Reducing health care expenses involves much more than simply finding the best value for services.  Everyone knows that eating healthier and exercising more can improve your health.  Maintaining good health goes a long way and here are some practical tips, in addition to eating healthy and exercising every day, that are guaranteed to improve your overall health.   These tips are easy to follow, cost nothing and you can start following these tips today to make a big difference.

• Drink more water
• Eat breakfast every day and try to include protein and fiber
• Increase your fiber intake
• Eat more fruits and vegetables.  Remember to eat a variety of colorful fruits & vegetables (red, orange, green, yellow and purple)
• Get at least seven hours of sleep a night
• Floss your teeth every day
• Find your spiritual self
• Develop a supportive network of friends
• Stop drinking soda
• Smile more often

Over the past few years, I have researched most the price transparency tools that are available to consumers.  Some of these tools can be accessed only by members of health insurance plans.  Some tools require a subscription or fee to access the pricing report data.  There are many other free tools that enable consumers to look-up prices of health care services.

 

Here is a short list of free public tools that consumers can use to look-up price of health care services.  If you would like the list of URLs to access these tools, please send us an email info@outofpocket.com

• AMA CPT Online
• Carol
• Cost Helper
• DoctorPricing
• Healthcare Blue Book
• Health Pricer
• LesliesList.org
• MainStreetMedica
• MyHealthScore
• New Choice Health
• OutofPocket
• Spectrum Health
• State Hospital Websites
• USA Healthcare Costs
• Vimo

Consumers with health insurance plans that have low-deductibles and low co-payments have absolutely no motivation to shop around for the best value or compare prices before visiting a provider for even the most routine type of services (MRIs, x-rays, mammograms, lab tests, dental and vision).   They purchase health care services from whomever, regardless of price or quality of service.  They visit emergency rooms for non-emergency conditions because “it only cost $75 co-pay for a visit to the ER.”  They often overuse medical services, have an unnecessary number of diagnostic tests performed, and fill every prescription a doctor prescribes without questioning generic alternatives.  These consumers are not concerned about the true cost of health care services.

When consumers have high-deductible health plans, they are rewarded financially for making good choices.  Spending health care dollars is spending their own money so they are interested in making cost-effective choices.  Everything changes.  People become responsible about their health and their health care costs, and expenditures drop like a rock.

Healthcare Prices:  Looking Behind the Curtain is a new blog that you should follow. Jeffrey Rice, CEO, HealthCare Blue Book, covers healthcare transparency news and discusses issues that you will find interesting.  His recent post discusses the disparities in health care pricing and how paying more doesn’t always mean better quality.  The fact is that the price for an MRI can range from $500-$2500 in the same geographic area.  Let’s take a look at some of the real out-of-pocket savings when consumers choose a provider that charges $500 for an MRI, rather than the provider that charges $2500 for the exact same diagnostic test.

• An individual with a co-pay would save $100 out-of-pocket by selecting the $500 MRI , rather than using the $2500 provider
• An individual with a high-deductible would save $2000 by selecting the $500 MRI
• Employers that are self-insured would save ½ million dollars a year just on MRIs of the knee, if they encouraged employees to use the cost-effective provider that charges $500 for their MRI.
• Total dollar amount of claims would be reduced, and this could result in lower premiums
• Just imagine how much $$$$ insurers would save if consumers adopted cost-effective behavior 

One of the greatest challenges in getting people to use cost-effective providers is how do we encourage and enforce this cost-effective behavior?  One of the few unquestionable principles of economics is that people respond to incentives.  If you give people more of a reason to do something, they will do more of it.  If you make it easier to do more of something they are already inclined to do, they will also do more of it.  Reducing my out-of-pocket expenses is enough of a reason for me to select the provider that offers the best value. 

