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You can price shop if you put a great deal of effort into it. I got a MRI on my lower back in April. Going to my insurance provider I was able to get a list o

by NDizzle 11y ago

You can price shop if you put a great deal of effort into it. I got a MRI on my lower back in April. Going to my insurance provider I was able to get a list of places to get a MRI near me. Since I kind of live in the boonies, everything was 45 to 60 miles away so it was a difficult search of an unfamiliar area. Anyways, going through this list I called them and made sure they accepted my insurance plan. This is a super small business plan that costs me $1400/mo. On top of this it has a huge deductible. The magic words are "contracted rate" - call up the office and get the specific code for the procedure that your doctor prescribed. Call up your insurance company and ask them, at this physician, what is the contracted rate for this code? They will put you on hold for 10-30 minutes and come back with a number. Doing this 4 times I had 3 places that were between $1100 and $1800. That is my out of pocket cost for the procedure. Then I found one place that had a contracted rate of $440. That's a quarter the most expensive place! There is NO UI or no realistic way to do this. This process took me about 5 hours of work on the phone to complete. As a bonus, you can ask the physician what the insurer pays them for the procedure. Once you have all of the numbers in front of you it's a bit easier to tell why one place was 25% the cost of another place. Anyways. Contracted rate and medical procedure codes. Those are the things you need.

ethbro 11y ago
The sad thing is that all of this information is already in an electronic system somewhere. It's just a matter of access to data. Your insurer should absolutely be able to answer if you ask "What are the 5 cheapest places to get an MRI within 60 miles of me?"
- steeef 11y ago
  It's up to your insurer to provide that information in a usable format. There are products out there that will present this information in a searchable format that makes it easy to do cost-comparisons like your example, all from within your insurer's portal. The problem is getting these insurers to realize that features like these are important to their clients.
- deleted 11y ago
  [deleted]
Lagged2Death 11y ago
You can price shop if you put a great deal of effort into it. I'm glad this worked out for you, but if one is visiting the doctor because of some symptoms, rather than visiting a technician to have a specific, prescribed, and highly standardized service (like an MRI) performed, I'm sure you'd agree that situation is different. It's simply not in the nature of medical care to have price-tags (although the situation could certainly be better that what we have in the US today). I'd argue this is the case with all sorts of expertise-based services, actually - auto mechanics, lawyers, consultancies of all kinds, etc. You can't know how much a visit to your lawyer will cost unless you know exactly what you need - but much of the time you don't know what you need. You're visiting the lawyer so he can figure out what you need. Yet every time I see an article that involves economists pondering medical care costs, this fundamental uncertainty (at the personal level) is just elided, as if the economists never thought of that. As if they never actually deal with the health care system themselves.
- aggieben 11y ago
  Lawyers, accountants, and mechanics all have to provide estimates to a client precisely for this reason. I see no reason why medical practitioners should be any different. As an anecdote, I have found that price comparisons are perfectly feasible in a non-emergency situation. My son broke his arm, and instead of just driving to the nearest emergency room, I called around to a handful of urgent-care clinics and found one that was able to quote me some prices that were reasonable, so we went there to get him treated. Easy. In any case, I think the ACA is a train wreck, piling on more of the crap that makes our system suck: the disconnect between consumer and producer. If we ever want to make our healthcare market sane, we will have to largely cut out the middleman ("insurance"), and the only way to do that is have patients pay for their own care (particularly routine care).
  - kaitai 11y ago
    How long were you on hold while your kid was clutching his arm? On the one hand, on the other hand. Many people are not good at judging what is an emergency and what isn't when it comes to health care, especially since vast swathes of the public no longer have more than rudimentary home health-care skills. So breaking your arm -- emergency or not? Concussion -- emergency or not? Falling out of a tree or off a ladder and having lots of bleeding, but not sure what happened -- emergency or not? Chest pain -- emergency or not? And what if you're the one sick? Say you've got what you think is a gallstone and you're in a lot of pain. How do you shop around? How can you evaluate for yourself how long it is ok to wait, and how do you deal with it when you go to see the cheaper internist for an evaluation but want the surgery done at the cheaper surgery but the internist looks at you and says, "Holy )(&! you're going in now" and they take you to the expensive surgery? And then how do you make sure some specialist doesn't visit you while you are unconscious and then charge for that "consultation"? A fun read with respect to the last question is on pregnancy in the US [1]. I agree with you in many ways -- it would be reasonable to give estimates, the ACA is insurance "reform" rather than health care reform, insurance is not health care. One big problem is that if your car doesn't work you can put off repairing it for a bit until you find a decent mechanic, but when you get acutely ill you can't put off care. (Well, you can try, but it just costs more later unless you die quickly.) [1] http://www.nytimes.com/2013/07/01/health/american-way-of-birth-costliest-in-the-world.html http://www.nytimes.com/2013/07/01/health/american-way-of-bir...

