OK, but how much is it?

Original post:  Nov 19, 2014

One remedy that is often proposed in healthcare is to make it more responsive to market forces. In theory, the customer (i.e., the patient) should make informed choices and select the most cost-effective care. Setting aside the situations where you have a complete inability to choose (e.g., an emergency like a heart attack or broken leg), you should select the lowest cost provider for your procedure. That's the theory. The practice is much more uneven.

KQED in San Francisco recently collaborated with a startup called ClearHealthCosts.com. The idea was to crowdsource the prices that people paid for specific medical procedures. Hundreds of people have shared their experiences. Here is a sample from the article:

We thought we would find variation, and indeed we did. In California, commercial insurers paid from $128 to $694 for a screening mammogram. In Los Angeles,one woman's insurer paid $600 more than the lowest-cost screening mammogram reported in the area. "I'm sure every woman who's had a mammogram had the exact same experience I did," this woman said. "It was a friendly technician, but I don't think that's worth maybe 600 extra dollars."

In lower-back MRIs, we found that for CPT code 72148, insurers paid from $467 to $1,567. But when we looked beyond commercial insurers, we found even greater variation — from a low of $255 to a self-pay price of $6,221 at an academic medical center. That $255 MRI was paid by Medicare, and was just a fraction of the facility's charge of $2,450.

But the variation doesn't stop there. Yet another person went to the same facility and was charged $603 for the same procedure, same CPT code. This patient had commercial insurance but paid the entire amount out of pocket, the patient wrote, since "I had not yet met my deductible."

While price is certainly a major factor in the equation, quality is also a key component. You won't save any money if the procedure that you have is ineffective and you have to have a return visit to fix the original work! Unfortunately, it's really difficult to compare and little data exists.

Here is the link to the full article:  In California, That MRI Will Cost You $255 — Or Maybe $6,221 : Shots - Health News : NPR

For more on this topic, here is a link to the Masachusetts law that went into effect January 1, 2014 which mandates that hospitals must reveal their costs up front:

Price shopping....for healthcare?

Here is a link to a WSJ article comparing prices in Southern California:  How much will that be?