Jewish World Review
New online tools can help consumers find the best deals on medical care
Christopher J. Gearon
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?
It's something Chad Glaser, of East Amherst, N.Y., does often when he needs to find care for his 11-year-old son, a liver-transplant recipient, outside his health plan's network. Glaser's first online stop: the FAIR Health Consumer Cost Lookup (www.fairhealthconsumer.org), which finds the estimated provider charges for hundreds of medical and dental procedures.
The site also shows what you can expect to pay after insurance reimburses the provider for a service. The site gathers data from 15 billion medical claims from 70 private health and dental insurers.
Glaser recently priced the cost of his son's twice-yearly exam. FAIR Health showed an estimated $370 cost, while his son's doctor billed him for $375. The site also told him that he would pay $209 if the doctor were in network. Armed with the data, Glaser asked the provider if $209 was acceptable, and the doctor agreed.
"It is one of the most useful tools," says Glaser, a manager for a wholesale seafood distributor.
Americans always like to snag a bargain, and now new user-friendly technologies--as well as a wealth of new medical-payment data--are enabling health care consumers to find the best deals for doctor visits, health screenings, MRIs, drugs and even hospital care. And, like Glaser, some are using the information to demand lower prices from their providers.
A big eye-opener for cost-conscious consumers: The new data show that prices for the same service vary widely. For example, Maine's public database of pricing information from 30 hospitals in the state shows that hospital charges for uninsured patients for outpatient arthroscopic knee surgery in 2010 ranged from $5,676 to $14,967.
As people realize the variation in pricing, there's an opportunity to realize "hundreds of millions of dollars in savings," says Karynlee Harrington, acting executive director of the Maine Health Data Organization, which operates the database, Maine HealthCost (http://gateway.maine.gov/MHDO/healthcost).
The new information comes at a time when consumers are paying bigger tabs for health care out of pocket before their health insurance kicks in. Nearly 31 million Americans in 2012 were enrolled in a health plan with at least a $1,000 deductible for individuals and $2,000 for families--nearly twice as many as in 2007, according to the Employee Benefit Research Institute.
FAIR Health and Maine's database are among a growing number of Web sites offering local pricing information. Several insurers, including Aetna, Cigna and UnitedHealthcare, offer pricing tools for scads of health services, based on the type of benefit plan a member has chosen. Aetna, for example, offers a tool to price the 10 most common medical procedures by zip code for in-network and out-of-network care.
FINDING A FAIR PRICE
Another free site for consumers and the uninsured is Healthcare Blue Book (www.healthcarebluebook.com), which provides the "fair" price for numerous services in your area. This price is the amount that many providers accept from insurance companies, and it's usually much less than the stated charges billed to consumers. If you are uninsured or have a high deductible, you can use data from this site to bargain a price that's closer to the insurer's negotiated price.
FAIR Health president Robin Gelburd says those with high-deductible health plans often visit her site to compare the costs of in-network and out-of-network care for specific procedures. They're also using the data to review physician charges--which Gelburd says can lead to discussions with a doctor about less costly alternative treatments and drugs.
Maine is in the forefront of 18 states that offer or plan to offer public pricing databases containing medical, pharmacy and sometimes dental information from commercial health plans, Medicare and Medicaid. The Maine HealthCost database lets residents find average prices charged by providers statewide for 30 common procedures, such as mammograms, hernia repairs and hip replacements.
The site also shows the average payments made by health plans for the procedures. Maine plans to expand the number of procedures to 300 and offer data on medical quality, as well.
"As people are responsible for more out-of-pocket costs, they are looking for resources to help them," Harrington says.
After a bad colonoscopy experience, Poppy Arford, 58, of Brunswick, went to Maine HealthCost and discovered her provider charged nearly double the amount the lowest-priced facility near her charged.
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"I felt like a fool," she says, after seeing that her procedure was "significantly more expensive and the quality of care wasn't significantly higher." She pledges to check the site before getting care in the future.
Although demand for health care price data appears to be gaining steam, most consumers are not as comfortable as Glaser is in talking to their doctors about prices or challenging providers on cost. They're more likely to use the data to compare prices on screenings and imaging procedures, pharmacies and insurance coverage, and to ask about generic drugs, says Douglas Ghertner, president of Change Healthcare, a Brentwood, Tenn., company that helps employers and health plans provide price information to consumers.
Ghertner says it's difficult for many patients to comparison shop for surgeries because "cost is not the only issue." To find the best physician or hospital at the best price, you need to be able to pair price with quality data at other sites.
You may try to use hospital pricing data along with available data on hospital quality. Hospital Compare (www.hospitalcompare.hhs.gov) is a free federal tool that compares hospitals by such quality measures as death rates for certain medical conditions, readmissions and the overuse of imaging. Another site with hospital data is WhyNotTheBest.org, which was created by the Commonwealth Fund, a health care foundation.
Other price-related health care sites include ConsumerHealthRatings.com, which offers links to groups and studies that provide price comparisons and quality ratings, and GoodRX.com, a free tool that allows consumers to find prices and discounts for thousands of prescription drugs at more than 70,000 local and mail-order pharmacies.
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Christopher J. Gearon is a writer for Kiplinger's Retirement Report
All contents copyright 2013 The Kiplinger Washington Editors, Inc. Distributed by Tribune Media Services. All rights reserved.