, it would make government prices—and costs—a bit higher. Disclosure has still not happened.

But if health reform is supposed to reduce costs, disclosing prices and enabling and incentivizing individuals to seek out the best value to serve their needs is a way to do that as a first step—and before making efforts to restrict or redirect care. I'd estimate a good 10 percent of total costs could be taken out of the system quickly, to the benefit of those in both private and public plans.

--Bernadine Healy, M.D.

How to fight back when your claim is denied

2009-09-25T10:04:23.098-04:00

If your health insurer denies a claim, you have the right to appeal the insurers’ rejection. From 2000 to 2006, the number of consumers appealing claims increased by 34%. Here are some strategies you can follow if you need to appeal a denied claim:

Write a good letter. Consumers (patients) who write insurers to appeal a claim are more likely to succeed if they include in their letter references to medical research. Some advocacy groups and associations offer helpful letter templates for common denials. You can look up these organizations in Google. Be sure to include every detail in your letter like dates, who you talked to, titles and contact information.

Get a second opinion. Obtaining an extra, concurring opinion adds credibility to your argument. Prestige also matters. Recruiting top doctors in the field can help your appeal.

Stay calm and collected. When the appeals process reaches a second round, the consumer will often get to talk on the phone or meet in person with a medical director from the insurance company. These conferences are as little as 10-15 minutes long. Staying calm and avoiding yelling and screaming will waste your time in this meeting/conference call.

Look for loop-holes. Many employers have outdated or poorly written summary plan documents, also known as your contract with insurers. These outdated documents can sometimes help “open doors” in the appeals process. Copies of the contracts should be available in an employer’s benefits office. If you have individual health insurance, make sure you keep a copy of this contract when you sign up for the health plan.

Private health insurers reject tens of millions of medical claims every year, leaving patients scrambling for alternatives. The October issue of SmartMoney includes an interesting article, Paging Doctor No that shadows an insurance-company medical director to see how the toughest decisions get made.