by NDizzle 11y ago

ethbro 11y ago

The sad thing is that all of this information is already in an electronic system somewhere. It's just a matter of access to data. Your insurer should absolutely be able to answer if you ask "What are the 5 cheapest places to get an MRI within 60 miles of me?"

steeef 11y ago
It's up to your insurer to provide that information in a usable format. There are products out there that will present this information in a searchable format that makes it easy to do cost-comparisons like your example, all from within your insurer's portal. The problem is getting these insurers to realize that features like these are important to their clients.
deleted 11y ago
[deleted]

Lagged2Death 11y ago

You can price shop if you put a great deal of effort into it. I'm glad this worked out for you, but if one is visiting the doctor because of some symptoms, rather than visiting a technician to have a specific, prescribed, and highly standardized service (like an MRI) performed, I'm sure you'd agree that situation is different. It's simply not in the nature of medical care to have price-tags (although the situation could certainly be better that what we have in the US today). I'd argue this is the case with all sorts of expertise-based services, actually - auto mechanics, lawyers, consultancies of all kinds, etc. You can't know how much a visit to your lawyer will cost unless you know exactly what you need - but much of the time you don't know what you need. You're visiting the lawyer so he can figure out what you need. Yet every time I see an article that involves economists pondering medical care costs, this fundamental uncertainty (at the personal level) is just elided, as if the economists never thought of that. As if they never actually deal with the health care system themselves.

aggieben 11y ago
Lawyers, accountants, and mechanics all have to provide estimates to a client precisely for this reason. I see no reason why medical practitioners should be any different. As an anecdote, I have found that price comparisons are perfectly feasible in a non-emergency situation. My son broke his arm, and instead of just driving to the nearest emergency room, I called around to a handful of urgent-care clinics and found one that was able to quote me some prices that were reasonable, so we went there to get him treated. Easy. In any case, I think the ACA is a train wreck, piling on more of the crap that makes our system suck: the disconnect between consumer and producer. If we ever want to make our healthcare market sane, we will have to largely cut out the middleman ("insurance"), and the only way to do that is have patients pay for their own care (particularly routine care).
- kaitai 11y ago
  How long were you on hold while your kid was clutching his arm? On the one hand, on the other hand. Many people are not good at judging what is an emergency and what isn't when it comes to health care, especially since vast swathes of the public no longer have more than rudimentary home health-care skills. So breaking your arm -- emergency or not? Concussion -- emergency or not? Falling out of a tree or off a ladder and having lots of bleeding, but not sure what happened -- emergency or not? Chest pain -- emergency or not? And what if you're the one sick? Say you've got what you think is a gallstone and you're in a lot of pain. How do you shop around? How can you evaluate for yourself how long it is ok to wait, and how do you deal with it when you go to see the cheaper internist for an evaluation but want the surgery done at the cheaper surgery but the internist looks at you and says, "Holy )(&! you're going in now" and they take you to the expensive surgery? And then how do you make sure some specialist doesn't visit you while you are unconscious and then charge for that "consultation"? A fun read with respect to the last question is on pregnancy in the US [1]. I agree with you in many ways -- it would be reasonable to give estimates, the ACA is insurance "reform" rather than health care reform, insurance is not health care. One big problem is that if your car doesn't work you can put off repairing it for a bit until you find a decent mechanic, but when you get acutely ill you can't put off care. (Well, you can try, but it just costs more later unless you die quickly.) [1] http://www.nytimes.com/2013/07/01/health/american-way-of-birth-costliest-in-the-world.html http://www.nytimes.com/2013/07/01/health/american-way-of-bir...