Consider Prices Before You Receive a Test, Treatment or Surgery

Employers offering higher deductible plans should help their employees learn to price healthcare services before they have them. Most employees don’t realize how much prices vary between different healthcare providers. Healthcarebluebook.com research found that the prices charged for the same test or treatment, even in the same market and within the same health plan, can vary by thousands of dollars. For example:

• In Chicago, IL prices for an MRI of the lumbar spine with contrast ranged from $500-$2661.00 among three hospitals and five imaging centers. (Healthcare Blue Book fair price is $522.00).
• In Washington, DC prices for an MRI of the right knee without contrast among five imaging centers ranged from $400-$1504 for the same test. (Healthcare Blue Book price is $912.00).
• In Nashville, TN prices for an MRI of the hip at five imaging centers ranged from $455 to $1302. (Healthcare Blue Book price – $507)

People are struggling to pay their medical bills and often suffer from sticker shock after they get the bill. Here are some steps that employers can share with their employees to help them get fair prices.

1. Ask the doctor to clearly explain the healthcare service you need. You should understand what you need done, why it’s important, and what options are available for where it can be performed. Don’t be afraid to ask your doctor, or another medical professional in that office, to be specific about the procedure or test and discuss it in plain language. There are also medical resources online such as WebMD and Mayo Clinic that will explain your treatment in less clinical terms.

2. Determine what a fair price is for your treatment or test in your market. Make sure you know how much services should cost. You can look up many healthcare services on the free consumer website at www.healthcarebluebook.com. Even when you get care from in-network providers, the prices you will pay for the exact same service, test or treatment can vary by 300-500 percent. Many employees assume they will pay a fair price if they stay in-network. Unfortunately this is not the case. While it is generally best to use in-network providers, employees still need to compare quality and prices.

3. Find out how much your provider charges. When possible, you should always ask your provider how much your treatment will cost before you receive care. Make sure to let your provider know which insurance company and plan type you have so he or she gives you the correct price. In some cases, you may have to call your insurance company to get a price. If your provider offers a reasonable price compared to the Healthcare Blue Book fair price, then you can be confident you are getting a good value. If their price is much higher than the fair price, then you may need to consider other options.

4. Compare prices from several providers. If you are uncomfortable with the value offered by your first provider, compare prices with other providers. Always start with in-network providers if you have a provider network. Call provider offices and request the price for the service. It is generally best to compare prices from 3 to 5 providers. And remember to consider different types of providers that can provide your service.

For example, if you need an MRI make sure to check prices at out-patient imaging centers. You may find a high quality center that charges $1000 to $2000 less than the high cost centers. If you need surgery, you may be able to have it performed at an Ambulatory Surgery Center (ASC) which can also save you as much as 50%. Fortunately, comparing prices usually only takes a few phone calls.

5. Get the agreed upon price in writing. If you are using out-of-network providers or if your provider quoted you a price that is different from its plan agreement, you should get a copy of the agreed upon charges in writing. This will eliminate problems that can arise if you receive an incorrect bill.

Companies of all sizes are struggling under the burden of skyrocketing healthcare costs. Consumer directed health plans (CDHP) and high deductible plans (HDHP) with health savings accounts (HSA) can save employers money but also require employees to be smart consumers. Employers can help their employees most by providing the tools they need to get fair prices.