Help: A PriceCheck FAQ

So you have questions about our PriceCheck health costs project? Here are answers! Click on the question to jump to an explanation. Other questions? Email: info@clearhealthcosts.com.

So I was going to share prices.  You said I should use the “explanation of benefits,” but it’s really confusing. Can you help?

What is this project?

Why don’t you have prices for everything in every city?

Are these prices guaranteed?

I want to search for prices. You have some information, but not what I’m looking for. Can you explain?

What data do I supply? My wife had a colonoscopy. There were bills from the gastroenterologist, the facility, the anesthesiologist and the lab. Should I add all of these together as the “total cost” of the procedure? Or just report what the gastroenterologist charged?

The procedure descriptions are confusing. There are a lot of things named “colonoscopy” on this list. Which one am I supposed to pick?

I want to put in something that’s not on the list. Why can’t I?

My provider is not in this database. Or: I am a provider and I am not in this database. What gives?

I tried to enter my information, but it didn’t seem to work.

What I had does not show up in your list.

What prices are you interested in? I have a whole bunch of bills.

What about quality? My provider is better than anybody else.

Why would anyone care about a cash or self-pay price? Now that insurance is extended to many – if not all – under the Affordable Care Act, isn’t everybody paying a slight copay or co-insurance, so the cash price matters not a bit to anyone?

Has anybody ever done this before?

What about my privacy?

So this is crowdsourced information –- why would you believe any of it?

Tell me again about these numbers — 72148, 93015. Gah.

If you don’t have my procedure, how can I search for a price?

My insurance company has a price-shopping tool. Its results are different from yours.

What about prices for medications?

O.K., I’m in. What did you want me to do again?

I have a suggestion/question/comment that you didn’t address here.

So I was going to share prices.  You said I should use the “explanation of benefits,” but it’s really confusing. Can you help?

Here’s page with a video and explainer from two of our partners, WVUE Fox 8 Live and NOLA.com I The Times-Picayune in New Orleans.

Here’s our blog post collecting a number of examples of confusing paperwork and explaining the ins and outs of billing.

Here’s a great deconstruction of the explanation of benefits from our partners at KQED public radio in San Francisco.

Here’s an explanation of a colonoscopy bill from our partner at WHYY public radio in Philadelphia.

Here’s another article on colonoscopy billing, from our partner WVUE Fox 8 Live in New Orleans.

Here’s an article with  explanations of common terms and frequently confusing entries.

Confused by the numbers? Here’s an explainer. 

Here’s a Facebook Live video, of about 30 minutes, with a discussion of the project, from our partners at WLRN in Miami.

What is this project?

Glad you asked!

We’re building this community-created guide to health prices by doing intense reporting, and by asking you, our community members, to contribute your knowledge to our efforts. Here’s an introduction to a previous partnership.

The community partners are you, our readers and listeners.

Our current and former media partners include CBS national news; The Philadelphia Inquirer, The Daily News and philly.com in Philadelphia; 6ABC Action News in Philadelphia; WVUE Fox 8 Live and NOLA.com I The Times-Picayune in New Orleans; WLRN public radio in Miami; WUSF public radio in Tampa-St. Petersburg; KQED public radio in San Francisco; KPCC public radio in Los Angeles; WHYY public radio in Philadelphia; WNYC public radio in New York City; and us — we’re ClearHealthCosts.com, a New York City journalism startup bringing transparency to the health care marketplace by telling people what stuff costs.

We’re not only revealing pricing, we’re also making great journalism out of the data you help us collect – attacking the problem of health care pricing by full-on transparency.

Why don’t you have prices for everything in every city?

That price list does not exist. We believe that opaque pricing contributes to many of the current problems in health care, and we’re trying to change that — as journalists, as concerned consumers, as people interested in attacking this huge national problem.
We’re focused on a limited number of cities right now, with planned expansion. If you’re interested in having us come to your city or state, email partner@clearhealthcosts.com

Are these prices guaranteed?

