What Really Drives Up Health Insurance Premiums

July 19, 2013 in Health Insurance

Every year it seems that we are paying more and more for health insurance. According to an informative infographic Carrington College, the health care costs in the United States have grown 2.4 percent faster than the GDP, meaning that as of 2010, people were paying more than 8,000 dollars per person, and that money represented about 18 percent of the United States’ economy.

There are several factors, which have contributed to the rising price of health insurance. For example, one benefit which has had unexpected costs is the medical technology that is now being used. The technology that is used to diagnose and treat illnesses accounts for at least 50 percent of the growth of medical expenditures since the 1960s, putting an increased burden on the people paying for their health insurance.

Another factor that affects the health insurance rate for most people is the failure to use a primary care physician. With more people only going to see doctors for emergencies, there is actually less money being spent on primary care doctors, a practice which has been shown to lower costs. In comparison with other industrialized countries, the United States spends three to six times as much money on specialist doctors.

There are many factors that tie into the rise of health insurance costs, including things like medical billing fraud and an aging population, so check out this informative infographic to learn more about what really drives up those premiums.

Why is Health Insurance So Expensive


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by HCSavvy

If you’re shopping for the best place to get a new hip or knee…

July 17, 2013 in health care costs, health care quality, Hospital Bills, Medical Care

take a look at this article.

You can pay $23,000 for the highest quality hip, knee or ankle or, if you prefer, spend $64,000 for the lowest quality procedure in Boston, according to an analysis from Castlight. In Washington, D.C., the cheapest top quality operation is $30,000 as compared to $69,000 for the most expensive low quality job.Picture 2

Picture 3

Many of us routinely opt for the most expensive option, assuming more expensive equals better.  There’s a growing body of research that proves us wrong, but changing that association (the Nieman Marcus effect) is really hard, especially since we don’t usually have to pay the difference.

In NYC and LA higher quality joint replacements do cost more than the lower quality procedures.  What gives?  Are patients there smarter shoppers?

Picture 4

Another example of the insanity of “pricing” in the US health care “system”

July 16, 2013 in health care costs, Health Insurance, Insurance Bills

A family member had some lab work done by Quest Diagnostics, which is under contract with Harvard Pilgrim Health Care, our health insurer.  Because we have a high deductible plan, we were expecting a bill.  No problem.  The bill comes and it lists each test’s CPT Code along with a description – although admittedly I have no idea what these tests are – as well as the “charge” the “insurance discount” and a column that indicates “patient owes,” among others.

Here’s what was listed on the laboratory invoice:

Date CPT Code Test Description


Insurance Discount

Insurance Paid

Medicare/ Medicaid Paid

Patient Paid

Patient Owes

05/29/13 86036 ANA SCREEN, IFA


05/29/13 82784 GAMMAGLOBULIN




05/29/13 83516 GLIADIN (DEAMIDATED)


05/29/13 86039 ANA TITIER











I called Quest to get an explanation about the invoice.  In particular, I didn’t understand what they meant by “Insurance Discount” vis-à-vis the “Charge.”  After some back and forth, it was explained that the insurance discount is the difference between what Quest charges someone without insurance – i.e., their “list” price – and the amount that Harvard Pilgrim pays them for the test.  In my instance, it’s the difference between what I would pay if I didn’t have insurance and the amount that I owed because we’re covered through Harvard Pilgrim.

Their so-called charge for these services – the amount that they would charge me if I were to walk in off the street and get some routine blood work done – is more than SEVEN times the amount that they charge my insurance company.  Read the rest of this entry →

June 24, 2013 in Member Stories


I asked a couple of questions concerning healthcare costs and electronic health records and the fact that EHR’s are not lending themselves to effectively coordinate care among hospitals.

Click on the Thumbnail to view the questions – or view

The Full Clip


Stress and Your Health

June 24, 2013 in Member Stories

Stress and Your Health
Source: Best Psychology Degrees

Where’s the best? Prices in health care mean nothing unless you answer that question first

June 4, 2013 in health care costs, health care quality, Member Stories

The New York Times makes a strong argument for paying more attention to the price of a colonoscopy: “Colonoscopies Explain Why the US Leads the World in Health Expenditure.

But most Americans will be very uncomfortable choosing the cheapest test unless there’s proof the quality is just as good as the more expensive options.



