Buyer Beware in Healthcare – Some tips to Find out the Real Cost of A Medical Test or Health Care Procedure

Part One of our Investigative Report on Getting Pricing information in Austin Texas Hospitals and Outpatient Imaging Centers in Texas

Everyone’s talking about healthcare reform these days, but just what are some of the important healthcare issues, and which ones should you as a consumer, be concerned about right now?

One of the most crucial elements in terms of fixing our healthcare system should be to establish more transparency in terms of pricing among our health care providers.  There are discussions about pricing and discounts and you may think as a consumer that you may be offered a “cash pay” discount if you offer to pay in full or upfront for a particular test or medical procedure. But even those who consumer themselves savvy consumers may find themselves wondering what the “real” price is of a procedure.

healthcarecosts We recently sent a reporter on an assignment to try to obtain pricing costs from different providers in the Austin Texas Area, including Texas Hospitals, Texas Outpatient Facilities and Imaging Centers in Texas.

Here’s an overview of how to try to obtain cost information for medical procedures. Note, your mileage may vary, and plan to spend much time on the phone, but here are some tips that may help you in this process.

1. Step One: The first thing you need to determine when you are having a medical test done is if you will be using insurance or not. Some of you will obviously have healthcare insurance while others may not, but there are different costs of a procedure which can vary widely, and one of the things you need to know is that some facilities will be less if you pay up front and in cash, while others may actually charge you more. And this can also vary depending upon the procedure, the facility, and the test. 

2. If you can, ask your doctor for the CPT Code, which stands for Current Procedural Terminology, and is the number that is assigned to a particular procedure or task within the healthcare community. Doctors, hospitals, and other healthcare providers and medical professionals use CPT codes for billing and reimbursement purposes.

Note: If your doctor has not provided you with a CPT code but you are interested in getting a price for a service, sometimes you can call the scheduling office first, for example, of an imaging center, or a hospital facility, and ask them for the CPT code for a particular procedure, then write this number down and use it when you are speaking to the billing department when trying to obtain the price.

2. Step Two: In order to get the cost of a procedure your best bet will be to ask to speak to the billing manager of the facility where you are considering going for your test or procedure.

3. How to Ask for Pricing Information: Tell the billing manager you are interested in finding out the price for a particular service or procedure. You may be asked to provide the CPT code, which if you have done your research in advance you will already have. The initial price you will be given will probably be the “regular price” which is not necessarily the best price.  Here’s where you will need your patience and ability to remain on the line to question further.

If you will not be using insurance, ask the billing manager if they have a cash discount option or what is the best price for a patient who will not be using insurance. You may be surprised to learn that your “cash discount” price may be higher than what your insurance company would be charged, even though you are paying in cash, at the time of service while your insurance company could take weeks or even months to pay.

If you have insurance you may have another hoop to jump through. Did you know that the providers of services are not required to disclose the prices to you, the consumer, that you would be charged if you are using your insurance company to pay for a service?  You may get that information depending on the facility and whomever you happen to get on the phone on that particular day and time, but they are not required to disclose this information to you.

According to a leading insurance company representative who wishes to remain anonymous, the providers themselves, own the rights to the actual cost amounts, or contracted amounts that they pay the insurance companies. So, as the consumer, even though most of us have lifetime limits on our insurance company policies, and it is in our best interests to know how much we would be paying on tests that are done, especially if we have the time to “shop around for healthcare”  and are not in an emergency room situation, are not being currently provided with the actual costs for our own healthcare?

This is absurd and absolutely needs to be changed. What other service or product that we would purchase would we have to pay for or have deducted from our “limits” on payments when we don’t know or can’t get the amount that a service costs?  In part two of our series on Healthcare costs we will share with you the actual variances that we received on pricing for the cost of a CAT scan in Austin Texas. Note:  the range was between $250.00 and $1650.00 for the same test. So it does pay to do your research up front, and to understand the real costs of healthcare. 

Note: as I mentioned in the article above, one of the things we discovered was that if using a “negotiated” or contracted rate which would be your insurance company discount, that facilities are not “required” to provide you with that information. Because this is not currently a law that there would be transparency in making pricing information available to consumers, one of the ways that some of our colleagues are dealing with this now is by refusing to use any facility that does not offer at least a range of pricing or attempt to be helpful to a consumer seeking price information. Now, granted, it is impossible for a facility to be “exact” with some amounts of testing, because, let’s say for example, the patient arrives at the testing facility and the radiologist on staff determines that there needs to be more than one view or picture taken of a certain area. Or perhaps the price that was obtained was given “without contrast” which means that the exam was initially supposed to be done without having the patient drink or receive fluids which would illuminate certain areas for testing, but it is later decided that the exam needs to be done with contrast or adjusted in some other manner. Of course, the pricing in these situations would need to be changed, but it is our opinion, that the consumer should be given at least a base price range up front if they ask for it, and there should not be a veil of “secrecy” behind health care pricing which is the way that our current system has existed for years.

What are your thoughts? Have you tried to obtain pricing information for a procedure and could not? Have you found out that certain procedures have huge differences in costs depending upon the facility?


Note: We are not saying that it is wise to make health care decisions based solely on costs. There are some tests and procedures that are highly specialized or in some cases use better equipment or machines where it may make more sense to pay more and obtain the best quality care. But, in certain instances, where the machine and equipment are the same, and you can get good quality radiologists or practitioners reading your exam results (that’s another issue for a future article) where you, as the consumer, should be aware that there are certain tests that you may be charged way over and above what you could have paid, and that information should be available to you, so that you can investigate your choices like you would any other important purchase in your life. 
Do you think we should take the Secrecy out of Healthcare pricing and Procedures? What are your thoughts?