Price Comparisons

If you have to ask how much it costs, you can't afford it - J. P. Morgan

Price Comparisons

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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 The insurer’s list may be out-of-date and an out-of-network bill could send your out-of-pocket costs soaring.

Price-comparison tool

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., 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. 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.

Measuring quality

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 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.

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Last Updated : Saturday, December 9, 2017