But here’s where health care information breaks down. If you think it’s hard to find the price of colonoscopy – finding out who provides the safest, most reliable test, is close to impossible.

I, with the help of some brave docs in Boston, put together a sample chart.

There’s a much better example of how to shop for a quality colonoscopy here, from the folks at Quality Quest for Health.

Until someone can tell me where I can get the best colonoscopy, I’m going to resist shopping based on price.

Exercises to ease back pain

May 15, 2013 in fitness, health care costs, lifestyle, Member Stories

I’ve always been a money-saver  When I was younger, my mom looked in wonder as I handed her my birthday money and asked her to put it in the bank for me. I might not have had a Razor scooter like all of the other kids, but hey, I was able to pay off a third of my college loans before I even graduated. This frugal attitude has lead me to believe that I can save money in any situation, even when it comes to my health.

Photo Credit (www.mybackpain.info)

I still go to the doctor when I have to (broken bone, the flu, etc.), but if I ever see a chance to avoid a trip to the doctor, I’ll take it. A couple of years ago I hurt my upper back when I was playing in a rugby match (poor choice of sport), and now I have a tight muscle that flares up every now and then. When the injury initially occurred, an athletic trainer told me that I could get an MRI, but that it wouldn’t do much for me. In a nutshell, the MRI could possibly reveal what was wrong with my back, but even if it did, the doctor would probably recommend the same thing that I could have come up with on my own: exercise.

According to an article on Health.com, Read the rest of this entry →

Crazy, irrational hospital billing (with no connection to quality)

May 8, 2013 in health care costs, health care quality, Hospital Bills

Try explaining this…

One hospital in my state, Massachusetts, bills Medicare $75,197 to take care of a patient with heart failure, another charges $13,960.

There’s a huge gap in the charge for patients with breathing problems who are put on a ventilator: $23,044 to $120,888.

Thanks to The Washington Post for this article with a great graphic that shows how much prices vary in each state, using data released today, by the Centers for Medicare and Medicaid Services.

Why are there huge differences in what hospitals charge?

Don’t expect a satisfying answer. Read the rest of this entry →

Do Not Covet Thy Neighbor’s Medicine

May 8, 2013 in lifestyle, Member Stories

Back in the day, sugar sprinkled with a spoonful of gossip was the typical commodity to share over the fence between neighbors and friends.  Perhaps if cooking or scandal was not your forte, then an innocent request for a snow blower may be on par.  Yet today, what is freely passing over neighborly coffees and talk of petunias is prescription medications whereby turning innocent backyards into outdoor pill dispensaries.

It is common to hear that we have become desensitized.  Typically desensitization refers to such offensive stuff such as violent carjacking video games, bad manners and daily mentions of ill at large.  Yet, we have also become immune to the dangers that lurk deep in the bowels of our own medicine cabinet and the quick impulse to dole out said medicine.  Perhaps in a neighborly gesture gone array, friends teeming with good intentions, offer their prescription meds to others in need of a pill.

Sharing we are taught is a good thing.  From days long before we can even remember, our mothers were reminding us and scolding us to share, share, share.  Share your favorite toy, share that half eaten cracker, share the remote with your brother.  Thus, it may only be succumbing to a natural instinct that to see a friend in need illicits a helpful response.  Urinary tract infection? Oh here are some unused antibiotics.  Stress at work or a big presentation coming up?  Here is some Adderall or Ritalin.  Wisdom teeth bothering you?  Here’s some Oxycontin.  Bad breakup?  Here’s a Valium. That’s what friends are for after all.

According to a Center for Disease Control and Prevention study, women 18 to 44 lead the trend.  Over 36% polled in this group, admitted that they have either lent or borrowed a prescription drug from a friend or family member. Read the rest of this entry →

Value of yoga

May 6, 2013 in fitness, lifestyle, Member Stories, News

I’ve never been one for yoga. My roommate has been trying to get me to go to a class with her for months, but I always tell her that I’m more of a cardio kickboxing type of girl. What can I say? I’d rather de-stress by punching and kicking the air than pose like a tree. However, I might now consider going to yoga after a recent study was released that claims yoga does much more than relax the body and mind; it can actually change the expression of genes.

