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Health Insurance Cost Information
It’s long been hard for health-care consumers to learn how much doctor visits or hospital stays will cost them. That’s now beginning to change, as a growing array of Web sites try to lift the veil on pricing.
The online resources come from insurers, government agencies, Internet companies and medical-care providers. The sites aren’t perfect: Unlike online retailers that sell products such as televisions, the health sites can’t typically give exact prices for medical procedures and services. Still, consumers can get a rough idea of typical costs in their area, and that can help them choose doctors and hospitals, budget for medical costs and sort out disputed bills.
The mystery surrounding health-care pricing stems partly from the fact that hospitals and other providers generally don’t publicize how much they’re paid for services, which varies depending on who’s footing the bill. Insurers, which often contract to receive lower prices for their customers, also have traditionally not revealed these negotiated amounts.
But soaring health-care costs have made consumers more conscious of price. Even consumers with health insurance increasingly find that they have a stake in the cost of their care because they’re paying a far bigger share out of their own pockets. For instance, more than half of workers pay a percentage of the price of outpatient surgery and hospital admissions, rather than just flat copayments.
Consumers also can’t rely on their health plan’s contracts to always deliver the lowest price, because the same insurer might pay widely varying amounts to different care providers. In Maine, one insurer’s preferred-provider organization has paid between $559 and $4,526 for a colonoscopy in a given year, including the portion due from patients, according to data compiled by the state.
To find useful information, you’ll generally have to do some digging and check multiple sites. Each takes a different approach, and they can be confusing. Several sites, including some offered by hospital associations, use listed charges—the “sticker prices” that are typically much more than insurers pay. Other sites focus on the rates paid by private insurance plans or Medicare. It’s also often unclear whether a Web site’s estimate represents the full cost of a procedure, including, for instance, anesthesiology fees.
Consumers also should pay attention to the quality of care, by seeking personal references or checking Web sites such as Medicare’s HospitalCompare.hhs.gov and LeapfrogGroup.org.
If you’re insured, a good place to start your research is your health plan. The big national insurers, including WellPoint, UnitedHealth Group Inc., Humana Inc., Aetna Inc. and Cigna Corp., offer pricing tools to their customers, which the companies are continuing to enhance. Still, insurance company data don’t include all health-care providers or procedures, and they typically only give price ranges. Also, of course, you won’t be able to directly access the information if you aren’t a client.
A few states, including New Hampshire, Maine, Oregon and Massachusetts, have started providing pricing information based on databases of insurance claims, which give a detailed picture of costs. Other states, including Utah, Vermont and Tennessee, are building similar databases. And some nonprofits, such as MN Community Measurement in Minnesota, are also offering state-focused pricing information based on insurer data.
Several Internet companies now operate sites that let consumers around the U.S. search for pricing in their area. HealthcareBlueBook.com offers a suggested “fair price” for a service, based on a database of rates paid by private insurers, according to parent company CareOperative LLC.
Changehealthcare.com, a unit of change:healthcare Inc., provides estimates of how much individual providers are paid by insurers, based on claims data from health plans. And NewChoiceHealth.com gives providers’ list prices, which are derived from Medicare data, according to New Choice Health Inc. Another site, OutOfPocket.com, has a search service to help users find online pricing information listed on various sites.
You can also check for prices posted by specific hospitals and doctors. These are still relatively rare, and may represent list charges. But a few hospitals are also revealing roughly what they’re paid by insurers or offering calculators so insured patients can figure their out-of-pocket fees. A site called PriceDoc.com seeks to aggregate listings from doctors.
Medicare data can also be a useful resource, though hard to find in a consumer-friendly format. A few savvy consumers use an American Medical Association Web site to look up what the federal program pays doctors for that type of care, then use that as a starting point in seeking a good price.
Once you’ve done your online financial due diligence, you should discuss prices with medical practices or hospitals before going in for any treatment. If you’re not insured, or going out of your health plan’s network, and want to negotiate, you can start by aiming for the Medicare rate or something close to what commercial insurers pay, though you may not be able to get to that price point. You may get a better deal if you are willing to pay cash up front.
If you have coverage, you should also talk to your insurer about what you will pay out of pocket for any care. Keep in mind that even a relatively simple procedure can cost more if there are complications.
Researching health-care pricing online can also help after you’ve already had a medical procedure, if you want to dispute a bill, negotiate it down, or figure out if you’ve been overcharged.
"The quality of the coverage is transparent, so you know what is covered and that you can count on it, without having to worry that your coverage will end when you need it the most," said Joanne Peters, a spokeswoman for the Department of Health and Human Services.
Consumers in states that aren't creating their own health exchanges will use an exchange run by the federal government. Americans who already get health coverage on the job or through Medicare or Medicaid are likely to be affected more by other elements of the 2010 Affordable Care Act, such as those encouraging doctors and hospitals to cut back on inefficient care.On the exchanges, not everybody will have to pay the prices in full, because the law offers some income-based subsidies toward the cost of premiums.
A 40-year-old with income near the poverty level—currently $11,490 a year for a single person—would likely qualify for a subsidy of as much as $234 a month toward the cost of premiums in Virginia, potentially covering the entire cost of a bronze plan.
Any subsidy in Virginia would vanish once an individual reached annual income of about $33,150.
Tom Perriello, who voted for the law as a Democratic House member from Virginia and who now works for the left-leaning Center for American Progress, called the costs of premiums "a work in progress" and added, "Over the next few years, we should see that cost curve bend."
Prices may change slightly in some states before the fall, and the picture for 2015 and beyond is fuzzy.
Some carriers have been more cautious in judging the risks of the new market, and several large insurers are mostly sitting out the exchanges for the first year to see how they work.
