“How much will my MRI cost?” It sounds like a simple question. But before Oct. 1, it was very difficult to get an answer.
Now, Massachusetts is pulling back the curtain on what has been a largely secret world of health care prices. A new state law says health insurers must be able to tell members, in advance, how much a test, treatment or surgery will cost. The idea is to help patients become health care shoppers — especially patients who have to pay a lot out of pocket before their insurance kicks in.
Phone Calls And Forms
I threw out my back last week and went to the doctor. She sent me down the hall for X-rays. I may need more. So, I was curious: How much does an X-ray cost? I called my insurer, Blue Cross.
The recorded message didn’t mention health care prices, so I went with, “For all other inquires, press 0.”
On came Jamie D. (customer service reps don’t give out their last names) and I explained that I wanted to compare the price of lower back X-rays at a few different facilities.
“Absolutely,” Jamie said. “Do you know the name of the provider you’re going to be working with?”
I had the doctor’s name, but I didn’t have most of the other information Jamie wanted. Blue Cross, Harvard Pilgrim and Tufts Health Plan will ask you for lots of details before giving you an estimate.
Blue Cross, for instance, wants the procedure and/or diagnostic codes (CPT or ICD-9) for each X-ray I may need, my doctor’s National Provider Identifier (NPI) and the name, address and NPI for my hospital or lab, so it can consolidate all the charges into one estimate.
“Typically with the X-rays there’s going to be a charge for the provider who renders the X-ray and then who’s reading it,” Jamie explained, “so it’s like a professional and a facility charge.”
Jamie directed me to an online form. I called my doctor and got the information. Twenty minutes later I clicked submit, and that was for just one lab. If I wanted to compare prices, I’d have to fill out separate forms for each one. Once I’d submitted all the correct information, Blue Cross had 48 hours to get me an estimate. I guess it goes without saying I’d never do this in an emergency.
So far, it didn’t feel like shopping. The main point of this new requirement is to help patients make smarter choices. We’re supposed to start behaving more like consumers of health care. So where’s the instant gratification I get from finding a designer sweater for $16.99 at T.J. Maxx?