Photo Credit (www.nytimes.com)

According to a new study from the Benson-Henry Institute for Mind/Body Medicine at Massachusetts General Hospital (MGH)  and Beth Israel Deaconess Medical Center, “elicitation of the relaxation response – a physiologic state of deep rest induced by practices such as meditation, yoga, deep breathing and prayer – produces immediate changes in the expression of genes involved in immune function, energy metabolism and insulin secretion.”

The study consisted of blood samples from 26 healthy adults who had never participated in relaxation response practices. The samples were taken before and after they completed an Read the rest of this entry →

Don’t let the doctors dissuade you

May 1, 2013 in health care quality, Medical Care, Member Stories

The Boston Globe recently reported that “Dr. Richard Aghababian, president of the Massachusetts Medical Society, believes rating websites present a skewed picture of doctors because patients are more likely to post about negative experiences.” This sentiment resonates with the results of a recently published survey conducted by the American College of Physician Executives, which was announced with the headline “Survey Finds Physicians Very Wary of Doctor Ratings.”

Dr. Aghababian’s belief is conventional wisdom — after all, who else besides disgruntled patients would bother to post a review? However, there have been a number of studies that disprove this notion. One study showed a median rating of 4.5 out of 5, while another study found that 88% of the reviews it looked at were positive. Curious about the subject, we at DocSpot (a free consumer website that helps people find doctors and allows patients to leave reviews) conducted our own study of nearly a quarter million online patient reviews and found that the majority of online reviews gave doctors the top score possible (5 out of 5). Is that the skewed picture that Dr. Aghababian was referring to?

To be fair, we don’t believe that online patient ratings give a comprehensive and accurate picture of doctors. We think that patient reviews are better indicators for certain aspects of care than others. “Is a doctor rude?” and “Does a patient feel rushed?” are questions that online reviews can lend insight into. Online reviews are also likely to alert prospective patients to other aspects of the experience, such as any unexpected billing practices. When people want to know “will I be healed?”, that’s a much trickier question. Read the rest of this entry →

Claim Modifiers: More Code-Speak on Your Medical Bills

April 26, 2013 in health care costs, Health Insurance, Hospital Bills, Insurance Bills

If you have ever been hospitalized or had a major test/procedure performed, you may have received a frustratingly hard to decipher medical bill from your provider. And, if you are insured, you will also have received a similarly cryptic Explanation of Benefits (EOB) describing your insurance company’s payment decision. (The EOBs can sometimes be a bit clearer and more detailed than the average provider bill.) To the average lay person, medical bill jargon does not sync with customer psychology in the way that other bills, like retail, residential services, etc. do. Most other industries present their bills in a careful way, focusing on clear billing, to make sure that customers know why they have financial responsibility.

CPT and Claim Modifier Codes

With that in mind, let’s look more closely at some of the usual suspects that show up on an unreadable medical bill. One type of common code is called a Current Procedural Terminology or CPT code. This code, in plain English, represents a service that a doctor (or other medical professional) provides.

CPTs often do not “read” well. Patients not involved in the medical industry themselves may have no idea what one of these codes represents on a bill. Looking at the charge associated with it can be frustrating when there’s no common-vocabulary explanation to make the patient remember just what was done in the provider office. This means that patients who are proactively concerned about their care, and costs, will often call providers or insurers just to ask “what does this CPT code mean?”

About Claim Modifiers

Claim modifiers are additional digits attached to a CPT to explain to an insurer or other party how a procedure may have differed from “the norm.” Some modifiers are also used to differentiate a core service from an advanced service level based on the doctor’s documentation. Read the rest of this entry →

The cost of prosthetics

April 23, 2013 in Medical Care, News

For the 14 people who lost at least one lower-limb during the bombings on Marathon Monday, learning how to incorporate a prosthesis, or a prosthetic leg, is in their near future.

The “C-Leg” prosthetic. Photo credit (www.life2heal.files.wordpress.com)

Simona Manasian, a rehabilitation doctor at Boston Medical Center, said that patients with amputations can be fitted with a temporary prosthesis two to three months after the injury took place. However, according to Paul Martino, the president of United Prosthetics in Dorchester and Braintree, the patients will not be fitted with a permanent prosthesis until a year later, when the residual limb has stopped changing in size.

