A recent study found that consumers who know how much a medical procedure will cost save money on healthcare overall—presumably because they choose the lower-priced practitioner.
However, it’s harder than you might think to get a price on a medical procedure. I speak from experience, having tried to comparison shop for an MRI over the summer. I have a high-deductible plan—as do an increasing number of Americans under the Affordable Care Act—so the first few thousand in medical expenses are out of pocket. Hence, I have some skin in the game.
“If you are in a high-deductible health plan, you have a financial incentive to shop for a lower priced MRI, but it’s incredibly difficult to do so,” says Neeraj Sood, Ph.D., director of research at the Leonard D. Schaeffer Center for Health Policy & Economics at the University of Southern California and one of the authors of the aforementioned study.
Here’s what I discovered:
My insurer’s cost estimator tool couldn’t help me. My health insurer offers a fairly comprehensive cost estimator calculator on the company’s site. The only problem: I couldn’t look up the specific procedure I was trying to price, and the tool didn’t list every MRI facility in my area, including several that were recommended to me as quality choices. That meant I had to call all of them individually.
MRIs at hospitals, as expected, are not bargains. The doctor who prescribed my MRI is associated with a specialized hospital in New York City, so he recommended that I get it done there. I was pretty sure that was going to be my most expensive option, but I called to make sure. Their price: $2,100.
How much will that MRI cost? That depends on who you ask. (Photo credit: TheeErin)
Many providers didn’t understand why I was asking. “Your insurance will pay for it,” they said. Even in an era in which more consumers are responsible for the first large chunk of their medical costs, doctor’s offices don’t understand why you’re calling and asking about prices.
Some providers needed additional information. I was asked by more than one office for the CPT (Current Procedural Terminology) codes for the procedure, which is what they use to bill for it. I had to call the original doctor’s office and track those down. Even then, each facility seemed to use its own set of accompanying CPT codes, resulting in a wide variety of prices.
Some providers couldn’t answer my question. One billing coordinator told me she couldn’t tell me how much it would cost. When I called my insurer, I was told that they couldn’t tell me how much it would cost at that facility either. In other words, no one could give me a price, despite the fact that I’d be paying for it. “Imagine if you went to buy a car, and after a month, you got a bill saying how much the car cost,” Sood says. “And the price of the car is different for different consumers.”
Some providers gave me the wrong number. When I called one facility, they told me the MRI I described would cost $1,600. When I called later to check that number, the billing coordinator said, “Oh, but after insurance, you won’t have to pay that much.” She didn’t understand that I was asking for the agreed-upon rate based on my health insurance contract, which is what I would have to pay in the end.
The price range was substantial. How much could you really save by calling around for the best deal? A lot. I heard price quotes from $500 to more than $3,000.
The process isn’t quick. Some facilities told me they’d have to call me back—and never did, forcing me to call repeatedly to try to catch the billing coordinator.
My experience isn’t unique. Despite high deductible plans becoming more common, with much talk of being “in control of your health care costs,” medical costs still hide behind an opaque curtain. Be persistent enough, and ask the right questions, and you can probably find out what a procedure will cost beforehand. But you might not get the right information, and the process is frustrating.
Thankfully, the tide is slowly—very slowly—turning. Software is being developed that will allow employees to visit a website, type in their zip code and procedure, and get prices from all of the participating facilities in their areas. (Although, in fairness, my insurer offered a tool like this and it didn’t work for me.) Many of these programs are still being tweaked.
There’s also the possibility that making prices more transparent over time will result in a lowering of costs overall. “Take the example of MRIs,” Sood says. “If we make shopping for MRIs easier, the higher-priced providers are going to lose market share.”
One can only hope.
