Consumers have grown accustomed to using online searches to compare prices. We go online to find low prices on everything from cars to groceries. However, a Duke University study recently found that there is one purchase that cannot be easily researched online: medical treatment. The study found that a search for medical treatment online resulted in only 17 percent of the price estimates requested. Researchers searched prices for cholesterol blood tests, hip replacements, brain MRIs and an upper GI endoscopy. The study was conducted because researchers felt consumers could make better decisions on healthcare if they knew what procedures would cost. The problem is making sure that information is readily available.
Why Knowing Prices Can Help
One of the main reasons that knowing what a medical procedure will cost is beneficial is that you can get a better understanding of what your out-of-pocket costs will be. For example, if a hip replacement will cost $10,000 and you have a $5,000 deductible that has not been met, your out-of-pocket costs will be at least $5,000. With co-payments, your personal costs could be even higher. If that surgery costs $7,000 in another county, then you’ll pay less out of pocket after you meet the deductible.
- $10,000 surgery with a $5,000 deductible = $5,000 bill sent to your insurer.
- The insurer covers its share, let’s say 70 percent, which comes to $3,500. That leaves you with a bill for $1,500.
- $7,000 surgery with a $5,000 deductible = $2,000 bill sent to your insurer.
- The insurer covers 70 percent, leaving you with a bill of $600.
- By shopping around, you would save about $900 after paying your deductible.
Research shows that even if you have health insurance, knowing what a procedure costs can lead to a reduction in unnecessary testing and treatment. Transparency is another way for you to reduce your healthcare costs. As premiums rise, families are making more educated decisions regarding healthcare, including researching the cost of procedures in an effort to find good care at the lowest price.
Searching for Information
The best place to start looking for the cost of healthcare treatment is at the website for your own insurance plan. UnitedHealth Group, Aetna, Cigna and WellPoint are just a few of the large health insurance companies that have added pricing tools online for customers. They usually provide only price ranges and, if you are not a client, you may not be able to access the information.
In an effort to provide consumers with more readily accessible information, some states have created databases, known as All-Payer Claims Databases (APCDs), with pricing information. New Hampshire, Maine, Oregon and Massachusetts currently have detailed databases that are compiled from insurance claim information. Utah, Vermont and Tennessee are also building databases for residents to research the cost of healthcare services. MN Community Measurement, a non-profit agency in Minnesota, offers pricing based on data provided by insurers.
A growing number of healthcare providers are also including cost estimates on their websites as well. And while this is still relatively rare, some doctors and hospitals are even offering calculators, so you can get a rough idea of what a procedure may cost, or displaying procedure costs on their website based on list prices rather than actual pricing.
The Growth of Independent Pricing Websites
As more consumers search for information on the cost of healthcare services, there is a growing population of online companies that now provide pricing information based on geographical areas. These independent websites collect data from multiple sources to create a more accurate picture of the cost of medical procedures.
- HealthcareBlueBook.com lists what they call “fair price” for services in a database compiled from information they receive from private insurers.
- ChangeHealthcare.com uses claims from insurance companies to create estimates of payments to providers, which can give you an idea of what a particular service may cost in your area.
- Other online sources include FairHealthConsumer.org, CostHelper.com, NewChoiceHealth.com and OutOfPocket.com.
- If you’re nearing retirement and want to estimate your costs as you get older, AARP offers a calculator specifically designed for seniors to determine how much you should account for.
It’s important to note that many of these sites use averages and estimates to determine pricing, but they may have more accurate information than other sites since they are independent from an insurance company or healthcare provider. Use these sites as a base, but don’t assume that they’re completely accurate when you’re shopping for prices.
Tips for Searching
If you’re trying to determine the price of a medical procedure or treatment, there are some things to keep in mind before beginning your search. The first thing to do is to find out the exact name of the procedure and how the medical billing system refers to it to simplify the search. You can search for this information online, but the best way would be to ask your provider’s office what the billing code is. Medical billing codes are uniform and universal.
Next, check to see if multiple providers are required for the procedure. For example, a colonoscopy may require a doctor, an anesthesiologist and charges for pathology, all of which require their own fees. If you do not have insurance, see if the site lists a cash or self-pay price, which may be different than what is charged to an insurance company. Keep in mind that prices can vary among providers, even in the same area. A hospital may charge much more for an X-ray, for instance, than a clinic in the same town.
Challenges with Data
Even after searching for the cost of medical procedures and tests online, you may be confused at the wide range of pricing you discover. It’s one of the reasons insurance companies don’t release information on what they pay for procedures as prices can vary widely among providers. In Maine, for example, one insurer’s payment for a colonoscopy was $559 to one provider and $4,526 to another with no difference between the services. The U.S. Government Accountability Office conducted a survey of healthcare providers, asking them the cost of a knee replacement. Estimates ranged from $33,000 to $101,000, but providers could not offer any explanation for the wide range of costs.
A growing number of consumers believe that higher prices do not equate with better care, demonstrating a higher demand for transparency among providers and insurers. Many healthcare providers also cite legal reasons for not reporting price information. In some cases, there are contractual issues that prevent the release of price information, often between insurance companies and healthcare providers.
Even though the data today is difficult to understand, there’s been progress in helping consumers make more informed choices about where and how they get care. As more healthcare providers gain an understanding of transparency in the price of procedures, it will become easier for consumers to find estimates for what a procedure may cost. With the wide array of websites offering information on the average price of a medical procedure or treatment, it is possible to compare your options, whether to eliminate an unnecessary procedure or to find a less expensive treatment in order to lower your out-of-pocket expenses.