Shots - Health News
3:18 pm
Fri November 8, 2013

In Massachusetts, Health Care Prices Remain Hard To Get

Originally published on Fri November 8, 2013 6:08 pm

I threw out my back in September playing squash and went to the doctor. She sent me down the hall for X-rays. I may need more of them.

So I'm curious, how much does an X-ray cost? It sounds like a simple question. In most places, it's impossible to find out, but I live in Massachusetts, where a new state law says insurers must be able to tell members, in advance, how much a test, treatment or surgical procedure will cost.

So I call my insurer, Blue Cross. The recorded menu option doesn't mention health care prices, so I press zero, for all other inquiries.

Eventually, I connect with a company rep named Jamie, and I explain that I'd like to compare the price of lower back X-rays at a few facilities.

She starts in with the questions. What's the doctor's name? Where do I want to have the X-ray done? I have the doctor's name and a facility in mind, but then I'm stuck. Blue Cross wants the procedure codes for each X-ray I may need, my doctor's national ID number and the name, address and ID number for my hospital or lab. Why? So the insurer can consolidate all the charges into one estimate.

Jamie directs me to a form online. I call my doctor and get the info. If I want to compare prices, I'll have to fill out separate forms for each X-ray lab. Then Blue Cross has 48 hours to get me an estimate. It takes me 20 minutes to fill out the form, so I only fill out one.

This doesn't feel very much like shopping. The point of this new requirement is to help patients make smarter choices right? That way patients can start behaving more like savvy consumers.

Insurers aren't thinking that way. They all sound a little overwhelmed by trying to put a price tag on medical care.

"The challenge is really about trying to make this information personalized and useful," says Derek Abruzzese, a vice president at Tufts Health Plan. "Unfortunately health care is very complex, and so it's difficult to make things simple, straightforward and precise."

So many things can change when patients go in for treatment, explains Bill Gerlach, director of member decision support at Blue Cross.

"You know they needed an extra lab, an extra MRI or some sort of diagnostic that we, nor the member — or the provider for that matter — couldn't have foreseen at the time that estimate was requested," he explains.

Insurers also worry about getting the price right because the new state law puts insurers on the hook if they are wrong.

"If we show an estimate that is lower and someone goes and pays more, then we are liable," says Sue Amsel, who is working on a shopping tool that insurer Harvard Pilgrim Health Care is developing.

She shows me a demo that ends up revealing that the range of costs for a brain MRI is between $372 and $1,223.

Amsel says that kind of range is not unusual, which is one reason it's important for people to know how much health costs.

"We know that people are frustrated," she says. "They go to the doctor not knowing. They come back with a big bill that they didn't expect, they weren't able to plan for it, and they weren't able to prepare for it. So I think this will help them quite a bit."

Harvard Pilgrim will spell out what's included and what's not in its estimate. I went back and forth several times with my insurer, Blue Cross, and then it took two days to find out my X-ray would cost $147.

So we can find out in advance how much everything from a blood test to open heart surgery costs. But in these early days at least, it isn't quick or easy.

This story is part of a collaboration among NPR, WBUR, and Kaiser Health News.

Copyright 2013 WBUR. To see more, visit http://www.wbur.org.

Transcript

AUDIE CORNISH, HOST:

Now to a story about a plan to help patients become smarter health care shoppers. Massachusetts has a new law. Insurers have to be able to answer simple questions about prices in advance, questions such as how much will my x-ray cost? That kind of information is almost impossible to find out in most places. Now, in Massachusetts, if people ask, insurers have to tell them.

WBUR's Martha Bebinger tried it out.

MARTHA BEBINGER, BYLINE: I threw out my back in September playing squash and went to the doctor. She sent me down the hall for X-rays. And I may need more. So I'm curious, how much does an X-ray cost? I call my insurer, Blue Cross.

UNIDENTIFIED WOMAN: To check the status of a medical or dental claim, press one.

BEBINGER: The recorded message doesn't mention health care prices, so I go with the default option.

UNIDENTIFIED WOMAN: For all other inquiries press zero.

BEBINGER: Eventually, I connect with Jamie D. Customer service reps don't give out their last names.

JAMIE D.: Thank you and how may I help you today?

BEBINGER: I explain that I'd like to compare the price of lower back X-rays at a few different facilities.

D.: Absolutely. Now do you know the name of the provider that you're going to be working with?

BEBINGER: I have the doctor's name, but insurers will ask you for lot more details before giving you an estimate. Blue Cross wants the procedure codes for each X-ray I may need, my doctor's national ID number and the name, address and ID number for my hospital or lab, so that it can consolidate all the charges into one estimate.

D.: So the claim with the x-rays, there's going to be a charge for the provider who's rendering the x-ray and then who is reading it. So, like, a professional and a facility charge.

BEBINGER: Jamie directs me to a form online. I call my doctor and get the info. If I want to compare prices, I'll have to fill out separate forms for each X-ray lab. Then Blue Cross has 48 hours to get me an estimate. It takes me 20 minutes to fill out the form, so I only fill out one. This doesn't feel very much like shopping.

The point of this new requirement is to help patients make smarter choices, right? To start behaving more like consumers of health care. Insurers aren't thinking that way. They all sound a little overwhelmed by trying to put a price tag on medical care. Derek Abruzzese is the VP for strategy and product development at Tufts Health Plan.

DEREK ABRUZZESE: The challenge is really about trying to make this information personalized and useful. And, you know, unfortunately health care is very complex, and so it's difficult to make things simple, straightforward and precise.

BEBINGER: So many things can change when patients go in for treatment, says Bill Gerlach, director of member decision support at Blue Cross.

BILL GERLACH: You know they needed an extra lab, they needed an extra MRI or, you know, some sort of diagnostic that we, nor the member or the provider for that matter, couldn't have foreseen at the time that the estimate was requested.

BEBINGER: Insurers also worry about getting the price right because the new state law puts insurers on the hook if they are wrong.

SUE AMSEL: If we show an estimate that is lower and someone goes and pays more, then we are liable.

BEBINGER: Sue Amsel is working on a shopping tool that insurer Harvard Pilgrim Health Care is developing. She shows me a demo.

AMSEL: I'm going to just click on MRI.

BEBINGER: Amsel clicks to a page that shows prices for the most common brain MRI at different Boston hospitals.

AMSEL: So here you see that your range is from $372 to $1,223.

BEBINGER: Amsel says that kind of range is not unusual, which is one reason it's important for people to know how much health care costs.

AMSEL: We know that people are frustrated. They go to the doctor not knowing. They come back with a big bill that they didn't expect, they weren't able to prepare for it, they weren't able to plan for it, and we think this will help them quite a bit.

BEBINGER: Harvard Pilgrim will spell out what's included and what's not in its estimate. I went back and forth several times with my insurer, Blue Cross, and then it took two days to find out that my X-ray would cost $147. So we can find out in advance how much everything from a blood test to open heart surgery costs. But in these early days, at least, it isn't quick or easy. For NPR News, I'm Martha Bebinger in Boston.

CORNISH: This story is part of a collaboration with NPR, WBUR and Kaiser Health News. Transcript provided by NPR, Copyright NPR.