While technology has changed how we all shop for everything from car rides to vacation rentals, health care quality and cost information has often remained elusive for many Pennsylvania residents. In fact, research shows only a fraction of people were able to find the health care cost information they wanted, and 60% said they would like more information when deciding where to go to get care.
Improving access to health care quality and price transparency information may help reduce out-of-pocket costs for consumers and lower the total cost of care. That’s because the cost for health care services at hospitals and doctors’ offices can vary nationwide and within the same city, despite research showing higher-priced care does not necessarily deliver higher-quality care.
In Pittsburgh, a knee MRI can cost from $200 to $3,630, and back surgery (lumbar fusion) can range from $30,890 to $66,570.
In Northeast Pennsylvania, a knee MRI can cost from $190 to $8,050, and back surgery (lumbar fusion) can range from $32,640 to $127,720.
In Philadelphia, a knee MRI can cost from $190 to $8,050, and back surgery (lumbar fusion) can range from $12,120 to $112,440.
To help make comparison shopping for care more available, some hospitals and health plans are now publicly sharing price information, while new safeguards are helping reduce the likelihood of people receiving an unexpectedly large medical bill in certain emergency or surprise scenarios. While these are important efforts, people still need to understand where and how to access this information – and what to do with it once they have it.
Consider these five strategies to help you more effectively comparison shop for health care:
Check with your hospital or health plan. Some hospitals and health plans are publicly disclosing cost information, including online. However, it may be difficult to decipher what you’ll pay for a visit or procedure if you’re only looking at online data, especially hospital pricing information that may not account for your health plan. Checking with your health plan is generally the better option, as some are making available estimates based on the member’s specific plan and actual contracted rates with care providers. Other approaches to consider include reviewing publicly available transparency resources, asking your doctor or their support staff how much the service will cost or calling around to other local health care providers to ask about pricing.
Enroll in a plan with upfront pricing. Some newer health plans are moving away from estimates and instead offering upfront pricing, which enables members to review – and pay for – out-of-pocket expenses before medical care is delivered. Some of these plans use variable copays, rather than deductibles or coinsurance, which means the copay for the same service may vary depending on the care provider and facility you select. This approach may encourage people to select high-quality, lower-cost care providers and settings, in the process reducing out-of-pocket costs and lowering the total cost of care.
Select the right setting. When seeking nonemergency care, it’s important to always start with in-network health care professionals and facilities, as receiving care out of network may lead to an exorbitant charge. The type of facility you select can also have a significant impact on the cost. Receiving care at a hospital tends to be the costliest setting, while services at freestanding, ambulatory or same-day clinics typically cost less. For instance, UnitedHealthcare data shows that MRIs and CT scans at hospitals average over $1,250, compared to $480 at freestanding facilities. For minor, nonemergency and some specialty services, a virtual care appointment may offer improved convenience and affordability, in some cases costing $0 out of pocket.
Save on prescription medications. About half of Americans take at least one prescription medication, resulting in out-of-pocket expenses of more than $1,200 per year. For help to lower that, new resources are enabling people to compare available direct-to-consumer pricing for traditional generic drugs with insurance pricing to help individuals get the best available prescription drug price. Separately, care providers are gaining access to systems that enable them to identify which medications are covered by a patient’s health plan and the cost for each, offering suggestions for other clinically appropriate, lower-cost alternatives that could be prescribed.
Avoid and negotiate surprise bills. Even with upfront research, there are still a few potential risks to be aware of. To ensure preventive services are covered by your health plan, and not deemed an advanced screening that could result in an out-of-pocket charge, confirm with your health plan that any services or tests are covered under your benefits. In the event of a surprise bill, first talk with the support staff at the hospital or doctor’s office to request that the charge be waived or reduced. If needed, some health plans offer access to resolution support to help negotiate on behalf of members with hospitals and care providers. If you receive a surprise bill from an out-of-network care provider, call the number on your insurance ID card to alert your health plan and check on assistance.
Shawn Wagoner is senior vice president of Surest, UnitedHealthcare.