Consumer Health Choices | Consumer Reports

'Choosing Wisely' Helps Patients and Providers Change Patterns. “It just makes sense, and it's a way for us to get aligned and have a good conversation.”.
829KB Sizes 16 Downloads 181 Views
The real cost of care

How to save on medical bills, without compromising quality

Contents Special report That CT Scan Costs How Much? ............. Page 3

Health Care Blue Book Reports Hip Replacement ...................................Page 7

Lap Band ............................................. Page 29

Hysterectomy ...................................... Page 11

Brain MRI ............................................ Page 34

Knee Replacement .............................. Page 16

Rhinoplasty ......................................... Page 38

Knee Scope .......................................... Page 20

Colonoscopy ....................................... Page 42

Laminectomy ...................................... Page 25

2

2

FEATURE

OUCH. AGAIN. Rachel Collier, of San Jose, Calif., visited an emergency room for abdominal pain that went away without treatment. The bill: $14,638, including $9,038 for a CT scan that would have cost $318 at a nearby imaging center in her health plan’s network.

T hat CT scan costs how much?

I

f gas stations worked like health

nearest department store—and the clothes wouldn’t have price tags on them. “Why can’t you or I as a consumer ask what it’s going to cost and be met with something other than a blank stare?” asks Will Fox, a principal with Milliman, a national health actuarial consulting firm.

care, you wouldn’t find out until the pump switched off whether you paid $3 or $30 a gallon. If clothes shopping worked like health care, you might pay $80 for a pair of jeans at your local boutique and $400 for the identical pair at the

Professional

DID YOU KNOW? total

1

Source: Healthcare Blue Book

$4,500

4500

Medical costs can vary substantially Facility fee

3000

Professional fee

1500

$3,000

$1,500

0

0

In one Midwestern city the in-network price of a colonoscopy ranged from $840 at a freestanding medical practice to more than five times that amount at the local academic medical center. Big variations in the facility fee (dark purple) account for most of the difference. The light purple represents professional fees for the gastroenterologist.

$840

$4,481

combined fee

combined fee

3

The answer, he says, is that neither providers nor health insurers really want consumers to have that information. Here’s why: The contracted prices that health plans negotiate with providers in their networks have little or nothing to do with the actual quality of services provided and everything to do with the relative bargaining power of the providers. Here’s what this system means for consumers: Ŝ Not even staying within your plan’s network will guarantee you low prices. Providers who have a lot of market clout, such as a prestigious university hospital, may command prices several times higher than providers who don’t. Ŝ It may be difficult, if not impossible, to find out the price of health care ahead of time, especially for complex services such as elective surgery. That’s a special problem for people with high-deductible

P H OTO : RO B E RT H O U S E R

Health-care prices are all over the map, even within your plan’s network

plans, who may be responsible for the first $5,000 or even $10,000 of their health expenses every year. Ŝ If you go out of network, whether on purpose or involuntarily, you may be hit with a five-figure bill that your insurance company isn’t obligated to pay. Ŝ There are ways to protect yourself against being blindsided by a huge bill. But they’re often not easy and don’t always work.

The $4,400 colonoscopy

Co