If you have to ask how much it costs, you can't afford it - J. P. Morgan
Comparing prices for health-care services can be time-consuming and frustrating. But it’s easier than it used to be—if you know where to look.
Common tests and procedures like ultrasounds, MRIs and arthroscopic surgeries that can be scheduled in advance are the most “shoppable.” Start by asking your doctor if the service being ordered needs to be a specific kind and get the exact CPT code, which is used for billing purposes. Make sure you understand why the test or procedure is being ordered, which can affect the cost. A colonoscopy, for example, could cost an insured patient anywhere from zero to $10,000 out of pocket, depending on whether it’s considered “screening” or “diagnostic,” where it’s performed, and whether the facility and the physician are in-network or not.
Most insurers now have online tools that let plan members see how their out-of-pocket costs might vary for the same service at different in-network providers. (A search for a pelvic ultrasound on Aetna ’s member cost-estimator, for example, brings up 69 facilities within 5 miles of New York City, with out-of-pocket costs ranging from $8.53 to $93.76, depending on the rates Aetna has agreed to pay, as well as the member’s deductible.)
Some insurers’ tools are cumbersome or spotty, and most caution that the amounts listed are just estimates that could change without notice. Be sure to check that any provider is still in your health plan’s network. The insurer’s list may be out-of-date and an out-of-network bill could send your out-of-pocket costs soaring.
Many providers now offer cash rates that may be lower than what you would pay using your insurance. Insurers’ cost-estimator tools generally won’t give you this information, so you’ll have to do your own research.
Stand-alone imaging centers, outpatient surgery centers and urgent-care clinics are generally much less expensive than hospitals, and some offer very low cash rates to patients who pay at the time of service. Some will look up your coverage, so you can compare the cash price they are offering to the out-of-pocket amount you would owe using your insurance.
Hospitals also offer self-pay rates, though their policies vary widely. Some offer cash payers the Medicare rate; others offer discounts of 20% to 80% off their “charges,” but that generally means their sky-high “chargemaster” rates, the often highly inflated list prices that providers set before any negotiations have begun. Deeper discounts may be available to those who qualify for financial aid, so it pays to call the hospital’s financial-services department and ask.
If a hospital says its cash price is only for the uninsured, don’t let that dissuade you. There is no law saying that just because you have insurance you have to use it—in fact, a 2013 federal law requires providers to honor patients’ requests to withhold information from their insurers if they pay cash in full at the time of service.
Consumers seeking to compare cash prices for medical services can now turn to a growing number of websites for help.
PricingHealthcare posts cash rates for hospitals and surgical centers around the country, while Healthcare Bluebook cites “fair” prices for services in specific ZIP Codes. Sites such as New Choice Health offer to match consumers with low-cost providers in their areas. “A lot of these providers don’t want to publish their prices, but they’re happy to talk to an individual patient about them. We facilitate that conversation,” says Brad Nihls, vice president of operations.
Clearhealthcosts.com, meanwhile, posts cash prices for health services in eight cities, as well as crowdsourced information from thousands of consumers that provides a rare glimpse into how insured rates differ. “People love to share this information—it’s like primal-scream therapy,” say founder Jeanne Pinder.
Goodrx.com lets users compare cash prices for prescription drugs at local pharmacies and other retailers. You can also see whether changing brands, quantities or dosages would affect the price. (Buying 15 40-milligram pills each month and splitting them may cost less than buying 30 20-milligram pills, for example.) If you see a way to save, ask your doctor if it makes sense. Be sure to check retailers’ own websites as well, since prices may differ.
Insurers caution consumers to be sure they are comparing apples to apples when they are price-shopping. (Is that prescription price for a one-month supply, or three months? Does a quoted price for a surgery include the physician and the facility fee? Is the radiologist’s report included with the MRI or billed separately?)
Assessing how providers compare in quality is also important, although that information can be just as difficult to find.
“Now that prices are coming out of the shadows, people want to know—is that $6,000 MRI so much better than a $300 one with the same billing code two blocks away?” says Ms. Pinder of Clearhealthcosts.com. Ask your doctor, and if you don’t get a satisfactory answer, ask again, she says.
Source: Melinda Beck, How to Shop Around and Save on Health Care, The Wall Street Journal, February 15, 2016.
Proponents of consumerism in health care say simple steps can save patients a lot of money. Skeptics say the system is too complex for shopping to pay off in most cases.
Opaque and sky high bills are breaking Americans — and our health care system.
