HCNC Blog

Do you understand Healthcare Pricing?

images-1I have gone to doctors offices, laboratories and hospital to receive services without a clue how much the services cost.  Healthcare is the only industry that gets away without fully informing the healthcare consumer of prices. Just for fun, the next time you go to receive a medical service, ask the price.  Let me know what they said.  The following may help.

Most,  if not all,  healthcare consumers do not understand how healthcare pricing works.  In fact, many individuals  who work in the healthcare business do not understand how it works. Very sobering and quite frankly, very scary.

Healthcare consumers would not buy a house, car or a gallon of milk without knowing the price.  Healthcare consumers are expected to purchase elective services(non-emergent) such as  a Surgery, a X-ray Procedure or a Lab Test  without knowing the retail price or out of pocket costs.  These procedures and tests could cost consumers thousands of dollars.  They are purchasing services without any idea of financial liability.  Emergent services, like an emergency visit, are almost impossible to price.

Since healthcare consumers are paying more for insurance premiums and are experiencing cost shifting, with higher deductibles and out of pocket costs, the insurance companies and the healthcare industry must provide accurate information to the consumer.  In addition, employers need to pressure insurance companies to provide the information to the consumer.

 

So, what does the consumer do in the meantime?  The following are some thoughts.

  • Review Your Healthcare Insurance Company Web Site: Some insurance companies have pricing tools on their website.  These tools are a start.  More refinement is required.
  • Healthcare Providers in Your Service Area:Hospitals and other healthcare providers have their own specific retail pricing information. The consumer can call the provider or check their web site.  Some states mandate healthcare providers to publish pricing.  Most providers have difficulty estimating the amount the insurance company will pay and then providing the consumer  with a reasonably accurate out of pocket estimate.
  • Private Companies:Entrepreneurial companies are trying to  provide pricing information to consumers.  The data is helpful but limited.

The healthcare consumer assumes financial risk every time they purchase a healthcare service.  They assume their health insurance will pay the designated amount and they will be liable for a predetermined amount. Pricing transparency starts with the insurance companies and healthcare providers.  Both have claim information that shows retail prices and what amount has been paid by the insurance company by insurance plan.  They could not be  in business without that information.  The consumer and the employer community should lobby insurance companies and healthcare providers to make the information available to the consumer.



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