Stuart Isett for The New York Times By WALECIA KONRAD Published: November 27, 2009
Health care consumers are encouraged to comparison-shop on things like doctor’s fees and heart surgery rates. But unfortunately, most of us have little clear or useful information to go shopping with.
“When you go to the doctor, how much you fork over when all is said and done is often just a mystery,” said Dr. Anthony P. Geraci, a Manhattan neurologist who is trying to buck that trend by posting his prices on his Web site.
With the growing number of uninsured people, the increase in high-deductible insurance plans and big jumps in co-payments, just about everybody is paying more out of pocket for health care nowadays. An estimated 15 percent of adults younger than 65 now pay with their own money medical costs greater than 5 percent of their annual household income, according to the Center for Studying Health System Change, a nonpartisan research group in Washington.
So the typical person is probably far more motivated to ask how much an M.R.I. or a hip replacement costs. And just as often, people are asking — or should be — “How can I get a better price?”
Take Katie Kyser, 30, the mother of a year-old daughter, who lives north of Seattle. She and her husband, Jason, who works in construction, recently moved from California. They have no health insurance, so they pay all costs out of pocket.
When Ms. Kyser needed a routine gynecological exam, she called a handful of local doctors, all of whom were charging $200 or more. “There’s no way we could pay that,” Ms. Kyser said. “I had to find another way.” .
” Having seen an ad for PriceDoc.com, a new Web site that lists doctors throughout the country who are willing to post their prices and negotiate with patients, she decided to try it. Ms. Kyser found a nearby clinic where doctors charged only $75 for the exam.
“I was a little nervous at first because the price was so cheap, but when I got there, it was wonderful,” Ms. Kyser said. “Everyone was so professional and helpful.”
The crucial part of shopping wisely for health care (or anything else for that matter) is comparing prices the way Ms. Kyser did.
But that is also where problems arise. Medical pricing is a quagmire, oozing with jargon and current procedural terminology codes. Just look, if you dare, at your latest “explanation of benefits” from your insurer.
What’s more, rarely is there one standard price for a medical treatment. Prices vary based on geography and type of provider — whether hospital, stand-alone clinic or any alternative.
Then, doctors, hospitals and other providers may negotiate different rates with different insurers. It is not unusual for a provider to have 10 or more different prices for the same procedure, depending on who is paying. Providers often charge a completely different rate for people paying on their own, which is almost always much more expensive than the discounted rate that insurers pay.
“It’s a challenge for consumers to sift through these different price structures,” said Ha T. Tu, senior health researcher at the Center for Studying Health System Change. And there is no one place to go for good information, she added.
Despite the challenges, here are several steps consumers can take to make health care shopping a bit more manageable:
CHECK WITH YOUR INSURER Many insurance companies have begun posting provider prices on their Web sites so enrollees can access cost information. These tools allow you to compare prices among network doctors (not all network doctors are paid the same) and check on the price of diagnostic tests and other treatments.
“This is especially helpful if you’re in a high-deductible plan,” said Ms. Tu, “because you can see how much you’ll pay out of pocket.”
USE THE INTERNET A few Web companies have tried to fill the price information gap online, all with varying approaches.
On PriceDoc.com, the site Ms. Kyser used, you plug in your ZIP code to find a list of providers in your area who have posted their prices. You can also plug in the price you’re willing to pay. Providers will then respond if they are willing to accept that price.
HealthcareBlueBook.com compiles prices paid for specific treatments and procedures in ZIP codes throughout the country, then lists what the site determines is a range of fair prices. Consumers can then use these ranges as a jumping-off point for negotiating with their providers, said Dr. Jeffrey Rice, the chief executive of the concern.
Dr. Rice tells the story of a woman in northern Ohio who had been quoted a price at a local hospital of $2,500 for an M.R.I. of her knee. When she looked up the test on the site, she found the fair price in that area was more like $500.
She went back to the hospital where she had been quoted the high price and started asking questions. The clerk told her it would be much less expensive if she went to the clinic down the street instead of the hospital. The woman followed that advice and paid $300 for her M.R.I.
Another Web site, OutOfPocket.com, combines price information that users send in to determine a going rate for specific health care costs throughout the country.
None of these sites are comprehensive, although all of them are easy to use and are expanding their listings. It’s worth taking a look to see if you can glean any useful information from them.
BROWSE STATE DATA If you’re checking out hospitals, you will want to see what information your state government offers. At least 33 states mandate that hospitals make their prices public, Ms. Tu says.
But there are caveats. Often, only the most expensive, nondiscounted prices are listed
Moreover, on most sites, costs are not bundled, so you may find the price of a general surgery, for example, but it would not include the surgeon’s or anesthesiologist’s fees.
Some states offer more information than others, points out Ms. Tu. Minnesota, for example, uses average prices for some procedures, and New Hampshire and Maine have some bundled prices. To see what information, if any, is available in your state, you can use the links on healthcarebluebook.com.
PICK UP THE PHONE “The most important thing to do if you’re looking for price information is call your doctor,” said Jonathan Weiner, professor of health policy and management at Johns Hopkins University.
“This is still an awkward discussion for most doctors,” Professor Weiner said. “But if you sit down and talk about money, it almost always leads to discounts, particularly for self-paid people.”
If your doctor balks at having this conversation, ask to speak to the office worker in charge of billing, who will know the prices your doctor charges and can at least estimate what you will be paying. Then, when you do collect price information, you can return to that person to negotiate a better price.
Sign in to Recommend More Articles in Health » A version of this article appeared in print on November 28, 2009, on page B5 of the New York edition.