What Every Patient Should Know About Shopping For Health Care

When I recently decided to shop around for a pelvic ultrasound ordered by my doctor, I discovered something sobering:

We comparison-shop for cereal, so why not for health care?

Within a 7-mile radius in greater Boston, the pricetag for the very same diagnostic test varied widely, from $500 to $2,500. “Eye-opening,” was the way Robert Seifert, a principal associate at the Center for Health Law and Economics at the University of Massachusetts Medical School, described it.

My family, like most in Massachusetts, has health insurance that covers this type of test, so normally I wouldn’t have cared too much about the cost. But I was motivated to find out because a colleague, WBUR’s Martha Bebinger just launched a new social networking site, Healthcare Savvy, that allows patients to compare prices, share ideas on bringing down the cost of health care and generally vent.

So, inspired by this new community, I set out to do something radical: comparison shop for health care. Here’s what I learned:

At the prestigious downtown Boston teaching hospital, Massachusetts General, I was quoted a price of $2,563 for my ultrasound. At the well-respected community hospital, Mount Auburn in Cambridge (where both of my children were born), the price was $971.96. At Diagnostic Ultrasound Associates, the stand-alone imaging center in the Longwood section of town, I was told the price was $519. (After I posted my story on the Savvy site, I got a note from the interim CEO of another Harvard teaching hospital, Beth Isreal Deaconess Medical Center, who said at his hospital, the test would be $307. Sold.)

With national health reform unfolding, and pressure mounting for greater price transparency and lower costs, patients are being pushed, inexorably, to become smarter health-care shoppers. Right now, most of us still have “no skin in the game” as the policy types like to say, meaning, essentially, we don’t feel the pain of paying for our health care. Sure, we cough up cash for co-pays and deductibles, but for the majority of families and individuals, insurance pretty much covers the bills and we remain blithely ignorant about what our health care actually costs.

At Massachusetts General Hospital, I was quoted $2,563 for an ultrasound. At Diagnostic Ultrasound Associates, the price was $519.
But that will soon change: high-deductible plans are on the rise, “tiered products” with their pay-more-to-get-more approach are looming, and costs are increasingly being passed along to consumers. Anticipating this inevitable shift, the Obama administration this week proposed the so-called “plain English” mandate — that is, new rules that would require health insurers and employers to provide consumers with information about health benefits, coverage and costs in language they can actually understand.

After writing about my own ultrasound pricing spree and reading the initial posts on Healthcare Savvy, I’ve come up with a short list of three key concepts that the modern health care shopper should know.

1. Don’t Be Shy.

There’s still a good deal of fear among patients about asking a doctor or any medical provider about cost. It feels somewhat shabby, a little unseemly. After all, the intimate relationship between physician and patient is all about healing and caring; it’s not supposed to be tarnished by money or bargaining over price, right?

So, one of the most helpful tools on the Savvy site is “How To Ask…”, a section that includes guidance and actual questions for doctors, nurses, billing clerks, insurers, etc., simply scripted for patients who may not know quite how to begin such discussions. Martha B. explains:

If your doctor doesn’t want to talk about it, we don’t suggest creating a confrontational situation. But we also do hear from a lot of doctors who are frustrated themselves, about the way pricing and payments and such in the health care system work, and they want the information about what they’re doing, as much as patients do.

2. Less May Be More.

Sometimes, simple solutions in health care can be the most effective and the cheapest. Amy Lischko, of Topsfield, Mass., posted an illuminating story about taking her 7-year-old son to a well-child visit at the pediatrician’s office. During the visit, the doctor diagnosed a plantar’s wart on the boy’s foot. Lischko writes:

We were referred to a dermatologist who the doctor said would treat it by freezing it off — “cryotherapy” in several sessions. My son was not excited about this and I couldn’t blame him! While discussing it with another mother the next day she suggested an unusual solution…..duct tape! She said her daughter had the same problem a while back and her doctor said to put some duct tape on it, wait until it falls off, use an emory board to smooth it down and then put another piece of duct tape on it. Within 6 weeks it will be gone. Painless and almost free. I was skeptical upon hearing this so I called his pediatrician and the nurse said that it had been shown to be effective and that it would probably work. Why hadn’t I been told upfront about this effective, non-invasive treatment? Why was the more expensive, more invasive treatment the first course of action? This is an example of what is wrong with our medical system.

3. Be Pushy.

Lisa, who works at a global technology company based in Andover, Mass., learned about cost the hard way: with a $4,000 bill for the birth of her child that her insurer has so far refused to pay. It’s a mess — she’s covered by one health plan, her husband has another, and due to the complexities of bundled maternity care in the state, neither insurer wants to pay. After 20 to 30 calls and countless hours (on top of a full-time job and a new baby), Lisa says her husband’s insurer has indicated that, with the right paperwork, the plan may reimburse some of the costs. But it’s only through the couple’s perseverance and patience that they may, ultimately, get the bill cut down.  Stay tuned.