Unfortunately, more so than in recent years, financial anxiety about health care is valid: Costs are up, and they’re up at a clip that’s making industry analysts nervous.
There are a number of websites that boast efforts to improve healthcare transparency and consumerism, but which ones are helping real patients? We have taken the time to evaluate a number of healthcare consumerism websites and have found these to be the very best.
“Our mission is to make medication inexpensive, clearly priced and easy to purchase.” While drug companies tend to reserve their lowest rates for big employers and insurance companies, Blink negotiates similarly low rates by grouping its users’ purchases to make the company look like a large drug buying organization...
Should anyone be surprised that high insurance deductibles are motivating patients to shop for the best value on all sorts of healthcare services–including medical laboratory tests? One way consumers can shop for the lowest price is to utilize new web sites that allow providers to bid for the patient’s business!
Hospitals and other providers increasingly are offering cash prices far below what they charge through insurance.
Are you paying more because you have health insurance than a cash customer pays? It’s definitely happening for some people.
Americans have come to rely on their smartphones to help them do seemingly everything, like hailing a taxi and comparing prices of dog food. But when it comes to buying prescription drugs, consumers still find the process maddeningly antiquated. Now, a few entrepreneurs say they are aiming to fundamentally change the way people buy drugs, bringing the industry into the digital age by disclosing the lowest prices for generic prescriptions to allow comparison-shopping.
The cost of drugs continues to sky rocket. Once you to understand how drug pricing works, you will be able to make some choices that will reduce your overall prescription drug expenses. It pays in the long run!
People are telling us they are paying cash for common medical procedures, even if they’re insured — and getting lower prices. Is this common? Is it legal? Why don’t more people ask for lower cash rates, and why don’t more providers offer?
Right now, buying health care is like going to the grocery store and finding all the price tags removed. Even worse, bananas might cost you $4 and another shopper $400, and you wouldn’t know which until you handed over your debit card. By collecting information from you and others like you, we can help change that.
You've probably shopped online and checked the Web when buying everything from cars to even water filters. How about going to the Internet to find the best deals on medical care?
Prices can vary greatly for all kinds of health services. Follow these tips to get the best deals.
Get access to information you can’t find anywhere else—from cost estimates at facilities to detailed stats about every doctor in America. Amino is a quick and easy way to find and book the right care at the right price.
Many adults over 55 need help paying for prescription drugs, health care, utilities, and other basic needs. There are over 2,000 federal, state and private benefits programs available to help. But many people don’t know these programs exist or how they can apply. BenefitsCheckUp asks a series of questions to help identify benefits that could save you money and cover the costs of everyday expenses.
Blink Health beats traditional prescription discount options in nearly every way.
We’re working to bring transparency to the health-care marketplace. By building a platform that focuses on price information for medical procedures, we are empowering consumers to make informed decisions about the costs of their medical care and coverage
FAIR Health is a national independent, not-for-profit corporation whose mission is to bring transparency to healthcare costs and health insurance information through comprehensive data products and consumer resources.
Even if you can afford your prescriptions, you're probably paying too much. It costs as little as 1¢ to manufacture a pill, so why do our prescriptions cost $10, $100 or even $1,000?
The Healthcare Bluebook is a guide to help you determine Fair Prices in your area for healthcare services.
HealthPricer is an independent, award-winning product finder and comparison shopping site dedicated to helping you find the best healthcare products from trusted merchants online. We are a free site that helps consumers compare prices on a range of healthcare products including prescription and OTC drugs, contact lenses, supplements and beauty products (more to come).
MediBid is an online marketplace which is about quality, choice, and value. Many insurance companies show you no more than whether your doctor is “in-network” or not. MediBid allows you to see the training, education and experience of the doctor before you make your selection. The doctor’s profile, or bid, will usually include specifics such as how many of your procedure they perform per year.
Save money on common medical procedures.
Busting healthcare pricing wide open.
Our price transparency tool helps patients find affordable medical procedures.
Surgeo is a logistics service built for patients by surgeons. Surgeo simplifies access to quality care by bringing in highly qualified, peer credentialed surgeons – the surgeons we would use if we needed surgery – and offering their services in flat-cost packages. Surgeo enables you to compare packages by surgeon, cost, and location and get quality, convenience, and choice. Surgeo does not provide healthcare services, make referrals, or negotiate cost.
The growing cost of medical procedures, lack of pricing transparency, and bewildering amount of information have generated a need for a new way of finding standard health and dental care. ZendyHealth makes it easier than ever before to find popular and highly effective cosmetic, dental and health procedures at fabulous prices without sacrificing quality.