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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.

Read and watch 13WHAM Special Report: Shopping for Surgery.

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.”

I can’t wait to see “Lincoln.”

10 Responses to Consumers Left Out

  1. I think the lesson is that the hospitals now need to compete for customers and they’re going to quickly need to come to some sort of solution. I’m not a “market forces first” kind of guy, but this actually is the beauty of the high-deductible insurance plan: patients, not arbitrary government action, will drive prices into alignment.

  2. Thanks for this very thorough and informative report, Rachel.

    I am encouraged by the fact that Congressional leaders on both side of the aisle have pledged to continue the healthcare debate and to work collaboratively on associated insurance issues.

    I was fortunate to have my treatment for prostate cancer last March covered in full by my MVP insurance. I also appreciated my receiving itemized charges following my treatment, which informed me that if I had not been covered by insurance, my out-of-pocket expenses would have amounted to approximately $30,000.00. This was inclusive of diagnostic tests, brachytherapy (insertion of radioactive seeds into the prostate), and follow-ups.

    I am grateful that my long-term prognosis is good, and I am appreciative of the excellent care I received via the University of Rochester Medical Center and Highland Hospital. I am also aware that for someone without insurance, or for someone with a policy requiring high co-pays, the type of treatment I had could be financially burdensome. I was extremely fortunate that my MVP policy covered my expenses in full. However, it is important that the national debate on health insurance continues, so all Americans will have affordable options.

  3. Gee and I would expect most readers on this forum were “appalled” at Paul Ryan / Romney’s HCP / Medicaid that included Vouchers.

    With Vouchers part of a health care plan for ALL — hospitals would have to publish and answer questions on the cost of procedures etc. With all their charges known, they would then compete to lower costs to win business. And consumers would learn and know who offers the best quality care for the lowest cost. Sounds like the solution to me.

    But hey voters said Obama understood “me” better and knows whats good for me. I feel a repeat of the second term of Clinton coming. Except for the Economic part which was the result of the Dot Com boom and y2K spending. (never mentioned while we praise Clinton.) You know Bill, the guy who had 4 major terrorist attacks, he did not respond to, during the time he was playing with Monica.

  4. Nice to see you’re not bitter or anything, Orielly.

    And there is a qualitative difference between what we do for healthy adults and what we do for seniors.

  5. Health care costs a lot because it is an extremely valuable service. The cost in training a physician alone is about half of a million dollars to the physician, several hundred thousand dollar from the government (to support their residency training) and 11-15 years of the physicians life. That’s not even including the incredible training for nurses, NPs, PAs and techs involved in care. Or the cost of malpractice insurance, overhead, sterile instruments, and billing. Is medicine expensive? Yes. Is some of it unnecessary costs? Yes. But getting a surgery is a health-altering event regardless of outcome, and in many cases, a life-saving or life-giving event. Getting a car is none of that.

  6. Glad to see you learned somethings from Obama. Like, when you can’t debate the point, personally slam the opposition person instead.

    And then later wonder why politics is so bitter?
    “Proceed Governor”

  7. In the not-too-distant future we’ll be thinking of these as “the good old days” – when doctors were plentiful and good. The only solution is to get government OUT of health care, because government IN health care created these problems.

  8. Often, when one discovers thier need for surgery its when you lying on your back in emergency, and its too late to go window shopping. Elective surgery, on the other hand may be the perfect opportunity for browsing costs. (folks do have elective surgery these days dont they or have costs shut down that avenue?)

  9. November 9, 2012 at 11:15 pm RaChaCha responds:

    Great reporting!

    I’m shocked that some hospitals are telling patients, essentially, to call for a price quote.

    Patient: Yes, um, how much will you charge to remove my uterus?

    Hospital inbound telemarketing: Stitches or staples? Oh, and this month we’re running a special — half-price tummy tucks with the removal of any reproductive organ!

    And so forth.

  10. Pingback: Step Forward in Transparency » The Rochesterian

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