Finding out the price of health care should be a realistic expectation

“Health care costs are sky-rocketing!” “The percentage of the U.S. GDP devoted to heath care costs is the highest in the world.” “The cost of Medicare is unsustainable.”

For most of us, the cost of health care (i.e., the dollars required by the system to produce and deliver care) isn’t what brings us the most anxiety.

It’s when we’re patients or helping a loved one find care that so many of us are deeply concerned about the price of our health care: what we — personally, individually — pay to acquire the services, drugs and devices we need.

We hear news stories about people who delay needed care, split pills and skip treatments because they just can’t afford them. We hear that more of us are going to a retail clinic in a Walmart to check out a bad cough because of convenience and lower prices. We watch family members and neighbors slip into bankruptcy because they can’t pay the medical bills from their car accident or their cancer treatment. We see jars of pennies at the corner 7-11 with a sick child’s face and a plea for help with unpaid hospital care.

These experiences hit home even among the well-insured as we watch our health insurance premiums make their annual leap along with our co-pays and as many of us find ourselves unceremoniously switched by our employers to high deductible insurance plans. Or we find ourselves staring the price of care in the face when we are between jobs or our company quits offering insurance because it’s just too expensive.

There is no doubt that more of us are becoming price-sensitive about our health care. An interesting online survey from Altarum indicates that we have considerable interest in unit pricing and comparison shopping for health care services and products.

You would think that, in response to this surge in interest, hospitals, diagnostic lab companies and clinicians would make it easy for us to find out what we will have to pay for a given procedure or service.

But you would be wrong. I think this is still true today, two years after a GAO report documented the sorry state of price transparency for the U.S. public. But I don’t know for sure. And neither do you.

From my own experience and the reports I have read and heard, finding out the price of a colonoscopy or an annual check-up with my kid’s pediatrician or the insertion of a cardiac stent still ranges from moderately simple to simply impossible.

I think it would be great if we could get an assessment of the availability of price information in different markets for different health conditions and for different insurance constellations. The review should be conducted annually and widely disseminated. There are a lot of us who really need to know about the actual price of our health care.

Who?

Well, of course, we the public have the most to gain — and lose — from not having good price information, even in the absence of meaningful quality information. These days we are exhorted by the media and our employers to act like consumers and “shop” for our health care even when critical information is rarely available.

Knowing that we probably can’t find the information we need or that it is tough to ferret out will:

  • Annoy us so sufficiently that we slam the phone down and take to the blogosphere with our frustration.
  • Resign ourselves to making potentially huge financial decisions in the dark.
  • Spark us to take collective action.

Got a hunch about which you’ll do?

Employers should know about the state of prices too. If, indeed, they are committed to us workers being engaged in our health care, such engagement should extend beyond losing weight and not smoking and encompass making informed choices about the health care services and products we purchase. Employers can exert pressure on institutions and corporations with a force that individuals (so far, at least) cannot.

Hospitals, clinics, practices, and diagnostic and treatment centers also need to know where they stack up. If health care is to work efficiently, price transparency for the public is a necessary component of market competition, even when most of us have some kind of insurance coverage.

Whether we think of ourselves as consumers or not, or believe that health care will ever operate as a real marketplace or not – these lofty considerations are immaterial to our immediate need to find out the price of having the tumor removed from our leg, my pack-a-day smoking brother to get a CT scan of his lungs or the antibiotics our friend’s sick baby needs to sleep through the night.

Being able to find out the price of health care services has to move from a rhetorical nicety to a realistic expectation. It’s not likely that any nascent regulation, policy or organizational change in health care will blow away the fog that obscures this information from the public.

But repeated systematic assessment that illuminates the size and scope of the challenge individuals face in finding out this basic information would remove important barriers to our effective engagement in our health care.

Jessie Gruman is the founder and president, Center for Advancing Health. She is the author of Aftershock: What to Do When You or Someone you Love is Diagnosed with a Devastating Diagnosis. She blogs regularly on the Prepared Patient blog.

