There’s been a lot of conversation lately about what insurance companies pay for medical procedures, a topic we’re deeply interested in.
For example, there’s the Health Care Cost Institute database, which encompasses payment records from “data voluntarily supplied by Aetna, Humana, UnitedHealth and Kaiser Permanente, it covers 33 million Americans with employer-sponsored health insurance,” according to Sarah Kliff, writing in The Washington Post. The data is available to researchers, but the people who hold it have been inundated with requests from big institutions. (
We haven’t asked for access over here at CHC. We figure we’d be behind the big boys in line, and we’re interested in what insurance companies pay but we think it’s probably on the order of the cash-price variations we’ve seen: for example, that MRI of your lower back could cost from $350 to $2,300. And I happen to know that insurance companies pay $2,300 in some cases; my insurance company, for example, paid $2,300 for the MRI of my lower back.
Other information is available too.
Today I tripped over an excerpt from a book that’s going onto my must-read list, “The Cost of Hope” by Amanda Bennett. The former editor of The Philadelphia Inquirer, she writes of the end of the life of her husband, Terence Bryan Foley, who died of kidney cancer. She pored over 5,000 pages of documents on his care, and wrote a book about it. Here’s a snippet:
“In late 2006, as his oncologist was checking how far the cancer had spread, Terence had a scan at University of Pennsylvania hospital, which billed the insurance company $3,232. My insurer that month was UnitedHealth Group, which paid $2,586.60, or 80 percent of what the hospital asked.
“Three months later, after some experimental drug treatment, Terence had another scan. Same patient. Same hospital. Same machine. Same $3,232 bill. The only thing that had changed is that our paper’s new owner had switched insurance companies. The new insurer, WellPoint Inc.’s Empire Blue Cross and Blue Shield, paid the hospital $775.68, or 24 percent.
“At that time, Medicare was reimbursing $250.94 for the same procedure.
“And what did someone without insurance pay the University of Pennsylvania hospital for a similar scan? We accidentally found that out too, when a stray record found its way into our pile.This unfortunate person, who was paying the bill out of pocket, paid $1,657 — or $881.32 more than Blue Cross paid the hospital, and $1406.06 more than Medicare paid.
“What did Terence and I pay?
Jeanne Pinder is the founder and CEO of ClearHealthCosts. She worked at The New York Times for almost 25 years as a reporter, editor and human resources executive, then volunteered for a buyout and founded ClearHealthCosts.
She was previously a fellow at the Tow Center for Digital Journalism at the Columbia University School of Journalism. ClearHealthCosts has won grants from the Tow-Knight Center for Entrepreneurial Journalism at the Craig Newmark Graduate School of Journalism at the City University of New York; the International Women’s Media Foundation; the John S. and James L. Knight Foundation with KQED public radio in San Francisco and KPCC in Los Angeles; the Lenfest Foundation in Philadelphia for a partnership with The Philadelphia Inquirer; and the New York State Health Foundation for a partnership with WNYC public radio/Gothamist in New York; and other honors.
Her TED talk about fixing health costs has surpassed 2 million views.