empty doctor office
“Doctor office” by Parker Knight, released on Flickr under the Creative Commons Attribution License

How do people use our data? Listen: “We recently spent much time trying to find the cost of a fairly routine thyroid ultrasound as we now have a high deductible insurance plan,” said the note to us. “It was extremely frustrating. Even Aetna could not give us expected costs or alternate locations for the test. In fact the Aetna website is out of date as it lists closed facilities and sites no longer in our plan. Using the ClearHealthCosts website (found via WHYY’s Pulse) we were able to drop our cost from $1325. at the local hospital off site radiology lab (the lab could not answer whether the rate was the negotiated rate, nor could Aetna), to $120 w/insurance and $150 cash, no insurance at a lab about 30 minutes away. The lab listed on the ClearHealthCosts website confirmed the costs listed were accurate. … We are convinced that this type of transparent system will be the only way to drive down healthcare costs.”

The writer of the note and her husband live in Newtown, Pa. I said I’d be writing a blog post. They asked me not to use their names, for privacy reasons, and I agreed.

The thyroid ultrasound is one she has done regularly, so she was familiar with the costs. But something changed: She’s retired, and her husband lost his job — and with the job went their employer-sponsored insurance. So they bought a high-deductible bronze plan via Aetna on healthcare.gov.

In pricing the ultrasound, their first stop was the Aetna site, which offers a price calculator. But the information was spotty and incomplete. “A lot of the things they have on their site for in-network providers were way out of date,” he said. “It is not accurate at all.”

The local hospital was on the in-network list, and when they asked what the ultrasound would cost, the hospital offered the procedure at $1,325, much higher than what she had been charged before.

Confusion and more confusion

Also, the people who worked there couldn’t say whether she would pay $1,325 or some other sum. “They didn’t know if the price was the negotiated rate, the member rate, or if it’s the full price,” she said. “They just kept saying ‘that’s the price they have to pay’ or ‘we can’t tell you until you get the bill.'”

In frustration, she remembered hearing public radio segments from WHYY in Philadelphia on our PriceCheck partnership. They found our home website, and searched for thyroid ultrasounds. Not finding thyroid ultrasounds (which we don’t price, because they’re not extremely common), they decided to use the abdominal ultrasound as a proxy search.
They called providers from our site, and found one 30 minutes away that did the thyroid ultrasound for $150 cash or $120 with insurance. It was indeed in network — confirmed both by the Aetna website, which listed it as a Tier 1 provider, and by the provider.

Another key: they found out the CPT code, 76536, which was not on the original prescription. (They’re not hard to find — we have them on our website, via the search function. Just type in “ultrasound” and pick from the menu, or “thyroid” — if you don’t find it on our site, Google it.) That makes for a better conversation when you’re asking about prices. Rather than saying “how much is an ultrasound?” you can say “what is your price for a thyroid ultrasound, CPT code 76536?”

She added, “If you’ve got a high deductible and you’re responsible, you’re doing the research.”

Upset by their experience, he said he’s planning to file a complaint with Aetna because the information on the web site is so out of date.

In general, she said, this shows what a little research can do. “I get annoyed when people just accept things the way they are and don’t try to make some small difference,” she said. “It’s all education and getting people to realize that they can have some say in what they pay.”

And, they saved $1,205.

Jeanne Pinder

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...