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  • JPedersenB

    I and many others have been commenting on this problem for several years. You are correct that nothing has changed. When you ask a medical provider for pricing, you will get a blank stare, questions about the adequacy of your insurance or you may get sent to the billing clerk who will tell you that unless you have all the codes that s/he cannot answer the question. When you try to find the doctor again to ask, s/he will be nowhere in sight…

    • guest

      If you are a direct cash pay patient and your medical provider is unable to tell you what your bill will be, that is definitely a problem.

      If you are like the vast majority of Americans, and going through insurance and expecting your provider to interact with your insurance company on your behalf in negotiating payment, it is unrealistic to expect that he or she will know that much, since the pricing is completely determined by the whims of your insurance company, and is highly variable.

      A good way to make sure you get a firm price would be to negotiate with the doctor to pay the bill yourself at the time of service, and then agree to handle seeking reimbursement on your own from your insurance company.

      Why patients should expect that they should be completely removed from the payment process except for a co-pay, but then expect that pricing should be promptly and accurately produced upon demand by the workers that the doctor has to hire to deal with the patient’s insurance company for the patient, is hard to understand. The expectation speaks to a level of entitlement that drives most doctors a little crazy and is probably the reason for the “blank stares” and the questions about the adequacy of your insurance. The doctor is attempting to be polite and not say “Why don’t you deal with your insurance company yourself if you are interested in pricing.”

  • ErnieG

    For price transparency
    1) end “preferred pricing” clauses between providers/hospitals and insurers- this is the direct cause of high chargemaster rates which protects providers and hospitals from the claim that they are not providing preferred rates to insured patients. This is because if they charge everyone high, they can accept lower “negotiated” payments, and be off the hook for not charging any one particular insurance lower rates.
    2) end deals between pharma and insurances for preferred drugs– really make it a market for drugs between patient and pharma, not pharma and insurance company.
    3) allow publication of discount rates for cash only patients within practices that accept insurance (without consequence from insurances making the claim providers are not accepting preferred rates for their customers.)
    4) allow balance billing of insured patients.
    ACA does nothing for reducing healthcare costs because it actually STRENGTHENS the role of third partier payers, and nothing to bring a “market” closer to patients.

  • Deceased MD

    The new insurance gimmick is there is NO Preauthorization required. The
    procedure or office visit is done. Then the insurance company “reviews AFTER the claim is submitted.

    At that point they decide if it WAS medically necessary. They can’t be blamed for withholding treatment because it already happened. But they are not obligated to pay the bill. IN addition the pt has no idea what the treatment costs. If it is a procedure, could cost a small fortune for the pt. Brilliant.
    What i doubt Obamacare addresses is denial of care, or in this case no reimbursement for care.

    • southerndoc1

      I haven’t heard of that one. Has that actually happened to you?

      • Deceased MD

        FOrtunately not. But I heard it from a colleague that does pain management and apparently it is becoming a big problem for them. Of most concern are with procedures that are quite costly where the pt can owe thousands.

  • Suzi Q 38

    Price comparisons backfired on me. First I found that it would cost about $25K for a series of 3 MRI’s, contrast and no contrast of the entire 3 parts of my spine (cervical, throacic, and lumbar). This took me 3 phone calls and two days to get the information about actual prices, which was incomplete. I could only get them to commit to a “guestimate.”
    The competing imaging company cost about 1/3 of the above. The total cost for a 3 images and evaluations by a radiologist was about $6-7K. This is a big difference.
    I took my DVD’s of my spine to show the new neurosurgeon, and he claimed they were not clear. He ordered them again! When I questioned him about the financial consideration for doing so, he said that he really did not like the image clarity.

    I had not choice but to get them done again! I could not believe that the insurance company approved the request.

    I did notice that the radiologist was a neuroradiologist the second time around. Maybe this was better. All in all, it did not change my diagnosis one bit.

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