 

The cost of medical care is rising by the day, and it’s becoming harder to stretch your dollars to meet medical expenses, especially if they occur on a regular basis. Even if you have health insurance, it’s important to spend your out-of-pocket dollars wisely. If you’re wise and careful enough, it’s easy to make the most of your healthcare dollars, by:

• Preventing illnesses by following routine precautions and basic cleanliness.
• Adhering to a healthy lifestyle – not smoking and drinking, eating healthy food, exercising regularly, drinking enough water, and keeping your mind relaxed and stress-free.
• Preventing accidents and keeping your home safe from potential hazards.
• Following safety precautions and road rules to avoid meeting with accidents that could prove to be extremely costly affairs.
• Getting yourself checked routinely to identify potential health risks.
• Understanding your illness, if you have one, its conditions and implications, and making an informed decision about the best treatment.
• Opting for treatment before conditions become serious and hence more expensive.
• Taking the medication that’s prescribed for you – some people stop taking them when they begin to feel better, but it’s imperative that you finish the course your doctor has prescribed.
• Reviewing your medication on a regular basis (if you have a chronic condition like diabetes) and ensuring that you’re not taking any that are not necessary.
• Asking questions about medication to ensure that they’re necessary and to know what they treat.
• Switch to generic drugs that are as effective but not as costly as the branded ones.
• Asking relevant questions about any prescribed diagnostic tests to ensure that they are absolutely necessary.
• Understanding the benefits you are entitled to under your insurance plan.
• Planning ahead for pregnancies and other medical routines that can be put off.

It’s a well know fact that health is wealth, and it’s absolutely imperative that we’re physically and mentally fit if we’re to enjoy and savor life. It’s also true that prevention is better than cure, so do your best to prevent diseases before they catch you. And if you still fall sick, make sure you do all it takes to get better soon rather than spend unnecessary time and money at the doctor’s office.

  

This article is contributed by Sarah Scrafford, who regularly writes on the topic of online pharmacy technician training. She invites your questions, comments and freelancing job inquiries at her email address: sarah.scrafford25@gmail.com.

 

The Chicago Tribune reported some great tips on where consumers can find affordable dental care in the Chicago area and suburbs.
 
Here are four options for you to check out:

• Children's Dental Clinic, 2100 Ridge Ave., Evanston. Call the clinic at 847-866-2953.
• Cook County Department of Public Health Dental Clinic, Suite 250, 2121 E. Euclid Ave., Rolling Meadows, Illinois.  Patients must live in Cook County and meet income guidelines. The clinic, in the Rolling Meadows branch of Circuit Court, accepts patients by appointment. Call the clinic at 847-470-7398.
• Northwest Community Hospital, Mobile Dental Clinic, 800 W. Central Rd., Arlington Heights, Illinois. The clinic accepts Public Aid and Kid Care.  Fees are charged according to sliding scale. All patients must be screened before receiving treatment. Call the clinic at 847-618-5573.
• Waukegan-Belvidere Medical Clinic, 2400 Belvidere Rd., Waukegan, Illinois. The clinic offers dental care for ages 3 and older. Patients must reside in Lake County. It accepts Public Aid and Kid Care and charges fees on a sliding scale. Call the clinic at 847-360-6525.

If you know of other clinics that offer affordable dental, vision or medical services, please send us an email so we can share this information on our blog with other consumers.

Mona Lori
info@outofpocket.com

Many of you are struggling to make ends meet while your health care expenses continue to rise. If you are well informed and you do your homework, you might be able to reduce your medical expenses by following some simple tips. Just remember A-B-C-D.

Ask the provider upfront (before services are delivered) for a price break. Each provider has their own rules about negotiating bills, and you should always ask. Explain your circumstances and offer to pay cash at time of service or develop a payment plan.

Bill review. Be sure to review your medical bills for possible errors. I can’t tell you how many times I found small errors on my medical bills just by casually browsing through the detail. As soon as the bill arrives, read through all the line items and make sure that you are being charged the correct price and charged only for services you received. Medical billing errors occur all the time. Why pay more than you have to? I am assuming you already review many of your household bills (cell phone, utilities, cable, appliances, groceries, auto insurance) for accuracy. Treat your medical bills with the same level of scrutiny.

