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Patients Exposing Medical Prices, Taking Matters Into Their Own Hands

August 14, 2013 in health care costs, Hospital Bills, Insurance Bills, News

The medical world is moving toward price transparency — very slowly.  Unfortunately the amount of data available is still relatively sparse, considering the wealth of useful data that could be published. What users are shown is often nothing more than an average or calculated estimate for an area.  When the rare facility-specific data is revealed, it is too often list prices (which almost no one pays) or several years old.

One reason for the crawling pace is the healthcare industry’s reticence to let consumers compare costs, which would surely send a great deal of business to lower-priced facilities and put downward pressure on prices.  It would be disastrous to their revenues.  And don’t think for a minute that the federal government is in a hurry to bring about transparency. The “Affordable” Care Act was carefully crafted to keep hospital revenues in tact, influenced by the billions politicians receive from healthcare lobbyists (more than 4 times greater than the next 3 largest lobbying groups combined). Patients just don’t stand a chance against such powerful forces.

Enter Pricing Healthcare, a relatively new addition to the playing field. They’re asking consumers for a little (anonymous) pricing data from their medical bills in an effort to expose what should be openly and readily available to patients. The company is interested not just in the prices hospitals and physicians charge, but more importantly what real patients are actually paying, in the form of discounted and insurance-negotiated rates. Users can enter data from bills going back nearly 3 years, but as people enter more recent data, it keeps the content current. The website makes the process relatively easy, and patients from all over the U.S. have already started submitting data, many with a great deal of enthusiasm.

Crowd-sourcing isn’t Pricing Healthcare’s only source of price information on the user-friendly site. While consumer data is being collected, the company is also pulling in data from other sources (as can be seen from the large amount of San Francisco data they have published). For the first time the company says, consumers can compare cash prices for scores of hospitals in a large metro area. They company is asking patients in the San Francisco area to help them discover insured rates (the hardest prices to come by) by supplementing the data already on the site from their own medical bills.

Grass roots efforts have done a great deal to influence the course of American history. The internet age certainly makes it easy for individuals to band together and force change. Pricing Healthcare hopes citizens will be concerned enough about the high cost of healthcare to lend their voices and make a difference. Time may be running out.

 
For more information, visit https://pricingHealthcare.com, or send the company a message at https://pricingHealthcare.com/contact.
 

Are Transparent Hospital and Medical Bills on the Rise?

December 3, 2012 in health care costs, Hospital Bills, Insurance Bills, Medical Care

News from an Ohio media news site indicates that “hospitals around the country” are trying to make their medical bills easier to read, citing the Healthcare Financial Management Association and a case study for the Cleveland Clinic, one site that has renovated the look of its paper bills.

Most of the changes focus on the idea that traditional bills just have too many lines and lack clarity about who has current responsibility for debt amounts vs. who has already paid. To this end, photos of new billing structures show that complicated sets of line items can be replaced with headings like “You Paid X on X Date” and “Insurance Company Paid X Amount.”

Changing the format for medical bills can help both you and your provider. Because when you can read a bill effectively at a glance, you are more likely to respond immediately to what you receive in the mail. Bills that are too cryptic often just end up getting thrown in the trash or added to the pile. This means the provider receives delayed payment or non-payment and you risk credit damage.

What These Medical Bill Improvements Don’t Address

Although it can be really helpful to make bills more readable, this still doesn’t address some of the most common challenges we encounter. Read the rest of this entry →

How to Protect Yourself from Higher Than Expected Medical Bills

September 28, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medical Care

If you are insured and visit your local emergency room at a hospital network in your area of residence, you expect to pay the stated co-pay that shows on your insurance card, right? This is, in some senses, a reasonable expectation, but it’s not always what happens. News media outlets around the country have aggressively broadcast many cases where huge out-of-network charges for secondary providers have led to excessive medical billing amounts for patients who simply visited the wrong hospital at the wrong time.

The Problem: Hospital Network Staff Outsourcing

This major problem, that results in more out of pocket dollars than expected, really has to do with how hospitals staff. Hospitals may simply bring in outside doctors, nurses, technicians and other staff who aren’t effectively on staff at that facility, in order to help fully staff an emergency room or other hospital department. This is a convenient fix for hospitals, but what’s enraging is the idea that hospital administrators don’t think about the dramatic impact that out-of-network charges can have on patients.

What happens with out-of-network charges is that when outside physicians or other staffers happen to provide care to a particular patient, that patient is simply billed for the balance of that care because of an automatic insurer denial. Insurance companies won’t usually pay for the work of out-of-network professionals, but hospitals hire them anyway. Read the rest of this entry →

Are You Being Treated by a Subcontracted Doctor?

May 28, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medical Care, Medicare

A recent story from Dayton, Ohio, caught our attention, where according to news reports, some patients remain responsible for emergency room charges when a hospital happens to ‘subcontract’  doctors who may not accept health insurance at all. This adds another layer to the oftentimes confusing in network vs. out of network debate. In many cases, especially in an emergency situation, patients who visit a local hospital or facility may experience unexpected costs after they are cared for by a doctor who may not be ‘in their network’, even if the facility itself is listed as an in network provider. There’s been a lot of discussion whether this, which may seem deceptive, especially to those without specialized knowledge in the medical billing and health insurance field, is fair. In fact, state officials, like in New York, are  looking to pass legislation which mandates better transparency for out of network charges. Taking the time to understand your health insurance plan and what defines a covered provider or facility can save you hundreds if not thousands of dollars in non-covered charges.

It seems providers tend to respond to these scenarios in two ways: Some indicate they will change their policies to include more transparency while others claim to be bound by federal laws that do not allow them to reveal to patients whether an on-call doctor or a physician on shift will accept their insurance or not.

We find the second argument to be completely unacceptable at face value. In fact, it’s reasonable that consumer advocates would expect state regulators to crack down on these well documented examples of seemingly unfair provisions in delivering medical services. It’s not outside the realm of possibility that a patient facing bankruptcy after a bill like this would have a basis for legal appeal, especially as new legislation is introduced and passed. It’s vitally important that you discuss your options and ask questions before treatment to minimize impact to your financial future. How prepared are you in the event of an emergency room visit?

“A bit of sunshine is creeping in” to health care prices, says The Economist

February 8, 2012 in health care costs

This cartoon leads a story in The Economist about US companies that are trying to making health care prices available to consumers. Here’s the first graph:

“AMERICANS spent $2.6 trillion on health care in 2010, a staggering 18% of GDP. Yet few of them have the faintest idea what any treatment costs or how it compares with any other treatment. Prices vary wildly and seemingly without reason (see chart).

Insurance terms require a dictionary. For most Americans, buying a procedure is akin to choosing a house blindfolded, signing a mortgage in Aramaic, then discovering the price later. Slowly, however, this is changing.”

Interesting that The Economist chooses to compare prices at three MA hospitals: Mass General, the Brigham and Mount Auburn. We’re hoping to arrange a demo on Savvy with Castlight, one of the companies mentioned in the article. We’ll keep you posted.