No. This is a journalistic survey of providers, augmented with some data and some crowdsourced pricing information.

In every case, if you’re seeking price information, you should ask the provider “How much will this cost? How much will this cost me?” Take notes. Take names. Take numbers. Get it in writing if you can.

I want to search for prices. You have some information, but not what I’m looking for. Can you explain?

We have started by collecting the cash or self-pay prices for 30-35 common, “shoppable” procedures. We have around 15 prices in each metro area that we cover for these procedures, and we’re in nine metro areas: New York City, New Orleans, northern New Jersey, San Francisco, Los Angeles, Philadelphia, Miami, Tampa-St. Petersburg and Dallas-Fort Worth.

We do it this way because we cannot pry from the insurance companies 1) their negotiated, or contracted, payment rates for providers; 2) the behavior of your deductible; 3) your co-insurance or co-pay or anything else that would reveal to us what you are actually paying beyond your premium.

So we give cash or self-pay prices, giving you a toehold in the marketplace. Here’s a blog post with more detail about what’s in the database.

Beyond our survey of cash or self-pay rates, your contributions of prices you charged, with what the insurance company paid, if applicable, will help us all understand what’s going on in this marketplace.

What data do I supply? My wife had a colonoscopy. There were bills from the gastroenterologist, the facility, the anesthesiologist and the lab. Should I add all of these together as the “total cost” of the procedure? Or just report what the gastroenterologist charged?

We are most interested in the “all-in” price, just as you probably are.

So if you choose the procedure that most closely matches what she had, and use the total prices charged, paid by insurance and paid by you, then specify a breakdown of other charges in the notes, that would be the best way for us to build a useful data set.

When we collect the  prices in our database, we try in every case to get that “all-in” price, for a cash or self-pay patient, though it’s not always available in advance.

Sometimes the individual charges you experience are also remarkable ($1,500 for anesthesia? $2,000 for a facility fee? come on!) so if the notes capture that, it’s awesome.

If you’re not sure we want it, here’s your answer: yes, we want it. Detail is good!

The procedure descriptions are confusing. There are a lot of things named “colonoscopy” on this list. Which one am I supposed to pick?

Look on your bill and see if you can find a five-digit code like 45378 or an alphanumeric code like G0202. That’s the closest description used in the medical system to standardize procedure identification. For more about the numbers, here’s a blog post.

Not every bill has these same codes on it; some have only verbal descriptions.

If you can get a code, that’s good, but if not, use the closest verbal description in our software – once you start typing, it will give you some suggestions from which to choose.

I want to put in something that’s not on the list. Why can’t I?

We’re working to make a database of good, comparable information for the thousands of major current procedural terminology (CPT) codes used commonly in the medical billing system.

If we had a freeform data field, then that would allow you to put in “hairy toenails” or “I hate my mother-in-law” or anything else you wanted to input. Our database would then be lacking.

So we made a “share” form that has only a few thousand options. Please choose the closest one.

But! If you have something that’s not on the list, choose “Other (please explain in the text box below),” and add details.

My provider is not in this database. Or: I am a provider and I am not in this database. What gives?

The provider list comes from Google, and we are aware that it has some faults in it. But the Google Places API that we are using is free, so we can’t go ask for our money back.

Also in fact, many of the provider lists are out of date in health care – there are a lot of mergers and acquisitions and so on.

If you’re a provider and want to change your listing with Google, here’s the link.

Have something you’d like to send in but find the form won’t take it? Here’s how we’d like to see it.

Generally here are the data points.
• Provider (as specific as possible, with address, city, zip, phone, website)
• Name of procedure
• CPT or HCPCS code
• Cash or self-pay price charged
• (If you’re sending in personal information, not practice information, tell us what insurance paid and what you paid)
• Comments
• Email address

Email to info@clearhealthcosts.com with “Pricecheck data share” in the subject line.

If you have lots of prices to share, you can go to this page and download our spreadsheet template and send it on in.