Over the decades, there has been a rapid advancement of lower-leg prosthetics, such as a battery-powered bionic ankle designed by iWalk that simulates a more natural way of walking than other prosthetics, the “C-Leg,” which uses a microprocessor and a lithium ion battery in order mimic the movements of the knee, and the “Flex-Foot Cheetah,” which stores kinetic energy and was made popular by Olympian Oscar Pistorius.

A combination of various factors, such as type of prosthetic device, level of limb loss, and functional capability, means that not every prosthesis is going to cost the same amount. The Journal of Rehabilitation Research and Development released a study analyzing the prosthetic cost projections for veterans. Here are the estimated costs:

  • Partial foot ($14,187)
  • Ankle disarticulation ($16,356)
  • Transtibial, or below the knee ($16,690)
  • Knee ($45,563)
  • Tranfemoral, or above the knee ($45,563)
  • Hip ($45,633)
  • Transpelvic disarticulation ($49,208)


  • Oscar Pistorius’ “Flex-Leg.” Photo credit (www.disabledlifemedia.com)

Who rates medical apps?

April 12, 2013 in Health care apps, Member Stories

With so many apps available to patients, at first glance it might be hard to tell which ones are useful and which ones will just eat up space on your phone. To save people the trouble of wasting money and time on an app, several websites have reviewed some of the top medical apps on the market so that you don’t have to.

iMedicalApps, a site that claims to be “the leading online publication for medical professionals, patients, and analysts interested in mobile medical technology and health care apps,” has physicians, health professionals, medical trainees, and health analysts review medical apps.The best part of this site is that the reviews leave nothing to be asked. Majority of the apps are reviewed based on price, the positives and negatives of the app, and its usefulness to both patients and medical experts. It also has a rating section for user interface, multimedia usage, and real world applicability. The one drawback is that the apps are not reviewed by patients themselves, which could bolster the reviews.

Sample of iMedicalApps.com’s review of the “Kids Beating Asthma” app.

Read the rest of this entry →

PricingHealthcare.com : healthcare prices in full view for facilities nationwide

April 10, 2013 in health care costs, Hospital Bills, Insurance Bills, Member Stories

Pricing Healthcare is blowing the doors off of healthcare pricing by exposing the closely guarded pricing secrets of insurers and healthcare providers – nationwide.

When we release our free Beta in June 2013 (pricingHealthcare.com), we won’t be just another site providing over-generalized estimates or very small fragments of the pricing picture for medical services.  We let consumers go to a single, easy-to-use website where they can compare actual procedure-level prices across all the healthcare facilities in their area.  There are a lot of prices out there: providers’ list prices, insurance-negotiated rates, and the “black market” price – discounted rates for cash payers not claiming insurance.  We show people all of it.  You wouldn’t believe how varied they can be, and you might find that paying cash is considerably cheaper than going through your insurance.  This doesn’t exist anywhere else, and it has the potential to save a lot of people in America hundreds and thousands of dollars in medical costs.

Other companies have tried to get ahold of pricing information from hospitals and insurers for years, but it’s in the best interests of the medical establishment to keep their prices from patients.  Open pricing leads to competition, when tends to lower prices.  The only people who benefit from this is consumers (exactly!).

The data that could transform the healthcare industry is out there.  It’s sitting in our file cabinets and in the pile of bills on our kitchen counter. Our model is to help patients come together at the grass roots level, and anonymously share the pricing data from their healthcare bills online.  That data is then combined and shown for your specific community, anywhere in the country.  It’s as simple as it is revolutionary.

Imagine what we could all do, collectively, with all the data from our healthcare bills anonymously online and freely available to other consumers.  Healthcare providers, like all American businesses, will have to compete on quality and price.

We are running a crowd-funding campaign to let consumers participate early and help ensure the revolution is a reality.  You can learn more about us at http://igg.me/at/pricingHealthcare.

A Picture of Health in America

April 8, 2013 in Member Stories

Health in America
Source: Best Masters in Healthcare

As one of the largest segements of the US economy, health care accounts for trillions of dollars in spending, both by governments and private individuals. At Top Masters in Healthcare, we decided to take a closer look at where the money goes in this infographic titled A Picture of Health.

