The challenge with the current tools available to patients is that they are trying to capture a moving target based on a specific facility as opposed to empowering the patient with insight and knowledge to the average procedure cost within their zip code. This will allow the patient to present these costs to the provider and potentially negotiate a better price. Our Unified Experience tool provides members with the ability to search providers, procedure costs, facilities, prescriptions and pharmacies all in one place. Members can compare high-quality healthcare services in their area, resulting in better customer satisfaction and savings for the consumer and the carrier.
As the current healthcare climate continues to shift and more consumers become informed and educated about their medical cost options, “it is creating a new breed of health care consumer: a savvy one.”
Kate and Scott Savett were trying to be responsible when they needed some medical care. They live about an hour north of Philadelphia with their dog, Frankie. Scott, 43, is a chemist and designs software for labs; Kate, 37, works in life insurance.
They buy their health insurance through Scott’s job, and to keep their premiums affordable, they chose a high-deductible plan. They understood from the beginning that this would mean shopping carefully when they needed care, because costs can vary a lot among doctors and hospitals.
For years the couple didn’t use their insurance much — but that all changed this year.
Kate was diagnosed with multiple sclerosis in January. Doctors did a lot of tests and then follow-up tests. On top of that, Scott needed some imaging tests for a spinal issue.
Under their insurance plan, the two have to pay in full for the first $3,000 of their combined care. After that, they still have to pay 20 percent of the cost, until they reach a total of $8,000 in out-of-pocket expenses.
That experience made them want to find the best care for the best deal. But how?
They investigated, using an online cost estimator offered through their insurance company.i
Scott logs in to use the tool, and searches for the typical cost of MRI scans in his region. The online calculator tells him the average cost is $1,270; the lowest is $512 and the “above average” is $1,790.
The tool then produced a list of different providers and an estimate of how much they will specifically charge under the plan the Savetts have.
At first, this kind of information seemed great to the couple. But it quickly proved to be quite the headache.
A few days before Kate was scheduled to have her first MRI, she and Scott got a call from the radiology office, saying that the scan would cost them $2,400. They were shocked — the online calculator had told them it would only be about $500.
What’s the source of the disconnect?
A hospital had bought the imaging center and raised the price.
There were misquotes on other procedures, too. The Savetts received some bills from health providers that were as much as a thousand dollars higher than the price the online calculator had led them to expect. Another time, they couldn’t find any listings at all for a procedure one of them needed.
The two quickly plowed through their $3,000 deductible. Financial planning became increasingly difficult. They delayed buying a new water heater for their house.
“It’s hard for us to pull the trigger on that, knowing that another bill could be coming around the corner,” Kate says.
It’s unclear how common these inaccuracies with online estimators are, but the tools are becoming more popular, as patients shoulder a bigger share of the cost of their medical care. Outside companies are developing the online calculators, and most insurers offer them.
“Each one of them — whether it’s Aetna, United, Cigna — they all have something,” says Francois de Brantes, the director of the Health Care Incentives Improvement Institute, a nonprofit based in Connecticut. De Brantes has been paying close attention to price-transparency tools.
“There’s lots and lots of variability in the information that’s provided to consumers,” he says.
Some of the estimators reflect an aggregate range of possible costs; others are based on historic pricing, or claims data from varying sources. Many, he says, are limited in the type of procedures they include.
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