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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.”



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Comments
18 Comments.
Comment #1 by lou posted on
lou
I wonder if any of the stuff in this article will be relevant once the new health care law becomes effective in 2014.

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Comment #2 by Anonymous posted on
Anonymous
Lou:  You really think there is going to be a new Healthcare Law in 2014?  Have you forgotten that we may have a new President who is determined to Repeal it?  I sure can't get them to tell me what they are going to put in it's place.  Everything is still a mess!

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Comment #3 by lou posted on
lou
Yeah, who knows what is going to happen. I wish there was more transparency in health care and some of the things Sheryl is describing was actually happening. It would be great if you could comparison-shop the cost of different procedures and have an easy way to compare prices and qualitative outcomes for different providers. If there was a real free market and consumers were incented to utilize it, I believe health care costs would start heading down..

2
Comment #4 by Anonymous posted on
Anonymous
This comparison shopping for healthcare procedures is not like comparison shopping for a new car or tv.  When we need an operation or medical care, we are usually in pain and/or not emotionally up to getting on the phone and bartering or calling for prices.  We don't always know ahead of time when we will get sick or what doctor we will need.  When my DD was in the Emergency Room some years ago with a case of severe appendicitis and they were doing tons of tests while she screamed in pain, do you think I was really going to ask them if all the tests were necessary and how much they cost?  I just wanted them to stop her pain!  I do my comparison shopping for medications, after I am home and up to making all the phone calls but we should have our primary care and all specialists we think we may need for problems lined up ahead of time.  You don't want to have to price shop for Specialists when you are in pain.   We also have to be sure to select a Primary Care doctor we trust to recommend Specialists when problems arise who he feels won't rip us up.  I have reported problems I have had with any recommendations from PC doctors so they will know before recommending to other patients.

2
Comment #5 by Anonymous posted on
Anonymous
Don’t count your chickens before they roost.
We must elect new president if we don’t like to be taxed into oblivion.
There are 22 new hidden taxes in Obamacare, so there are also penalties and rationed medications.
There is $500 billions taken out of medicare to fund Obamacare and you are talking about purchasing health care plans! This is not the time for it now.
We have to do one thing at a time, starting from the top.

8
Comment #6 by Anonymous posted on
Anonymous
#5 I basically agree with you but since you seem to know so much about Obamacare, do you also know as much about what Mitt Romney intends on doing for us with the healthcare issue.  Some people may not be able to wait until after the election to purchase healthcare.  They may need it now.  What is going to happen to the State Exchange?  Will we be allowed to purchase from them now and keep the plans if Romney makes it in?  Have you any info on Romney's plans if he truly Repeals Obamacare?  If so, I would love you to post whatever you know since I can't seem to get anything much out of them and what they do tell me, I am not too sure I can trust them to keep their word.  Thanks for any info you can share.

1
Comment #7 by Anonymous posted on
Anonymous
To #6,
Romney will work with Congress to implement cost cutting health care,
26 states will not implement any Obamacare rules nor will allow any exchanges to buy Obamacare in that state, most of the small business will completely dump Obamacare and will gladly pay the penalty instead of buying insurance. Most of the people will not subscribe for Obamacare and will pay the fine.

5
Comment #8 by lou posted on
lou
Obviously, in my previous post, I wasn't referring to emergency procedures. Most medical care is elective or not urgent and can be purchased by discriminating consumers in a free market, if one was allowed to function in the health care sector.

1
Comment #9 by EdG (anonymous) posted on
EdG
I tried to use Aetna's site for pricing on a MRI and I will say this is not eady for prime time.

They had incorrect locations and I could not verify any of the pricing that they had posted from the servive providers.

I would be happy just to have guidance, for example, that a MRI center is cheaper than a hospital. 

I wasted 1/2 a day on this and had no more info than when I started.

2
Comment #10 by Anonymous posted on
Anonymous
EDg:  Are you looking for pricing for the MRI facilities in your location for paying cash or will you be using insurance?  That makes a big difference.  If you are using insurance, I would write down the list of facilities which are in-network with my plan and also hospitals.  You can then call them and get prices over the phone or try googling up the info on your computer for your city.  If you are paying cash, and have no insurance I would ask google to give me prices for MRIs in facilities for my city and state and see what they show you.  You can then call these facilities and verify the prices over the phone.  Just make sure if you call, you let them know you need the "cash" price. 

You seemed to have done a lot already so if my advice is something you have already done, please disregard.   From my experience, the free-standing facilities which are not connected to hospitals usually have had cheaper prices but they need to be checked for your city.

2
Comment #11 by lou posted on
lou
Poster #10 is absolutely correct.

1
Comment #12 by ctgottapee posted on
ctgottapee
not partisan here
but the confliction in the statements about Obamacare reducing Medicare's costs being bad, but Mitt working to do the same thing is good baffles me???

not only that but congress already passed a healthcare savings bill... do all the legislators just change their minds because a white guy is president and find some magical savings nobody knew about before???

states don't have to implement exchanges, the feds will do it for them; no different than the federal govt propping up education spending on backwards states that don't fund public education which would leave the kids behind.
whether companies buy into exchanges or pay the fines is irrelevant to the effect of the legislation, the fines will pay for the employees to affordably buy healthcare, that is the point.
and for individuals who don't want to buy insurance, paying the fine covers their potential burden, so that works too. it would be silly for individuals with means pay fines when they could use the same money to buy insurance and get some benefit out of it, even if its just a free teeth cleaning. EVERYBODY gets sick.

health care costs too much as a value because the uninsured don't pay their fare share. any plan that exempts them just shifts costs to those who actually pay which is how things currently stand. if health care were an optional expense like cable tv, there would be no issue, but illness and tragedy hit everyone.
obviously, there is no utopian answer.

4
Comment #13 by Anonymous/Paoli (anonymous) posted on
Anonymous/Paoli
CT:  Your post reads so much like the letters I have written to the Republicans.  The problem is that politicians can't be counted on to do what makes sense.  Their entire philosophy seems to be to make the other party look bad.  I think if Pres. Obama were purple they would do the same thing.  If Romney gets the Presidency, he will just have to battle the Dems doing  to him what they did to Obama.  What a mess and we depend upon these "people" to run our country!

2
Comment #19 by Susie Fe Armentano (anonymous) posted on
Susie Fe Armentano
Talking about Health is not a joke, Health is very important. Now a days if your going to be sick you'll be paying more than what you have expected. 

1
Comment #20 by sun (anonymous) posted on
sun
While we can save for other material things, it's more important to save for our health care.  Particularly for those who are looking at LTC plans.  Save time and money on this type of policy by doing your own research and seeking long term care insurance quotes online.  Most of them are free.  With this, you can have an idea how much money will you likely need if you want to avail it and you'll know what insurance company offers the most affordable options.

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Comment #21 by Ted S. (anonymous) posted on
Ted S.
A day was there when people were not entering into a health problem. But now adays there is certainly uncertainity in the regular lifestyle of the people. So number of diseases have rapidly grown up. Since economy is decreasing and price is rising people are going for price insurance to minimize the price loss. So people are opting for low price health benefits, fast and easy medical emergency services too. But where to get it that is today's question too.

urgent care clinics

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