Compare prices using online tools. Insurers sometimes provide their members with tools to look up out-of-pocket costs for a specific plan. Other online tools are available to give you an idea of a fair or estimated price for a specific service. The more you know about fair pricing, the better price you will be able to negotiate. In addition to outofpocket.com be sure to check out healthcarebluebook.com, AMA CPT online, and costhelper.com to look up prices for services. For a more complete list of price tools, refer to the this list of price transparency tools. Remember also that where you go to receive care can also make a big difference in your costs. Emergency-room visits tend to cost $300 to $1000, compared with $150 at an urgent-care center, $65 to $75 at a doctor’s office, and $35 to $45 at a convenience-care clinic. For non-emergencies, it pays to call your insurer’s 24-hour advice hotline for guidance on where to go for care. Make sure the facility and provider are in your health plan’s network. In fact, don’t wait for an emergency to find the nearest ER or urgent care center in your network. Look it up now and keep this information handy so you can easily refer to it in case of an emergency, when it is often difficult to make cost effective decisions.

Discounts can make a big difference. You should make the most of discounts that are available to you from your insurer, dental/vision programs, prescription medications, and incentives from your employer. All these discounts help reduce your medical bills. Many insurers offer discounts on services to promote healthy lifestyles, including gym memberships, smoking-cessation and weight loss programs, chiropractic service and acupuncture. Ask your insurer or employer about these programs. Providers also offer discounts for paying in cash, or paying at time of service.

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

Did you know:

• The national average cost of an MRI is nearly $2,000
• Heart bypass surgery costs about $57,000
• The average cost of a 30-day prescription of one name brand drug is $71 compared to $22 for the generic equivalent
• National healthcare expenditures are expected to nearly double over the next 10 years

Knowing what you're spending and keeping an eye on health care costs are important parts of keeping health care affordable for all of us. Here are some things we can all do to make a difference:

• Ask for FDA-approved generic drugs instead of more expensive name brands
• Make sure you're getting the right treatment, and always ask your doctor any questions you may have
• Review all explanation of benefits for accuracy, and ask about any costs that you don't recognize or understand.
• Understand what your out-of-pocket costs will be before you receive medical services. Online tools are available for consumers to look-up average prices if your insurer or provider cannot answer this question.

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

Price variations for healthcare services, even within the same market and provider network, may be thousands of dollars. So knowing what the fair price is can help consumers better manage the cost of their health care. Unlike many other health care price tools, Healthcare Blue Book is very easy to use.  Type in the kind of healthcare service needed plus a zip code and the Healthcare Blue Book pulls up the fair price based on fees paid by Preferred Provider Organizations (PPO) to doctors for services in that market. Consumers can then use the suggested Healthcare Blue Book price to discuss prices for services and treatments with their doctors and other healthcare providers.

Americans do price/value comparisons for their homes, cars, vacations and the majority of goods and services they buy. “Why not healthcare?” asks Dr. Jeff Rice, Healthcarebluebook.com founder. The former CEO of CareSteps, Rice has a long history in the healthcare industry of developing innovative products for consumers.

“Patients should not assume that a high price means good quality,” says Rice. “It is up to patients to ask about the cost of services and to learn about the quality of their providers. Doctors and hospitals that charge a fair price, often provide the best value. Healthcarebluebook.com can help consumers figure out what they should pay.” Consumers need better education about the healthcare services they purchase and 2009 is a good year for them to start. Using the Healthcare Blue Book can help people learn how to obtain fair prices for their healthcare.

In addition to fair pricing, the website provides information on useful resources for patients including a list of websites by state that provide health care pricing.

