brings price transparency options to hospital care

Yesterday’s post about the challenges self-pay patients face in finding a cash-only or at least cash-friendly primary care doctor addressed a pretty common problem that the uninsured often face. One thing that I forgot to mention was telemedicine. Several companies including DocDial,* Connect2Docs,* 247DocRx,* American Well, and 1st Call MD all allow patients to consult with doctors over the phone, through e-mail, or via a video connection. These services all cater to self-pay patients, and their prices are generally much less than seeing a physician who isn’t cash-friendly.

But while paying too much for a primary care visit can be aggravating and a financial burden, paying too much for hospital or surgical treatment can be financially devastating. As I’ve mentioned several times in the past, most hospitals have wildly inflated ‘chargemaster’ price lists that typically charge the uninsured or out-of-network patients three to five times what an insurer might pay

And while there are facilities that offer real prices for self-pay patients, like the Surgery Center of Oklahoma and Regency Healthcare, they are few and far between, leaving most patients to deal with their local hospital, at least if they can’t easily travel for care.

But where to start? The best approach, as near as I can tell, is to have in hand information on what different insurers are paying for the treatment you need (or have had, if you’re doing it after-the-fact), and simply ask for that price. Explain that you intend to pay in full for your treatment, and because they won’t have to deal with the billing the insurance company and having to possibly wait months for payment, you would like the best price they offer to an insurance company.

But finding out what insurers are paying hospitals and other facilities can be a challenge. Fortunately a relatively new web site called Pricing Healthcare is putting this information at the fingertips of every self-pay patient. 

Here is how the site explains the service they provide:

Pricing Healthcare is busting the healthcare pricing market wide open, exposing the closely guarded pricing secrets of insurers and healthcare providers. We allow consumers to compare procedure-level prices across all the healthcare facilities in their area.

If you’ve ever experienced the shock of an expensive medical bill, or known someone who has, then you understand the problem we’re trying to solve. Consumers have no recourse for outrageously high prices. They want to know what they’re being billed for, what all of those procedure codes mean, if their bill is correct, and most importantly, if there’s a place nearby that charges less…

The data that could transform the healthcare industry is out there. It’s sitting in our filing cabinets and in the piles of bills on our kitchen counters. Our model is to help patients come together at the grass roots level, and anonymously share the pricing data from their healthcare bills. That data is then combined and shown for your specific community, anywhere in the country.

The site is still in the process of gathering billing information, with California seeming to have the best data at the moment. I decided to check out the information they had for Bakersfield, California (I have family there) to see what they offer. I selected ‘ultrasound of abdomen’ and it provided me with a wealth of information.

It turns out that the ‘chargemaster’ price for an abdominal ultrasound in Bakersfield ranges from $301 at Good Samaritan North to $1,122 at Mercy Hospitals of Bakersfield – Downtown Campus – quite a spread! It didn’t have the prices yet that insurers pay, but it did reveal the cash prices for two facilities – $211 at Good Samaritan North and $377 at Delano Regional Medical Center (list price at Delano is $419).

I also checked out a couple of treatments in Los Angeles. A carpal tunnel release surgery paid for in cash will cost $3,837 at Ronald Reagan UCLA Medical Center (list price, $5481), while Garfield Medical Center apparently thinks $26,509 is a reasonable price to charge patients paying cash, down from their list price of $29,454. It’s not hard to see which of these caters to self-pay patients and which doesn’t!

A quick look at hernia repairs found pretty much the same type of spread. The lowest list price, at $5,810 at Promise Hospital, East Los Angeles Campus, actually beat the lowest cash price, $6,670 at Children’s Hospital of Orange County. For an adult patient, the best cash price is again at Ronald Reagan UCLA Medical Center, $6,853, compared to their list price for the procedure of $9,790. Garfield Medical Center also leads the way in overcharging self-pay patients, with a cash price of $29,177 (down from their list price of $32,419).

As with almost all of the health care price transparency web sites, the data is still being entered, and depending on where you live there may not be much information available at this time.  Right now it looks like Pricing Healthcare has information available in eleven states including California, Oregon, Ohio, Michigan, and Wisconsin.

In part to help obtain the information they need, Pricing Healthcare allows people who sign up to have 10 free searches, after that they must enter billing information off of their own hospital bills. It’s an interesting way to obtain the data they need (they are also using more traditional methods of obtaining hospital price data, such as requesting hospital chargemasters).

Having access to what insurers and self-pay patients are really paying for treatment at hospitals and medical facilities across the country will be a tremendous help for anybody who has to pay directly for their health care, and I’d recommend every self-pay patient check out their site and if possible help to build the database by providing their own hospital bill information.

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