At this point, we’re still a long way from figuring out how to deal with the cost problem. But consumers are slowly becoming more conscious of the issue, and our growing sense of outrage when faced with irrational, seemingly arbitrary pricing is surely a motivating force to help fix things.

As for me and my ultrasound, in the end, since my insurance covered the entire cost, I chose the test site based on…parking. I found a free spot down the street from Mt. Auburn and was in and out of the hospital in less than half an hour, and on my way home. Oh, and the ultrasound was normal.

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  • susan256

    This is exactly the kind of homework we as individuals should be doing in the current health care climate. Know what stuff costs, and if you’re able, shop around. Perhaps we can pressure change. http://whatstherealcost.org/video.php?post=five-questions

  • http://tinyurl.com/3p23or9 Bobby
  • http://tinyurl.com/3tlawty Gina21
  • cathieman

    I would like to see health insurance policies geared to “healthy” people

  • Guest

    Check into what the cost would be if you don’t have health insurance. By not going through my insurer, the hospital charged me 40% of the cost of a colonoscopy. Down side is that the amount was not credited toward my $5000 deductible. The same percentage applied to my doctor’s bill. 

  • Ginger

    Is the excessive price at Matt General, due to caring for a large population with no health insurance?

    • Robyn

      Well, Mass General has a much lower percent of medicaid and uninsured than two of their main competitors who have much lower prices.  

  • http://pulse.yahoo.com/_ITM2R73CHZRMHZE5IQZ4XA3YEU Clvrgrl7

    It’s all about the cash, in case you didn’t already know. Where is my health insurance just like congress has President Obama? Single payer, sliding scale.

  • http://pickmybran.tumblr.com Brandon McLeod

    From the title, I thought the entire article would be:

    No matter what you choose, you’re getting screwed because in a system where healthcare is provided by corporations, profits are always the most important.

  • Ruby

    To be an informed consumer, one needs to be able to compare the quality of the process and the safety of the machines being used. Without  that information from a reliable source, one chooses blindly.

  • Bob Loblaw

    The problem is that someone will figure out how to “game ” the system.  There is no law preventing healthcare providers from changing the price on a precedure from day to day.  And once you’ve “shopped” around and are happy and comfortable with a provider, consumers are loathe to have to shop around again. 

    And then there’s catastrophic medical care… the NUMBER ONE cause of personal bankrupcy in this country.  You simply cannot “shop around” for this stuff.  An even if you could get your hands on a pricing chart, how would you or your family even know what you need?

  • http://tinyurl.com/3bsuzgj UPS005
  • Robyn

    Yes, Elijah.  I agree.  Rachel made a rational choice.  She minimized the cost of her time and money.  Anyone would do the same.  While I applaud the new Healthcare Savvy resource, until consumer incentives align with those footing the bills, access to prices won’t matter much at all.  Right now, insurers eager to retain members and the 10 cents on the dollar they make from each member, and policy-makers eager to look friendly to voters, pander more to consumers than to those footing the bills.  Employers and other payors need to take a hard look at benefit designs and give consumers a reason to care about those prices.  (Interesting to note that all of this talk about global payments does the exactly the opposite.  Instead of consumers becoming price-sensitive, physicians must take into consideration the costs of a pelvic ultrasound at Mt. Auburn or Longwood.  I wonder how Rachel would have felt being told she HAD to go to Longwood?)

     It is often pointed out that Massachusetts has the highest premiums in the country, but it is rarely mentioned that we also have the richest benefits in the nation too.  We cover more services and cover those services more fully than every other market in the country.  This has hugely contributed to the creation of high priced services here, and induced the eager consumption of the most expensive services by consumers who pay so very little to get them.   

  • Elijah Douglass

    In this post and your previous post you note that you picked your ultrasound site based on parking. The parking spot cost your insurance company about $200. How can we expect to cut healthcare costs through improved consumer awareness when even knowledgeable consumers are OK with receiving more expensive procedures because it is slightly more convenient? Those who advocate for healthcare consumer awareness often leave consumer responsibility. As these articles inadvertently point out, being an informed consumer is only half the battle, we must also be responsible and act on the information that we must work so hard to obtain. Thoughts?

    • Blurvie

      When I saw that the parking space mattered more than knowledge of price, I wondered what good it did to know.  The important thing to discover here is why the prices are so different.

      • Don_B1

        In the comments by Blurvie and Elijah Douglass, and even more importantly, in the article, I saw NO assessment or attempt at assessment of the QUALITY of the ultrasound that each facility provides. Better quality of the ultrasound equipment, the ability of the staff to read and evaluate it for abnormalities, etc. can justify at least SOME of the cost differentials although almost certainly not ALL the differences.

        Some of the differences come from the costs of being a teaching hospital versus a clinic and some come from some facilities having a low versus high utilization rate, which can be due to many different causes. Maybe the high cost at MGH results in fewer referrals and therefore lower utilization, or MGH normally uses a fancier machine for a more difficult problem, so running it costs more; or MGH simply needs to reevaluate its pricing or operating process.

        While reducing the costs of tests is significant, reducing the costs of how doctors practice and charge for their services is even more important.