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

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

An article in the Los Angeles Times Health Section, Cut health costs, not your care,  provides some valuable tips and techniques to help you reduce your health care costs  - while you continue to take care of your health. Here are some of the highlights:

Saving Money on Prescription Medications

• Compare drug prices before making a purchase by using tools like destinationrx.com and drugstore.com
• Save up to 80% by selecting generic rather than brand-name drugs
• Consider purchasing your medications in bulk to save money
• Do your research to find drug companies offering discounts on brand-name drugs
• Consider purchasing medications online (be sure to visit the U.S. FDA site for consumer information)
• Look for discounts on brand-name drugs by searching for coupons at www.internetdrugcoupons.com

Save Money on Doctor Visits

• Stay proactive about your health.  A doctor visit is a lot less expensive than an emergency room visit.
• Use network providers whenever you can.  Ask network providers for referrals from your network if you need to see a specialist.
• Consider bartering to help pay doctor fees. 
• Utilize retail clinics for non-emergency medical services
• Utilize urgent care centers rather than emergency rooms for conditions that are not life threatening
• Visit community health centers to locate medical help at low cost.
• Use resources like public libraries to find affordable medical services in your area.
• Contact disease/condition foundations for additional resources and options on affordable screenings.
• Negotiate a price for services if you are paying cash to save 50% or more off the list price.
  

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

 

·         Use generic prescriptions rather than brand-name

·         Use mail order service to fill prescriptions

·         Preventative care to keep yourself healthy

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

 

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

 

 

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

 

Affordable Medical Care Services

 

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

 

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

 

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

 

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

 

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

 

Affordable Eye Care/Vision Services

 

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

 

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

 

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

 

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

 

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

 

Affordable Dental Care

 

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

 

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

 

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

 

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

 

Are You Eligible for Medicaid or Assistance Programs?

 

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

 

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

 

 

Affordable Lab Tests

 

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

 

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

 

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

 

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

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

 

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

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

 

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

 

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

 

 

Wishing you a happy, healthy New Year!

 

Mona

 

 

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

Making Sense Out of Existing Data

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

For CONSUMERS

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

For INSURERS

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

For OUTOFPOCKET.COM

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

For PROVIDERS

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

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

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

Are these tools useful?

Doctor Review Websites

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

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

Price Transparency Tools

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

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

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

Doctor Ratings

 

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

 

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

 

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

 

alijor.com

angieslist.com

bookofdoctors.com

careseek.com

checkMD.com

doctorfeedback.com

doctorscorecard.com

drscore.com

findadoc.com

healthcare.com

healthgrades.com

healthworldweb.com

kudzu.com

mdnationwide.org

mydochub.com

ratemds.com

remarkabledocs.org

revolutionhealth.com

suggestadoctor.com

thehealthcarescoop.com

vimo.com

vitals.com

wellness.com

whitecollarfinder.com

zocdoc.com

 

Do you know how to find affordable lab tests?

 

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

 

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

 

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

 

Prices For My Lab Tests for Comprehensive Blood Test

Total Quest Labs billed to my insurance plan      $ 193.78

Total discounted by my insurance plan                 $ 143.78

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

 

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

 

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

 

www.PrivateMDLabs.com

www.MedLabUSA.com

www.DirectLabs.com

www.LabSafe.com

www.MyMedLab.com

www.QuestDiagnostics.com

 

 

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

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

Other interesting facts

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

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

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

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

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

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

 

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

 

Here's the scoop on the true price of an appendectomy.

If you are wondering what the true cost of an appendectomy is, keep reading....  Jaz-Michael King’s blog, A Scanner Brightly, provides the most thorough detail I have ever read on a patient’s charges for an appendectomy.  He wrote this blog earlier this year, and itemized the specific charges related to his appendectomy procedure.  A huge thank you to Jaz-Michael for sharing this detail with everyone to help us become better health care consumers.  I am glad everything turned out fine for Jaz-Michael and I would like to encourage him to keep up the great blog.  The data he shares is a wealth of information for consumers.

You definitely should read his blog entry, Hospital Bill: Appendix Ultimatum - it includes his comments and other useful information on the breakdown of costs for this procedure. 