I tried to enter my information, but it didn’t seem to work.

Sorry — if there is a bug, we’d like to know about it.

On the first point: if you would feel comfortable in sharing via email, here are the data points: If you return this to us, we’ll put it in for you!
• Provider (as specific as possible, with address, city, zip, phone, website)
• Name of procedure
• CPT or HCPCS code
• Cash or self-pay price charged
• (If you’re sending in personal information, not practice information, tell us what insurance paid and what you paid)
• Comments
• Email address

On the second point, here’s how we like to hear reports of malfunctions:

Bug (mandatory) or feature (optional)?
(bug is if it doesn’t work, feature is if I wish it would do something that was not in our design, like search by insurance company or by provider, instead of procedure)
• What it does—be as explicit as possible.
• What you would like it to do–be as explicit as possible.
• Tell us what device, operating system, browser–be explicit (MacBook Air, OS X 10.6.8, Chrome build 40.0.2214.93 64-bit or iPhone 5S, IOS 7, Safari).
• Pictures are great, so if you can attach screenshots, documents and so on, that’s ideal. Arrows are helpful.
• Email to info@clearhealthcosts.com with “PriceCheck bug report” in subject line.

Please email these to us at info@clearhealthcosts.com.

Thank you very much! We appreciate your help!

What I had does not show up in your list.

Please pick the closest thing you can find. There’s also a choice for “Other (please explain in the text box below).”

If you have other questions, email us at info@clearhealthcosts.com.

What prices are you interested in? I have a whole bunch of bills.

We are interested in all prices.

We’ve started the reporting with our survey of prices on 30-35 common “shoppable” procedures, which you can find described in this blog post, but we built the software to let you tell us what you experienced, and what you’re interested in.

You can share anything in the software.

We’ll be expanding our reporting depending on what we learn and what you tell us you’re interested in.

If you have lots of prices to share, you can go to this page and download our spreadsheet template and send it on in.

What about quality? My provider is better than anybody else.

We believe you. But there should be some better way than you telling us they’re great.

Quality measurements for health care providers, hospitals, surgical centers and so on are a hot topic.

Everybody’s got a favorite source (Yelp? healthgrades.com? AHRQ? Leapfrog? Consumer Reports? U.S. News and World Report? HEDIS? HCAHPS? your insurance company’s quality rankings? Your Facebook friends?) but the bottom line seems to be this: There’s a cacophony of competing sources of measurement, none of them definitive or over-arching. So we were interested to see this recent study revealing the outcome of a recent government effort to resolve the problem, as described by Alexandra Robbins in The Atlantic.

The Department of Health and Human Services is wrestling with this, and to hear Robbins tell it, they labored mightily and brought forth a mouse. If you have a favorite quality supplier, please tell us — and tell us why they are better than others.
From where we sit, there’s not much that is really actionable by individuals, or accepted and embraced by the clinician world.

In our view, bringing price out of the shadows speeds a thoughtful quality discussion: What makes that $6,000 MRI so much better than the $300 one?

There are many resources for measuring quality in health care, and many of them come to very different conclusions. Here are some resources.

State medical boards State boards govern medical licensing and malpractice. Here’s a list of state medical boards and their websites via the Federation of State Medical Boards. Also, the Administrators in Medicine (AIM) website, from a non-profit organization for state board executives, collects licensing and disciplinary information from each state’s medical board in its DocFinder physician directory. You may still need to search the individual state’s site, which is on the same page, if the state does not contribute to the DocFinder.

Hospitalinspections.org, a website run by the Association of Health Care Journalists, collects federal hospital inspection reports.

The federal government lists a number of quality tools on this section of healthcare.gov.

The Center for Medicare and Medicaid Services also released a ranking of hospitals on a five-star system called Hospital Compare. You can find it here; here’s a news article about the reaction to the rankings.

The investigative news organization ProPublica built a “Surgeon Scorecard” ranking doctors on several surgical procedures. You can find it here; here’s an article by ProPublica defending its methods by responding to critics.

