Have Knowledge of Medical Costs Prior to the Operation

Rick Preston of Town 'n' Country, Fla., wasn't worried about saving money when he had a quadruple bypass and heart valve replacement two years past.

"I have no idea what the cumulative expense of the surgery was because I was only interested in my bottom line," says the Angie's List member.

But barely a month Before, when Preston didn't have health insurance, he compared prices for extensive tests in regard to his heart and got estimates ranging from $25,000 at a Tampa, Fla., hospital to $2,500 at a hospital in Panama City, Panama.

"If I didn't carry health insurance at this time, I would commence checking prices again," says the 61-year-old.

Experts acknowledge patients formerly haven't asked or cared about medical costs. But with an estimated 46 million Americans uninsured and an additional 10 million to 11 million with high-deductible plans, providers assert they're seeing numerous patients nowadays distressed as to what they're spending out of pocket.

Results from a recent online opinion poll affirm the burgeoning trend, with 61 percent of Angie's List members saying they contrast health care costs at minimum most of the time. That same proportion of members communicate they'd be more disposed to examine costs if prices were more accessible.

Less 'Cadillac Care' Creates a Demand to Know

Jeffrey Rice, a former physician and counselor in Nashville, Tenn., says it's customarily been problematic for patients to find and scrutinize prices on health care services owing to a lack of transparency in the industry.

"People don't realize the same routine may vary by 500 percent or better from the identical city, or even on the same block," says Rice, who in 2008 founded Healthcare Blue Book, an online tool that is helping Angie's List members search for fair prices in reference to health care services. "Because people had insurance or the public administration paying their health care bills, they weren't in the habit of asking about or caring about costs, and providers weren't used to discussing prices or explaining how come things total up to as much as they do."

Jonah Keegan of Decatur, Ga., says he's had to adjust his course of assessment thanks to his health insurance plan with a $3,000 deductible.

"I didn't care in respect to price during which time i had 'Cadillac care,'" says the Angie's List member. "Nowadays it's a considerably bigger concern." While Keegan says he hasn't had to compare prices yet, he still has various apprehensions. "I'm scared it may happen to be rough to discover a doctor under my insurance policy who would give a lower compensation," he says.

Rice stresses that in-network providers will charge a broad divergence of prices for the same practice and recommends calling many for their fees before scheduling an appointment. Health care providers typically declare established fees, known as "billed amounts," or the sticker price. Yet they still negotiate with insurance companies to effect a fee, known as the "allowed amount," that is considerably lower as compared with the slated amounts but at any rate designed as financial remuneration in full. This negotiated fee is what Healthcare Blue Book considers the equitable price.

"You're pretty expected to procure a supplier who will be able to meet the fair price," Rice says, but notes a prevalence of patients don't want to switch doctors in order to lower costs. "Just tell your supplier cost matters," he advises.

Taking Notice of Consumer Demand

While some doctors may be willing to help you pinch pennies, Dave Mordo, the parliamentary leader of the New Jersey Association of Health Underwriters, says others may be opposed to disclosing their prices upfront.

"Providers fall back as regards the competition foolishness," says Mordo, who believes transparency allows patients to make informed choices. "They may suspect they can't have their colleagues find out what they're charging or their patients will leave them."

But some hospitals, such as notably rated Alegent Health in Omaha, Neb., have already started catching a closer glance at pricing so patients may cost out appropriately. In 2007, Alegent launched My Cost - an online tool that gives patients an evaluation based on their insurance arrangement and specific data.

"It gives patients peace of mind," says Linda Waldmann, the business manager of Alegent Health. "It's no longer a large black abyss you run into sight unseen. You wouldn't buy a car without checking beneath the hood."

Insurance companies are also taking heed in connection with user necessity for price transparency. Aetna, a highly rated insurance provider based in Hartford, Conn., launched an online out-of-pocket estimator in April that's based upon each customer's benefits and organization of providers.

"The population have additional financial investment concerned and want to know what they'll pay," says Wayne Gowdy, a leading project head with Aetna.

Hospitals Typically on the High End

Ginny Collins of Springfield, Ill., is overjoyed her son's physician suggested checking prices before moving forward for a pharynx procedure. The longtime registered nurse found it overly demanding to acquire the data - but she's happy she was persistent. She compared prices with the hospital she worked with and a nearby clinic and was taken aback with the enormous price difference.

"It would have cost $6,900 at the hospital and $1,500 for the clinic," she says. "Guess where we went?"

Both Rice and Gerard Anderson, director of Johns Hopkins Center for hospital accounting and oversight, say hospitals incline to be more pricey. "They commonly demand two to four times more than other providers," says Anderson, who attributes the higher fee to larger carrying charge.

The general public don't typically want to know why hospitals charge more, says Dan Perrin, an authority on health savings accounts and head of the HSA Coalition. "There's a conception public hospital prices need to be high," he says. "But you walk into these places and they've got granite floors and basically gold-handled toilets."

While hospitals may charge more, experts say it isn't in every instance possible to circumvent getting care there.

"Any time-critical and/or emergency oversight doesn't impart itself to price comparison shopping," says Kathleen Stoll, the director of health group policy at Families USA - a nonprofit health care consultation organization.

Stoll warns patients may also experience it difficult to do expense comparisons for complicated discretionary procedures. "The level of impairment and the patient's health may influence price," she says and recommends having a frank conversation in conjunction with your supplier.

Put the Focus on Quality Care

Dr. Robert Garrison, a well evaluated dentist in Columbus, Ohio, says he fears the movement favoring clarity and shopping will degrade health care providers to the equivalent position as a technician, like a car mechanic. "It's the wrong basis to decide on your medical care," Garrison says. "It should be about sixth on the checklist regarding deciding factors."

And even though price is quickly climbing as a top priority with consumers, others acknowledge dollar signs shouldn't bias your decision.

Dr. Rita Stec, an internist in Palm Desert, Calif., who publishes her fees online, stresses patients additionally need to search out the best care. "execute the research and check up on their reputation, preparation and expertise," says Stec, who suggests looking at Angie's List ratings. "once you've identified a compatible provider, next inquire pertaining to price."

After a dental exam, Evan Austill found out he needed a root canal, and his dentist, Dr. Allen Blourchian of Franklin, Tenn., gave him an estimation of $1,300. Being as how Austill was lacking major medical insurance, he logged on to Healthcare Blue Book's website after his visit and found the fair asking price listed at $900. He printed the text and presented the article to Blourchian.

"As a general rule, i don't okay patients to stroll into my office and dictate my fees," says Blourchian, who adds he did work out an allowance because he had no additional things to come and could fit Austill in on the spot.

Regardless, Austill says he's pleased he asked. "I got to put $400 back in my pocket," he says. "I presume a doctor that offers me a desirable valuation cares about my economic and health status - that's the grade of doctor for me."




“Under the care of Leo J. Borrell, M.D. since December 2001, I have seen a remarkable improvement in my mother’s condition. She is responding dramatically to the new regiment Dr. Borrell has prescribed”

- Beth Rose


Feb 3, 2008

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by Dr. Leo J. Borrell, featured in Assisted Living Consult for November/December 2006. A HealthCom Media Publication