Looking for (and finding) Pricing Transparency in Medicine


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As a Samaritan Member I am motivated to find my medical services at a fair price, because ultimately I am responsible for the bills, and while Samaritan members will share in that cost I certainly don’t want them to overpay. I have mentioned in other posts about asking for self pay/cash pay discounts, but how do we find out what a procedure is going to cost in advance? Obviously this doesn’t work in an emergency situation, but for scheduled procedures we should be able to find out pricing, in fact we should really WANT to know what it costs. I’m still baffled that health care is about the only service I can think of which is purchased without any idea of the costs. I can’t think of any other product or service that is purchased or contracted for without first asking, “and what is the cost?” or “Can I have a quote?” — in medicine we are often hit with partial answers, half truths, and “we don’t know what it will cost until we’re done.”

It is beginning to get a little easier to find out in advance what something should cost and will cost.

One method is using the healthcare blue book, which I’ve touched on in an earlier post. That website will show you the zip code specific pricing that hospitals are accepting for payment from insurance companies. Really there’s no reason the cash pay patient should pay over those prices, but I’m sure it happens all the time. we should reference the healthcare bluebook when quotes are high, but I can see how the billing person could try to excuse away the information. Another reference should be other hospitals. But how do we know what other hospitals charge for something?

While it’s not always possible to get pricing for a specific hospital, there are some out there posting their prices online. My favorite is the surgery center of Oklahoma, and now I’m learning that several other facilities in Oklahoma City have followed suit due to that competitive pressure.

Some of them are:

Also, you can do a search on google for “hospital pricing estimator” or some variation of that, and come up with a bunch of hospitals that have started posting their prices online. You may have to do a little digging on each website to find it, but I picked out a few and found a wide range of prices for identical procedures. The most accurate way to find out pricing is to be sure you’re search by the CPT codes. These are the billing codes used by medical facilities in order to track billing and bill insurance companies. Every procedure has a code. Some require multiple codes because of the way procedures are broken down into various steps. If you are needing a procedure soon, be sure to ask your doctor what the CPT code is so you can correctly hunt for pricing info. Also ask if multiple codes are common for the procedure you’re needing so nothing is left out. This works for tests, screenings, surgeries, anything you can think of.

Once you’ve looked up the published prices for hospitals in your area, (or called them), then you can start asking the tough questions to the hospital. “You are stating that your price for a gallbladder removal, CPT code 47562 or 47563, is $15,476. But I see that the surgery center of Oklahoma offers the exact same procedure for $5865. Would you be willing to match their price?” — If you factor in the price of  plane ticket ($400) and a couple night hotel room ($300), you would be fairly even if you negotiated your cost down to about $6500. If you are willing to travel and your local hospital isn’t willing to budge, then take a trip and save a fortune.

I believe it is our responsibility as patients to make these providers explain their prices. A huge problem in the medical world is they make more by being wasteful with time and supplies. They are motivated to take longer and use more products in order to bill you more. They are not motivated to reduce waste or be efficient (not all of them do this, but it’s definitely a problem at some locations). Of course we still demand high quality, but better quality doesn’t have to mean being wasteful. Insurance companies do not help the problem. They are not motivated to reduce costs, as they like being able to convince customers of how much money they saved. But if the procedure cost $10,000 (inflated), and your after insurance cost is $3000, but really the hospital would have made a healthy profit charging only $2500, you actually came out worse by having insurance “negotiate” a rate for you.

As a member of SMI, I am considered self pay which means I can freely negotiate my pricing without worrying about insurance contracts. I can actually get BETTER deals than insurance company rates. Especially if I’m willing to pay quickly. I wouldn’t pay sticker price for a car, I never do. We are expected to haggle over a car’s price, and the better educated we are about what the car should cost, the more likely we are to get the price we want. Health care shouldn’t be any different, and slowly but surely we will change the model. It starts with us. We must be educated, informed and we will not back down. If we are being overcharged for something we can take our business elsewhere. At first I thought finding out this information would be really hard (sometimes it’s tricky), but by knowing a few key things (healthcarebluebook.com and CPT codes) you can make quick work of getting pretty close to what any given procedure should cost. From there we politely negotiate what we need. Even if you can’t find a nearby hospital with their prices online, you can find a good representation of what other facilities are charging and can use that when you call.

For instance, if I am seeing that mammograms typically cost $200 for a self pay patient, and I am quoted $450, I would say, “wow, that’s really high. I’ve been researching and the typical price is about $200, are you quoting me the chargemaster rate or the self pay rate?” — We should be polite, but we should definitely inquire about pricing and let them know we are aware that we’re being overcharged.  The good news is that I have freedom of choice because Samaritan doesn’t restrict me to any networks, I can see any doctor I want. While a routine mammogram isn’t shared anyway, it would be if I was having symptoms and I love having the freedom to choose where I spend my dollars.


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