A state-by-state and category-by-category list has been compiled by consumerhealthratings.com. Another resource: The Informed Patient Institute.

For seeking out quality doctors, here’s a great handbook by Dr. Jay Parkinson, a co-founder of Sherpaa.com.

Why would anyone care about a cash or self-pay price? Now that insurance is extended to many – if not all – under the Affordable Care Act, isn’t everybody paying a slight copay or co-insurance, so the cash price matters not a bit to anyone?

First, not everyone is insured. And not all providers are in network.

Also, with rising deductibles and rising coinsurance, much more of the price is being paid by insured people.

Also, if you’re responsible for co-insurance of, say, 20 percent on a procedure, you might want to know if you’re paying 20 percent of $300 or 20 percent of $6,000. (Depending on the insurance plan’s language, you might be paying a percentage of the sticker price rather than of the negotiated price.)

We’ve heard of people on a high-deductible plan who routinely ask to pay the cash rate instead of the negotiated rate. Here’s one example: One person who responded to our California PriceCheck survey wrote: “I was told procedure would be 1850. I have a 7500 deductaible[sic]. So I talked to the office mgr who said if I paid upfront and agreed not to report the procedure to Blue Cross, that it would be $580.”

Of course, if you haven’t met your deductible, you may be paying full freight, even perhaps the chargemaster price. That’s right: insured people are paying the chargemaster price. Some of them might prefer to pay a lower, cash or self-pay rate. Here’s a blog post about that, with links to some other posts.

We heard of one insurance company whose online pricing tool explains the coinsurance for simple procedures: an MRI, for example, in our New York City backyard could cost $42.50 for the 10 percent coinsurance, or $253 for the same 10 percent coinsurance of a pricier procedure. In other words, since under this particular plan the coinsurance is 10 percent, that also reveals the reimbursement rate by the insurance company. Here’s a blog post about that.

There are a number of reasons that people might be interested in the cash or self-pay price, including the question of whether their insurance premiums are giving them access to the highest rate, rather than the lowest, until they have met their deductible. Put another way: Does your insurance premium cause you to pay a higher price than a cash customer? Why?

Also, in our crowdsourced database, we invite you and others to tell us what your insurance company is paying, and what you paid out of pocket.

In our California PriceCheck survey, that same MRI that the person above paid $580 for cost $2,885 for another person: The charge of $2,885 resulted in an insurance company payment of $944.97, and the individual had to pay $1,940.03 because the deductible hadn’t been met.

Has anybody ever done this before?

In reporting on this issue, we journalists from ClearHealthCosts.com have already partnered with public radio stations in Miami, Tampa-St. Petersburg, San Francisco, Los Angeles, Philadelphia and New York City to build community-created databases of prices, and to do in-depth reporting on this issue. We’ve also partnered with CBS national news; The Philadelphia Inquirer, The Daily News and philly.com in Philadelphia; 6ABC Action News in Philadelphia; WVUE Fox 8 Live and NOLA.com I The Times-Picayune in New Orleans. Here’s a roundup of our partnerships, with links.

We have collected cash or self-pay prices at ClearHealthCosts.com via a direct provider survey for several years. On the front page of our website, you can see the search box where you can seek prices.

That search tool also gives you the Medicare reimbursement rate for any one of the thousands of procedures in the government’s Medicare reimbursement data set, in any U.S. locale.

Here’s a Harvard Business Review piece about our work with our media partners. We’ve been featured in The Wall Street Journal and The New York Times and on NPR and in USA Today. Our partner Lisa Aliferis from KQED wrote about our work in JAMA Internal Medicine, and it was accompanied by a positive editor’s note from Rita Redberg, the JAMA editor, among other great earned media. (Look at our press page for some citations.)

We also have been asked to testify to the California State Senate Health Committee on transparency and we were cited in a Stanford Health-Anthem Blue Cross contract dispute.