Health Insurance Cost Information
It’s long been hard for health-care consumers to learn how much doctor visits or hospital stays will cost them. That’s now beginning to change, as a growing array of Web sites try to lift the veil on pricing.
The online resources come from insurers, government agencies, Internet companies and medical-care providers. The sites aren’t perfect: Unlike online retailers that sell products such as televisions, the health sites can’t typically give exact prices for medical procedures and services. Still, consumers can get a rough idea of typical costs in their area, and that can help them choose doctors and hospitals, budget for medical costs and sort out disputed bills.
The mystery surrounding health-care pricing stems partly from the fact that hospitals and other providers generally don’t publicize how much they’re paid for services, which varies depending on who’s footing the bill. Insurers, which often contract to receive lower prices for their customers, also have traditionally not revealed these negotiated amounts.
But soaring health-care costs have made consumers more conscious of price. Even consumers with health insurance increasingly find that they have a stake in the cost of their care because they’re paying a far bigger share out of their own pockets. For instance, more than half of workers pay a percentage of the price of outpatient surgery and hospital admissions, rather than just flat copayments.
Consumers also can’t rely on their health plan’s contracts to always deliver the lowest price, because the same insurer might pay widely varying amounts to different care providers. In Maine, one insurer’s preferred-provider organization has paid between $559 and $4,526 for a colonoscopy in a given year, including the portion due from patients, according to data compiled by the state.
To find useful information, you’ll generally have to do some digging and check multiple sites. Each takes a different approach, and they can be confusing. Several sites, including some offered by hospital associations, use listed charges—the “sticker prices” that are typically much more than insurers pay. Other sites focus on the rates paid by private insurance plans or Medicare. It’s also often unclear whether a Web site’s estimate represents the full cost of a procedure, including, for instance, anesthesiology fees.
Consumers also should pay attention to the quality of care, by seeking personal references or checking Web sites such as Medicare’s HospitalCompare.hhs.gov and LeapfrogGroup.org.
If you’re insured, a good place to start your research is your health plan. The big national insurers, including WellPoint, UnitedHealth Group Inc., Humana Inc., Aetna Inc. and Cigna Corp., offer pricing tools to their customers, which the companies are continuing to enhance. Still, insurance company data don’t include all health-care providers or procedures, and they typically only give price ranges. Also, of course, you won’t be able to directly access the information if you aren’t a client.
A few states, including New Hampshire, Maine, Oregon and Massachusetts, have started providing pricing information based on databases of insurance claims, which give a detailed picture of costs. Other states, including Utah, Vermont and Tennessee, are building similar databases. And some nonprofits, such as MN Community Measurement in Minnesota, are also offering state-focused pricing information based on insurer data.
Several Internet companies now operate sites that let consumers around the U.S. search for pricing in their area. HealthcareBlueBook.com offers a suggested “fair price” for a service, based on a database of rates paid by private insurers, according to parent company CareOperative LLC.
Changehealthcare.com, a unit of change:healthcare Inc., provides estimates of how much individual providers are paid by insurers, based on claims data from health plans. And NewChoiceHealth.com gives providers’ list prices, which are derived from Medicare data, according to New Choice Health Inc. Another site, OutOfPocket.com, has a search service to help users find online pricing information listed on various sites.
You can also check for prices posted by specific hospitals and doctors. These are still relatively rare, and may represent list charges. But a few hospitals are also revealing roughly what they’re paid by insurers or offering calculators so insured patients can figure their out-of-pocket fees. A site called PriceDoc.com seeks to aggregate listings from doctors.
Medicare data can also be a useful resource, though hard to find in a consumer-friendly format. A few savvy consumers use an American Medical Association Web site to look up what the federal program pays doctors for that type of care, then use that as a starting point in seeking a good price.
Once you’ve done your online financial due diligence, you should discuss prices with medical practices or hospitals before going in for any treatment. If you’re not insured, or going out of your health plan’s network, and want to negotiate, you can start by aiming for the Medicare rate or something close to what commercial insurers pay, though you may not be able to get to that price point. You may get a better deal if you are willing to pay cash up front.
If you have coverage, you should also talk to your insurer about what you will pay out of pocket for any care. Keep in mind that even a relatively simple procedure can cost more if there are complications.
Researching health-care pricing online can also help after you’ve already had a medical procedure, if you want to dispute a bill, negotiate it down, or figure out if you’ve been overcharged.
"The quality of the coverage is transparent, so you know what is covered and that you can count on it, without having to worry that your coverage will end when you need it the most," said Joanne Peters, a spokeswoman for the Department of Health and Human Services.
Consumers in states that aren't creating their own health exchanges will use an exchange run by the federal government. Americans who already get health coverage on the job or through Medicare or Medicaid are likely to be affected more by other elements of the 2010 Affordable Care Act, such as those encouraging doctors and hospitals to cut back on inefficient care.On the exchanges, not everybody will have to pay the prices in full, because the law offers some income-based subsidies toward the cost of premiums.
A 40-year-old with income near the poverty level—currently $11,490 a year for a single person—would likely qualify for a subsidy of as much as $234 a month toward the cost of premiums in Virginia, potentially covering the entire cost of a bronze plan.
Any subsidy in Virginia would vanish once an individual reached annual income of about $33,150.
Tom Perriello, who voted for the law as a Democratic House member from Virginia and who now works for the left-leaning Center for American Progress, called the costs of premiums "a work in progress" and added, "Over the next few years, we should see that cost curve bend."
Prices may change slightly in some states before the fall, and the picture for 2015 and beyond is fuzzy.
Some carriers have been more cautious in judging the risks of the new market, and several large insurers are mostly sitting out the exchanges for the first year to see how they work.
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