When we buy a new car, we shop around for the best price. But when it comes to health care, few us shop around. While we have an idea how much a new car costs, we have no idea what it costs to have an operation.
There’s no menu or specials board listing prices when you go to the hospital. Consumers typically find out health care prices after they’ve had a procedure. The issue was detailed in a General Accountability Office study.
This is becoming a huge problem, as many of us are moving into high deductible insurance plans. We have to shell out thousands of dollars before insurance picks up the tab. Even after a deductible has been met, patients may still be responsible for some bills. We can’t assume when we go to the doctor insurance will cover the visit beyond our co-pays. It doesn’t work that way anymore for a growing number of patients. The consumer is responsible for more of the cost.
If you think the solution is as easy as making price lists public, think again. The system is designed to prevent you from shopping around for health care. Providers are reluctant to give price estimates without doing a full workup on the patient. Insurance companies and hospitals have often-secret deals on prices. Surgeons and labs and doctors bill patients separately.
After reading about wide disparities and lack of transparency in health care pricing, I wanted to see what Rochester hospitals charge for common operations. I anticipated they would not be eager to help with my story, but all were very accommodating. They were even pleased I was looking into this issue. The hospitals are seeing more patients with high deductible insurance experiencing sticker shock.
That said, I did find a lack of transparency in surgery pricing. While all the hospitals gave me price lists, the data was not very useful to consumers. Rochester General posts its prices online, but without knowledge of medical procedures, billing codes and surgeon charges, it would be hard to figure out a full estimate. Unity did not include the cost of surgeons and anesthesiologists, which can be significant. (Unity does not employ its own surgeons.) Only Strong estimated the full price of surgeries, but gave a fairly wide range.
The system isn’t set up to give uniform pricing data. Every single patient is charged a different amount, even for the same procedure performed by the same surgeon. The reason isn’t only the complexities of the human body. The disparities are mostly because of insurance. Excellus may pay Strong one price for a procedure and Unity another. A patient’s out-of-pocket expenses can vary dramatically.
So what’s a patient to do? Fortunately, all of the hospitals have phone lines to give patients individualized estimated costs if a surgery is planned. But this system is inadequate to educate large numbers of consumers who do not think about pricing until something bad happens.
Links of the Day:
– Anyone want to bet the city won’t bring up 50 ticket-fixing cops on ethics charges? Meanwhile, the city has painted itself into a corner because it decided to bring up a parking official on ticket-fixing charges. Can’t wait to see how the mayor gets himself out of this one. (Another prediction: The city will end up paying the civilian worker off.)
– Century Safe is moving manufacturing jobs from China to Pittsford.
– The YMCA wants to move its Pittsford branch to Jefferson and Clover. I think this is a more accessible location for Henrietta and Brighton residents.
– This is the harrowing tale of shutting down the New York City subway system and getting it back up and running in the wake of Hurricane Sandy. The men in charge of buses and trains suddenly needed a bigger boat.
– There is no such thing as the “power flat.”