How to Price Shop for Medical Care
Knowledge is power. Just like consumers turned to the Internet for everything from electronics, cars, to toys, and took price shopping to a new level, they are now doing the same with their healthcare dollars.
A recent survey from the Thomson Reuters-NPR Health Poll, says more Americans are seeking pricing information before receiving healthcare, and the results they find are influencing their choice of healthcare provider. The survey found that 16 percent of Americans who had received some kind of healthcare service in the past year had sought out pricing information before receiving that care, up from 11 percent in 2010. People are turning to their insurance companies and their doctors for pricing information. Nearly 50 percent of those polled got their pricing information online, up from 22 percent in 2010.
Why is price shopping for medical treatments suddenly smart? “The poor economy, escalating health care costs, and uncertainty in healthcare reform all play into this consumer dynamic,” says Adam Frederic Dorin, MD, medical director of the Sharp Grossmont Plaza Surgery Center.
Quite simply, “People are looking to maximize the value they receive for their healthcare dollars without sacrificing on quality,” explains Johnny Wong, a spokesperson for Blue Shield of California. “Increased enrollment in high-deductible PPO plans is driving the need for more transparency in healthcare costs. People want to control their healthcare and costs.”
Everyone is looking to rein in medical costs. According to a recent study by Thomson Reuters, about $36 billion could be shaved off the costs of employer-based insurance plans when employees use pricing tools to select health services.
Tools and technology empower patients
With new tools, people are becoming savvier in comparing the total cost of an insurance plan, including premiums, deductibles, out of pocket maximums and co-insurance, says Annie Errstling, senior director, member communications for Florida Blue.
In March, Cigna launched a new online service that provides information on quality and out-of-pocket pricing on doctors and hospitals for more than 200 common medical procedures (representing more than 80 percent of all claims). Using the “Find Doctors and Services” search directory on Cigna's customer website, myCigna.com, customers can assess medical costs – including specialist, facility and related fees according to the real-time status of their health plan deductibles and co-insurance, as well as their available health spending account funds, before choosing their physician. “What's really groundbreaking is healthcare consumers can now shop for care in the same way that it's delivered,” says Joe Mondy, a spokesperson for Cigna. For example, you can look up a knee arthroscopy by doctor and get a precise estimate for what you will pay to get care through that doctor – that includes not just the doctor's fee, but also related services such as diagnostics and anesthesia, as well as hospital or facility costs, says Mondy. You can even compare a physician's costs for performing a procedure at different hospitals. “Services performed at various facilities can vary significantly in terms of quality and price,” says Mondy.
UnitedHealthcare's myHealthcare Cost Estimator does not rely on old claims data or a handful of employers, but draws on the company's actual contracted rates with doctors, hospitals, clinics and other health care providers in 47 markets, giving consumers a more accurate price estimate. It not only provides price comparison information for more than 100 treatments and procedures, it also provides “care paths” for individuals based on the treatment they are researching. Care paths bundle quality and price information, alternate treatment options, local doctors and hospitals performing the procedure, health benefits information, and make it easy for you to understand and anticipate the entire health care experience for a given treatment or procedure. “By building 'care paths', the tool creates a comprehensive view of what you should expect throughout your course of treatment, from the time you first visit the doctor, to the test or procedure, and all the way through to physical therapy or any necessary follow up care,” explains Yasmine Winkler, UnitedHealthcare's chief product and marketing officer.
In addition, says Erstling of Florida Blue, “Many of our members are shopping for the lowest cost locations to fill prescriptions. The mobile version will even locate the closest pharmacy with the best price and connect the member directly to the pharmacy via the phone.”
Where else can you find information?
There are all sorts of online pricing programs with plenty of bells and whistles being offered by insurance providers, but where else can you go for help?
“Calling doctors offices directly is most effective. For cash-pay services, entities such as Medibid (bartering brokers, www.medibid.com) can help compare the competition,” says Dorin, who also encourages people to negotiate once they have a good idea about prices.
HealthcareBlueBook.com is a free consumer guide that can help you determine fair prices in your area. FlordiaHealthFinder.gov, established by the Florida Agency for Health Care Administration, is a free, publicly accessible website that provides performance, health outcome and pricing information on health care providers, including doctors, hospitals, diagnostic centers, nursing homes and health plans. MyFloridaRX.com helps consumers shop for the lowest price for prescription drugs in their neighborhood.
Find out what's available in your state. “Some states provide average costs for procedures by hospital,” says Mondy.
Healthcare is a huge cost for most budgets, particularly in retirement. The new tools are a weapon. Says Wong, “We are empowering people by giving them the opportunity to choose more affordable providers without sacrificing quality. In addition to the freedom to choose based on costs, they can plan for services based on costs, according to their own budgetary considerations.”