Health Care Cost Reductions: Consumers Understanding the System

This all makes good sense for getting the public to take an interest in what they pay out for medical procedures. It also makes good sense that when the bill comes, the individual looks it over and tries to understand what was charged for each procedure and what we paid, what the insurance company paid, for each.

It's very important to understand this bill can be challenged by the patient. This isn't set in stone that we, as consumers, have to pay what ever they want us to pay, even if much of the bill is covered by an insurer. Call the insure if the bill looks out outrageous or just doesn't make good sense. You probably won't get anywhere with them, but it always makes one feel less helpless and it let's the insurance company know you are taking notice of what they are doing.

Just imagine what we could accomplish if everyone called.

What this all means is we have to take responsibility for what happens to us. Remember, nothing is free. If we, as consumers, don't pay attention now to what is going on around us and take a stand for what we know is right, all is lost.

Health Care Costs Vary Widely
Source: Kelly Kennedy, "Health Care Costs Vary Widely, Study Shows," USA Today, June 30, 2011. "Healthcare Transparency Index," Change:healthcare, June 2011.

Patients pay as much as 683 percent more for the same medical procedures, such as MRIs or CT scans, in the same town, depending on which doctor they choose, according to a new study by a national health care group, reports USA Today.

That means patients who pay for a percentage of their care, instead of a copayment, may end up spending hundreds of dollars more for a certain procedure than they would if they chose treatment somewhere else -- often within a few minutes' drive.

Change: healthcare looked at claims data from May 2010 to May 2011 for 82,000 employees of small businesses to determine price differences for several procedures: MRIs, CT scans, ultrasounds and PET scans. For a pelvic CT scan, they found that within one town in the Southwest, a person could pay as little as $230 for the procedure, or as a much as $1,800.
For a brain MRI in a town in the Northeast, a person could pay $1,540 -- or $3,500.

Howard McClure, CEO of Change:healthcare says health plans are moving toward "reference-based pricing," in which they look at the average price of a procedure for a region, then say that's all they'll reimburse. But if a patient does not know how much a procedure costs, he or she gets stuck with the remainder of the bill if it goes above that average price.

Providers, he said, often don't know real costs, either. When asked by patients for the cost of a procedure, providers often say they need to check with the insurer. The patient only learns the real cost when the bill arrives, McClure says.