We were also asked to supply information to Covered California and the Center for Medicare and Medicaid Services.

We have won numerous journalism awards. We were a finalist for a Peabody and we won an Edward R. Murrow national award and a Sigma Delta Chi public service gold medal, as well as numerous local and regional prizes.

Our partners in California won an SPJ award for innovation in journalism. They also presented at the NICAR-IRE and Association of Health Care Journalists conferences.

We have also been featured speakers at events including Investigative Reporters and Editors, the Midwest Public Risk conference, Politico Pro, the Department of Health and Human Services Datapalooza in Washington, the New York Ehealth Cooperative Patient Shark Tank (we won!) and Grantmakers in Health (for our demonstrated impact) and at other events and locations.

What about my privacy?

The health care information you provide to us in this form will be used only anonymously, and will never be paired publicly with your email address or phone number. ClearHealthCosts.com and our PriceCheck partners will preserve your privacy as part of our bond with you, our communities.

The pricing, procedure and location information you provide to us will be shared publicly in the “Find Prices” table on this site and on our PriceCheck partners’ sites to help you and others compare costs. Your comments may also be posted wherever the table is posted.

Except for your email address and phone number and other personal information, the information we collect, including your comments, may also serve as the basis for articles and reports about health costs.We have also provided an opportunity for you to email our reporters (info@clearhealthcosts.com) if you wish to provide information.

Our PriceCheck project partners may use your email address to contact you directly to request more information about the data you have submitted; they will not share your email address with any other third parties.

So this is crowdsourced information –- why would you believe any of it?

A lot of what’s here is reported information, collected by our journalists. (It’s flagged in orange.) A lot of it is crowdsourced (flagged in blue). The prices in green come from health care providers.

You can compare the data yourself and draw your own conclusions.

We trust our communities and believe in you. We believe your information, added to the reported information we already have, gives you actionable information about costs of items and procedures.

Tell me again about these numbers — 72148, 93015. Gah.

Yes, it’s confusing. The medical billing system uses numbers, which are sort of consistent and sort of not consistent. For more about the numbers, here’s a blog post.

Not every bill has these same codes on it; some have only verbal descriptions.

To make it more confusing, sometimes providers use their own codes — for example, lab test providers often have their own coding systems.

If you can get a code, that’s good, but if not, use the closest verbal description in our software – once you start typing, it will give you some suggestions from which to choose.

If you don’t have my procedure, how can I search for a price?

Here’s one example: a woman was looking for a thyroid ultrasound and found we have only detailed information on pelvic and abdominal ultrasounds. She called several providers and got a price for the ultrasound she needed; here’s a blog post about that.

Here’s another example: a woman was looking for an MRI: her doc recommended two providers, neither in our listings. She called the providers, and using the pricing range from our listings, got an MRI for $450 cash; here’s a blog post about that.

My insurance company has a price-shopping tool. Its results are different from yours.

A lot of the so-called “price-shopping” tools from insurers are weak and inaccurate. Read here and here and here. If people had good price-shopping tools, their behavior might well be very different — imagine realizing that you can get that MRI for $300 instead of $6,000!

As we mentioned above, the insurance companies don’t share their information with us. So we give cash prices — and then ask you, our community members, to help bolster our data with your information about insurance company payments, and your payments, for various procedures.

Yes, the data’s incomplete. That’s the definition of the problem: no full database exists of charged price, insurance payment, cash price, your payment or anything else that gives you knowledge and agency in the marketplace. That’s what we’re working to create.

So share prices! Thanks!

What about prices for medications?

Check our our handy “how to buy prescriptions” guide here.

O.K., I’m in. What did you want me to do again?

To contribute to or search our PriceCheck database, click here to go to the page displaying the form for entering and searching the data.

If you have lots of prices to contribute, you can download our handy spreadsheet on this page.

I have a suggestion/question/comment that you didn’t address here.

Please put it in the interactive form, or email to info@clearhealthcosts.com. Thanks!