The $6,500 question on health care • USA Today
When the Affordable Care Act (ACA) was passed, there were many promises made. We were told it would give more citizens access to health care and reduce the cost of care.
Market-based competition and an easy application process on a multibillion dollar website were supposed to bring rates down, but, as we all know, premiums soared. Though some consumers received a subsidy to help them pay those expensive rates, most found themselves with ever growing deductibles of $6,500 and $7,100. But there was no promise that they could find out the actual cost for a son’s broken arm or a daughter’s tonsillectomy.
They certainly won’t find those instructions in the reams of regulations that the Department of Health and Human Services (HHS) has given us. Millions are left with very high deductibles, but no instructions on how to find out the cost of a procedure or treatment before it’s needed.
When House Speaker Paul Ryan rolled out the American Health Care Act designed to dismantle and replace the ACA, he proudly announced that it will “create the conditions necessary for consumers to see costs come down…and to realize greater control over their health care than was possible after the Obama-led reforms became law.” We know for sure that it would expand health savings accounts (HSAs) and eliminate the mandate that requires people to buy insurance or pay a penalty. But would it make it easier to find out the price of an MRI?
Just ask Craig Campbell of Kansas how hard it is to shop prices of care. Campbell, a small business owner, has had his family of four on a private policy with an HSA for over 10 years. He enjoyed the low premium that came with his plan before the ACA, but it has had its challenges.
He has found it very complicated and time consuming to find out the actual cost of any service. He says, “The doctor and his staff had no clue what the price would be for an MRI that the doctor ordered on my neck.” Finding out his price required multiple phone calls, for which he received a range of expected costs rather than an exact number. It was worse when he recently found he needed a bone spur removed from his foot. Craig did his research and found out his cost. Or so he thought.
“It took some probing but I was eventually given an answer and made sure I had the funds in my HSA,” Campbell said. “It wasn’t until I received a call to come in and pay a down payment at the facility that I realized the $1,600 I was quoted was only for the doctor fee. It did not include the $6,000 for the facility charges.” He is hoping the carrier’s negotiated rate will be half that. “We can shop around online in a matter of minutes for other products or services. But this lack of price transparency means the competition among health care services is nonexistent,” he said.
Some carriers do have a “compare your cost” tool on their websites that allows members to register, enter a common procedure and look up the negotiated prices for that tonsillectomy, for example. The tool even lists the difference in pricing at local facilities and with in-network doctors. Campbell says he was unaware of such a tool offered by his carrier.
Perhaps the future in calculating one’s pricing for medical care is with sites like HealthCare BlueBook, SaveonMedical, or even GoodRx. Our search found an MRI in our Zip Code for a “fair price” of $1,105, but we weren’t sure if we should select “ankle with or without contrast” or maybe “ankle with contrast.” One site warns: “Prices for MRI and CT scans have some of the greatest price variances in healthcare. The most important factor impacting the cost of your care will be which facility you use. Some imaging centers charge three to five times more than other centers. Hospitals are usually the most expensive.”
By the way, a tonsillectomy will set you back $4,460 but “Discuss with your physician if this surgery can be performed as an outpatient procedure (no overnight stay).” Good to know. But how much is my negotiated price with my insurance carrier? That is the $6,500 question.
Beverly Gossage is a senior fellow for Independent Women’s Voice.