If you have high-deductible health insurance – possibly paying $2,000 or more out of pocket – the price of every test or procedure matters a lot. In theory, you should shop around.
But, that’s easier said than done, as Seattle real estate broker Steven Wayne discovered: He ran through his $3,800 deductible, pretty quickly, after a recent series of fainting spells.
Now, new online tools can help you compare real costs.
“Off to the hospital you go for CT-scans and MRI’s and all the rest of it. But, unfortunately they're up to $10,000 apiece, for a night at one of our local hospitals,” says Wayne.
His individual policy through Premera’s LifeWise division has been a pretty good deal, from his perspective, because the monthly cost, at $350, is about a quarter of what he used to pay for a traditional plan.
Growing awareness of costs
If he had been able to go online before landing in his hospital bed, and login to Premera’s website, he might have been able to save money. Like most insurers, Premera has a cost-comparison tool, available to members only. A number of for-profit businesses are trying to sell similar services, to corporate clients, which they compare to Expedia for medical care.
That’s increasingly important, as high-deductible policies become more common. Nationally, about 13 percent of employer-sponsored insurance plans fall in this category, according to recent surveys. One rationale for the high deductibles is they’re supposed to turn consumers into watchdogs for health care costs.
At Premera, nearly half their individual and small group members now have a high deductible, says spokesperson Amy Carter. The plans are much more common for individual subscribers, but one in five corporate clients now offers this option to employees.
Comparing the actual costs
The newest of these online tools – and possibly the most useful – was just unveiled by United Healthcare, a national firm with a big presence in Washington, covering 250,000 employees.
“It’s allowing them the knowledge of what that cost will be ahead of time, so they can budget for it and plan for it,” says Jim Schirmer, a local executive with United Healthcare.
What United has done is crack open the actual costs. Nearly all of the existing price comparison websites only give you an average cost per procedure for your region, or for a provider. But United is now providing the actual cost they’ve negotiated with doctors and hospitals. So, the estimate you see on your screen is more meaningful.
One early lesson: The variation in cost can be 4 to 1.
For example, if you had a knee injury that requires imaging, you can choose either CT scan or MRI. The cost of the MRI varies from $549 to $2,272 in the Seattle area – for the exact same service. The comparison also shows whether each provider is meeting industry standards for quality.
Schirmer says it’s even given him some questions for his family doctor:
“My wife and l looked at it the other night and looked at some of her providers and compared them, and it’s eye opening.”
They’re not switching doctors, but they may ask some questions.
Bypassing insurance
Having your insurance company negotiate prices and then list them is definitely a help. If you try it on your own, figuring out medical pricing is often nearly impossible.
There’s also a growing movement of medical practices that bypass insurance, or supplement it, by charging a flat, monthly subscription fee to cover all of your primary care and tests. One of the pioneers, Qliance of Seattle, has been expanding rapidly.
Qliance markets to people who have a high deductible insurance plan. Typically, these plans are coupled with a Health Savings Account, which can cover Qliance’s monthly fee.