The impact of the healthcare industry on everyday Americans continues to grow, whether they see it in their insurance bill or whether they earn their salaries from the health care industry. The issue also continues to dominate the political conversation… there’s no escaping it.

Review of free iPhone medical apps

April 3, 2013 in Health care apps, Medical Care, Member Stories

Nowadays there’s an app for everything, so it shouldn’t be too surprising that the medical world has converged with the app world to create apps that are marketed specifically towards patients. I decided to try out some of the top-rated free iPhone apps to see if they’re as user friendly as they claim to be, and I’ve picked out three of my favorite.

Photo Credit (www.blogcdn.com)

First Aid – American Red Cross

For me, this app from the American Red Cross is a must-have. Not only is there a section that informs you about common first aid procedures, but there is also an emergency button that you can press that has videos, pictures, and step-by step tutorials to help you in a medically related crisis. The only negative that I could come up with is that it might be stressful to read directions while you’re trying to help someone. Fortunately, the app has a “911” button under each procedure that instantly calls for help in the case that you cannot assist the person in need of help.


This app is ideal for patients who want to window-shop for prescriptions before they settle on the first one that they find. There is section called “Compare Rx Price” that allows you to type in your prescription and search for the lowest price at local and online pharmacies. It also has weekly deals, discount cards, and a pill identifier section. My favorite part of the app is the reminder that pops up on your phone to let you know it’s time to take your medication.

Pregnancy +

I might not be pregnant, but this app was rated number Read the rest of this entry →

Should Medicare fund sex change surgery?

March 30, 2013 in Health Insurance, Medical Care

I had a WOAH moment yesterday when I opened this email from a doctor who passes along developments in the exploding world of transgender health:

Medicare announced that beginning March 28, 2013 and for a 30 day period, it is inviting comments from the public regarding reconsideration of its current policy to deny coverage of sexual reassignment surgery.

Anyone wanting to recommend a change of this policy and to advocate for medicare covering sexual reassignment surgery, the website to go to is


Don’t bother trying to open the link. Less than 24 hours after the Centers

graphic courtesy of Wikimedia

for Medicare and Medicaid Services posted this announcement, they took it down. A spokesperson told The Hill the agency decided not to take public comments while a challenge to the agency’s policy is “working its way through the proper administrative challenges.”

Medicare and Medicare, and almost all commercial insurance plans, don’t fund surgery for men or women who feel like they were born into the wrong body.

So since Medicare can’t or won’t ask, we will:

Should Medicare and Medicaid fund sex change or gender reassignment surgery?

Robotic Surgery Warning!

March 21, 2013 in Medical Care, Member Stories

robotic surgeryRobot-assisted surgery is on the rise. If you’re thinking about it or your doctor is recommending it – Read This First.

In Massachusetts, the Board of Registration in Medicine says it is seeing an increasing number of “patient complications associated with robot-assisted surgery.”

Here’s one example:

The patient underwent elective robot-assisted laparoscopic hysterectomy and bilateral salpingo-oophorectomy, performed by two attending surgeons. After removal of the uterus, excessive bleeding was noted. Intraoperative colorectal and urologic consults found a significant length of the sigmoid colon mesentery damaged from incorrect tenaculum placement, left ureter dissection and cautery injury along the pelvic sidewall. The patient required laparotomy, sigmoid resection, diversion ileostomy and bilateral ureteral stents.

Paul Levy notes the obvious on his blog; this is more bad news for one of the major robotics manufacturers, Intuitive. Bloomberg reports on lawsuits mounting against the company for allegedly prioritizing sales over training.

So be prepared. If your doctor says she’s going to use a robotic device during your surgery, ask some questions:

1) Are you certified to use the robot?
2) How many surgeries have you performed with this particular device?
3) What’s your complication rate from surgeries using this robot?
4) What are the risks of surgery with and without the robot?
5) Is there any difference in cost?

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by HCSavvy

Cutting Your Prescription Costs

March 20, 2013 in health care costs

Castlight Health is out with an app that lets members compare retail vs. mail order prices for prescriptions and find the closest pharmacy with the best deal. There are a growing number of places online where patients can find some health care prices, but most don’t include pharmaceuticals. More sites will likely follow suit because consumers are realizing they can save money by checking the mail order price or making a few calls to find out which local pharmacy offers the best deal.