Pricing Health Care Can Be Frustrating But Dr. Herrick Has Suggestions - StarTribune.com
It helps to know the codes when comparing costs for medical procedures.
by Kara Mcguire
October 02, 2010
Three thoughts crossed my mind when my son cut his head open at school. Was he OK? (Thankfully, yes.) How much would it cost to stitch him up? And was there time to call around for price estimates?
After nine months with high-deductible health insurance, this was our first doctor visit for non-preventive care. For a cost-conscious shopper, naturally I wondered what we would pay and if it was the best price.
Welcome to the world of consumer-driven health care, where families pay out of pocket for procedures without knowing the price tag and even the most determined consumers have a tough time comparing costs.
We didn't know the cost of cleaning our 4-year-old's wound and gluing it shut until days later (the doctor couldn't tell us at the appointment). A quick call to the business office revealed a $362 charge.
Because we've been setting cash aside in our health savings account, we can afford the payment. But the less that treatment costs, the more I have set aside for the next illness or injury. So what could I have done differently?
In this case, probably not much. I wasn't going to spend time price-shopping with a bleeding 4-year-old in the car. And retail clinics that post prices, such as Minute Clinic and Target Clinic, don't do sutures.
In non-emergency situations, experts suggest starting your price quest on the Web. Many insurers post cost estimates for common treatments.
Then there's Healthcarebluebook.com. When creator Jeffrey Rice was overcharged for his cholesterol check, the frugal doctor decided to put his frustration to use.
"I am a physician, I am a managed-care executive, and I just got ripped off. And if I just told people what I knew, I could help a lot of people," said Rice, of Nashville.
A fair cash price to treat my son's cut, according to the blue book (named after the used-car shopping bible), was $251. That would have been good to know ahead of time.
Before I had this experience, I figured I'd just call some different providers and ask for their price. But there is no single price. There's the cash price, or sticker price, and there's the discounted cash price you might get if you ask. Then there are the 30 different prices that 30 different insurers negotiated with that doctor's office. Call around and chances are you'll be quoted different prices. Repeat the process until you suffer from exhaustion or exasperation.
And how do you even know if you're asking for the right price? You're not a doctor, after all.
Turns out it helps to know the procedure's CPT, or "current procedural terminology" code, said Stephen Parente, a Carlson School of Management professor and expert on health savings accounts. If you don't have a code from your doctor, you can Google "CPT-4" plus the procedure you need and a list of codes will pop up. Armed with this knowledge, call around and ask for the rate your insurer negotiated for those codes.
Be cost-conscious once you're at the doctor's office too. Devon Herrick, a senior fellow at the National Center for Policy Analysis who studies consumer-driven health care, suggests telling your doctor when you're paying out-of-pocket. The doctor might prescribe you a generic drug instead of the pricey patent-protected one. Herrick's research has shown that strategies such as going generic, buying in bulk or splitting double-strength pills can reduce prescription prices by as much as 95 percent.
Honestly, I wanted a high-deductible health care plan. I've been blessed with a healthy family, have enough saved to meet the deductible and am paying far less per month in health care premiums than before. But after delving into the mind-boggling world of health care pricing, is the savings worth the headache? Will it ever get easier?
"The way to get more price transparency is to get more people who have an incentive to ask these questions," Herrick said. That means more people with high-deductible health care plans. While the number is growing, Parente predicts that only 25 percent of us will be covered by these plans by the year 2019. One in four? I guess I'll be waiting a while for price transparency -- and that makes me mad.
Why is it that the pricier and more complex the purchase, the harder it is to know if you're getting a good deal? In a country where we're often labeled as "consumers," it's time to demand more price transparency, especially for purchases that hit our pocketbooks the hardest.