 

Here are the itemized charges for an emergency appendectomy.

 

Appendectomy -- Itemized Charges	Charges	Actual Negotiated Price
Emergency Room:	$1,185.00	$419.68
Emergency Room Physician:	$1,461	$460.60
Cat Scan:	$2,015.00	$713.64
Operating Room:	$3,250.00	1,151.03
Surgeon:	$1,740.00	$626.81
Anesthetist:	$1,601.00	$787.50
Recovery Room:	$3,100.00	$1,097.91
Pathologist:	$35.00	$35.00
Semi-Private Ward:	$5,000.00	$1,770.81
X-Ray:	$127.00	$44.98
Per Diems:	$5,850.70	$5,850.70
Labs, Supplies, Medical Services	$1,627.04	$652.65
New York State Service Charge	$523.64	$523.64
Total Hospital Charges:	$22,718.70
Total Paid:	$12,078.38
The hospital visit was reimbursed at 53.2% of charges
Insurance: CIGNA

Are you shopping around for a CT scan but have no idea how much your out-of-pocket costs will be? You are not alone. A new type of CT scan, called “virtual colonoscopy”, offers a noninvasive and less expensive alternative than the traditional CAT scan.

A virtual colonoscopy test can cost anywhere from $500 to $1,500, depending on where you go to have the test done. Another reason to consider a virtual colonoscopy test – it is half the cost of a standard colonoscopy. Before you make any decisions, make sure you check with your insurance plan to see if the virtual test is covered for routine cancer screening.

Wall Street Journal published a story on CT Scans and included some price comparisons at different facilities. If you have insurance or are paying cash, make sure you talk with the billing department before you have the test done, to understand your out-of-pocket costs for your specific situation.

Hospital or Clinic	Location	Price
Invision Sally Jobe	Denver, CO	$800
Johns Hopkins Hospital	Baltimore, MD	$1,000
M.D. Anderson Cancer Center	Houston, TX	$1,500
Virginia Commonwealth University Medical Center	Richmond, VA	$750
Mayo Clinic	Rochester, NY Scottsdale, AZ	$1,400-$1,500
Ronald Regan UCLA Hospital	Los Angeles, CA	$505
University of Chicago Hospital	Chicago, Il	$1,153
University of Wisconsin Hospital	Madison, WI	$1,200
Beth Israel Deaconess Medical Center	Boston, MA	$1,017

As the economy weakens, more people are looking for help from Prescription Drug Assistance Programs to pay for their medications . These programs are sponsored by pharmaceutical manufacturers and provide consumers with billions of dollars a year in free or low-cost drugs. In order to quality for this program, patients must meet very strict financial requirements. Here are some online resources where you can get help.

FINDING & NAVIGATING PATIENT-ASSISTANCE PROGRAMS

NeedyMeds.org online resource to find help with the cost of medicine Partnership for Prescription Assistance helps match patients to more than 475 private and public programs. This resource includes information on other types of assistance programs.

Partnership for Prescription Assistance helps match patients to more than 475 private and public programs.  This resource includes information on other types of assistance programs.

RxAssist.org allows patients to search a database of patient-assistant programs by medication. Provides tips on free and low-cost medications.

DISCOUNT DRUG CARDS

Together Rx Access – sponsored by nine major drug companies, this free card offers 20% to 40% discounts on retail prices for more than 300 drugs.

Merck & Pfizer offer separate discount cards for many of their medications. Discounts range from 15% to 50%.

OBTAINING LOW-COST GENERIC DRUGS

Rx Outreach offers more than 350 generic medications at a cost of $20-$95 for 180-day supplies. Xubex Pharmaceutical Services offer more than 250 generic medications at a cost of $20-$30 for most 90-day supplies.

Walmart, Target and Safeway and other retail chains offer many generic drugs at $4 for a 30-day supply with no eligibility restrictions. Some retain chains have recently lowered prices on 90-day supplies to $10-$15.