Culture change is here. People are upset about their health costs, and they’re acting like consumers in the marketplace. They’re looking for value, and for providers who will cure their ills and treat them like thinking beings. We know this because they’re telling us on our PriceCheck project, crowdsourcing health-care prices with our partners KQED public radio in San Francisco and KPCC/Southern California Public Radio in Los Angeles.
“Thank you for doing this!! Something I have wanted for years.”
“I love what you organization is trying to do and I would like to contribute information. … My 6 year old daughter had an MRI performed on her left ear and the explanation of benefits (EOB) itemized the services.
- Radiology (0611): $7,653
- Hospital Misc (0250): $133.40
- Hospital Misc (0370): $3,256
- Hospital Misc (0636): $152
- Hospital Misc (0710): $2,195
- My out of pocket for these set of bills is $876.62
“I also received a separate EOB for the anesthesia (01922AA): $1092. My out of pocket was $324.30.
“I have insurance (but not a very good one) through my employer. My daughter will need this MRI again next year and thanks to your organization and what I learned on NPR, I will shop around next year and maybe just pay cash.”
Perspectives on health costs matter: Why we’re doing this
In the three years of studying health prices at ClearHealthCosts.com, we’ve heard a lot of objections. “When Obamacare kicks in everybody will be insured.” “It all costs $20, or whatever your co-pay is.” “People don’t care about cost. They just want to do what their doctor says and get well.”
Here are some voices of our contributors to PriceCheck. (Here’s an earlier post about preliminary PriceCheck results; here’s a post I wrote last year about a similar project we did with WNYC public radio in New York City.)
A note: Your perspective on prices depends greatly on your situation. If you’ve got gold-plated insurance, maybe you don’t care. If you are uninsured or on a high-deductible plan, you probably care a lot.
Women generally care more than men — simply because women make 80 to 90 percent of the health-care decisions in this country. Women nag their spouses (be those spouses husbands or wives) to get treatment. Women make pediatricians’ appointments and run elder care. Women own reproductive health. Women pick up prescriptions and argue with the insurance company. Men simply have less familiarity with these matters, in our experience.
Our contributors’ voices
“Each August I have a mammogram. Each September I get a refusal to pay from Anthem Blue Cross saying they need additional information. Then I call Blue Cross and provide the information they need. Then each January I finally pay the $ 5 that is not covered by insurance. For the life of me I can not see why every year we need to go through this dance! If I did not have a family history of breast cancer I might give up.” This woman had a regular screening mammogram at Northern California Women’s Imaging Center in Palo Alto. She was charged $445, Anthem Blue Cross paid $212.26, and she paid $5.10.
“Blue Shield has excluded House Ear Clinic from its Network for all Individual policies. If it was In Network on Silver Plan the patient cost would have been $60 CoPay. Why?” This contributor had impacted ear wax removed at House Ear Clinic in Los Angeles. She was charged $34.50, insurance paid $17.25 and she paid $17.25.
“Without Obamacare, I would not have health insurance.” She had a mammogram at Kaiser Permanente Redwood City Medical Center in Redwood City. The charge was $415, all paid by her insurer.
“Excellent facility, very rapid service, good hours, competent, kind techs. What insurance is billed is largely mythologic, as PPO contracts pay a specific amount and the rest is ‘PPO discount.’ ” She had a mammogram at Huntington-Hill Breast Center in Pasadena; charge $258, insurance paid $152.98, no charge to the patient.
“At first PAMF sent me bill. Had to ask them to bill Medicare. Then Medicare denied. Then Medicare approved and paid. This allowed Blue Shield CA to also pay. Two different reasons for denials. Finally approved!” This person had a stress trans-thoracic echocardiogram at Palo Alto Medical Foundation; the bill was $766; Blue Shield paid $189.42 while Medicare paid $355.73; the patient paid nothing.
By the way, if you’re uninsured, free mammograms are available many places. Here’s one page of resources and here’s another page. Here’s our blog post on the topic of free mammograms under the Affordable Care Act from last year; it’s a little dated, but pretty much good to go.
Complaints about us: Ouch. We’ll try harder.
We’re working on improving the software. (Hey, it’s a prototype and a startup. We launched before we were perfect.)
Meanwhile, you told us that we needed to do better. We will try: it’s part of our commitment to you, our communities.
“I tried to enter my cost information but the options on your website are quite limiting. … Hence, I could not choose any of the MRI options from your dropdown list. Could you please update your website so that we can enter more free-form information?” Answer: We’re working on it.
“First, thank you for doing this!! Something I have wanted for years.
Second, I’m having trouble entering data.
My mammogram had 4 charges:
G0202 Screening Mammogram
77052 Mammography Other
76499 Radiology Other (likely additional films required as I have dense breasts and the doctor could not see what she wanted first time around)
99212 Office Visit
“Anthem paid for the first two but did not pay for the 2nd two. I am unable to enter the 2nd two because the codes are not listed on your website.” Answer: We’re working on it. Also, could our medical billing and payment system be any less user-friendly? That we can’t fix. Yikes.
“Just heard about this on the radio today, exactly when I received a ridiculously high bill after mammogram. Unfortunately, the website is not easily navigable. First, the type font is faint and difficult to read. Second, it is not intuitive at all. My bill doesn’t have a code or any info. Your website gives a spot to indicate Insurance Paid or Self Paid – my insurance paid a small fraction, does that mean I put information in ‘insurance paid’ section? Is the problem that the diagnostics are charging excessive prices or that private insurance (Blue Shield in this case) is using out of date information about how much they should cover?” Answer: Sorry for deficiencies in design; we’re working on that. Second, the billing system is complicated; sometimes codes are included and sometimes not. Payments: Insurance pays some, and in many cases you pay some too. The problem: the charged price and the paid price are disconnected. Charges are often like the M.S.R.P. or sticker price in electronics, or the “rack rate” in hotels, seldom actually paid; the price paid by the insurer is a product of closed-door negotiations with the provider. Our opaque system has led to questions like yours, which are totally reasonable, because no sane person would create or accept a system like what we have.
More of our contributors’ voices
We’re not naming the providers in this case because they have not had a chance to defend themselves, but ….
“This was a 5 minute visit, no tests were order or done, doctor was a bit curt and rude, charge seems excessive.” One woman wrote of an office visit to a clinic, where she was charged $367.96.
“The emergency department removed five small stitches from my daughters shin and gave her a prescription for antibiotics. We would have removed the stitches ourselves, but they were infected and sore and she needed the antibiotics which they would not prescribe over the phone. This was essentially a charge of $1,264.00 to receive a prescription.”
“How’s a civilian supposed to make any sense of this?”
From our email:
A broad policy recommendation from one community member: “Here in California auto mechanics must provide their hourly rates for servicing a vehicle. Healthcare is so much more important than that, and the system used to charge patients is so opaque. We as patients should be able to see the rates and charges ahead of time and be able to compare pricing, including how much will be covered by our insurance policies. The current system is so complex that the average patient cannot easily ascertain what the costs associated with a referral office visit or medical procedure will entail.”
From another community member, a note saying that even before we asked, she was struggling with this issue: “I just listened to a radio program on the Bay Area’s KQED about your website and your work. This is a wonderful project!
“I have tried very hard and failed to obtain after-the-fact health care costs from Kaiser in California. I recently had a surgery at Kaiser and I have called several different departments asking for total amounts billed for procedures including what I paid and what insurance paid. I have been working on this on and off for the past several months and I haven’t made any progress.”
To our contributors: Thank you.