NEW YORK (MainStreet) - Ensuring that you are paying a fair amount for your next medical procedure can be tricky.
Consumers are paying about 683% more for similar medical services at different facilities in the same city, according to the 2011 Healthcare Transparency Index Study. Spending for healthcare is taking up a large amount of consumers’ budgets even though the rise in premiums has been steady, a Kaiser Family Foundation survey found.
Before undergoing a treatment and being hit with a large bill, consumers can research doctors and hospitals and estimate their out-of-pocket health care costs.
Consumers should ask their doctor which specific services they will be receiving and if there are any additional add-on procedures that may contribute to the cost of care such as crutches, braces or wheelchairs, said Robin Gelburd, president of FAIR Health, a national not-for-profit corporation which brings transparency to healthcare costs.
“There are a number of factors that can influence the cost of a procedure among different medical facilities in a given area,” she said. “In order to avoid high medical bills, it is important for consumers to do their due diligence prior to receiving care. Even if a hospital is in the plan’s network, physicians and specialists may not be which may result in significantly higher medical bills.”
All cost comparisons do not reflect the same “bundle” of services and as a result may not be apples to apples comparisons. Once consumers find out the exact care they will be receiving, they can better estimate the cost through free online tools such as FAIR Health’s Consumer Cost Lookup.
Some insurance companies such Chicago-based Health Care Service Corporation (HCSC) allows its members to find estimates online. The software allows you to search and estimate out-of-pocket health care costs for more than 400 common medical procedures, research and compare more than 400,000 health professionals and over 21,000 facilities and read patient reviews, wait times and physician training.
Consumers who have used the tool have saved an average of $900 per procedure, according to an HCSC analysis, said Tom Meier, vice president of product development.
The cost for a knee replacement in the Dallas area could range from $18,801 to $47,324 in a ten-mile radius, depending on the facility, he said.
“Our goal is to optimize the value of health care for our members and the entire health system by advocating for quality care at lower costs,” said Dr. Stephen Ondra, chief medical officer for HCSC. “By providing information on clinical quality, patient outcomes and satisfaction, we empower our members to make better informed health care decisions which we believe can help drive higher quality experiences and lower out of pocket costs for the consumer.”
The software can be used by group members of Blue Cross and Blue Shield of Illinois, New Mexico, Oklahoma and Texas and will expand to allow access to all group PPO and HMO members in those states by the end of 2014. HCSC is the fourth largest health insurer with more than 14 million members in its Blue Cross and Blue Shield plans in Illinois, Montana, New Mexico, Oklahoma and Texas.
The true cost of a health insurance plan is about more than just monthly premiums and consumers must examine the co-payments, deductibles and co-insurance and to know when these may apply and when they don’t, said Carrie McLean, director of customer care at eHealth.com, an online health insurance exchange based in Mountain View, Calif.
“Even if your plan has an annual deductible, for example, you may not have to pay toward the deductible for all medical services,” she said.
When it comes to controlling costs, consumers also need to understand how provider networks function, McLean said. Most health plans limit you to seeing doctors and hospitals within a specific network, at least if you want to receive coverage at the highest level.
“Getting medical care out of network can cost a lot more – in fact, in some cases you may have no coverage at all out of network,” she said. “When considering any plan, you need to make sure that your preferred doctors and hospitals are within its provider network or at least that you won’t have to drive an hour to find someone in network.”
Even with preparation, unexpected costs can occur. If this happens, consumers should not be afraid to negotiate with the facility or physician, said Gelburd.
Consumers who can show lower costs from neighboring facilities for the same procedure and services might be able to convince the providers to accept a lower rate, she said. The facility or provider may also agree to an installment plan that better meets the needs of the consumer.
Comparing co-pays for doctor visits or treatments or prescription drugs can also cut costs for consumers, said Hector De La Torre, executive director for Transamerica Center for Health Studies, a national non-profit.
“Once you have these comparisons, you can make a realistic choice that keeps your costs down while maintaining access to the health care you need,” he said.
--Written by Ellen Chang for MainStreet