How To Navigate the Healthcare Pricing Maze GEN

Introduction

Healthcare consumers that want to be proactive about managing their healthcare spending are finding it difficult if not impossible to “Shop For Healthcare Prices”. Shopping for healthcare prices is becoming more common.   Unfortunately, consumers are not using the tools available. Two recent consumer surveys indicated that only about 10% of consumers use healthcare pricing tools. Why?  Because it is very difficult for the healthcare consumer to use and understand the tools.  Non-healthcare organizations like Amazon and other online retailers make it easy for the consumer to search for and buy goods and services. Most Healthcare organizations make it difficult for consumers to navigate their web sites and find prices.

Healthcare Consumer Navigator Center is dedicated to help consumers navigate the healthcare system maze.  To that end, the Healthcare Consumer Navigator Center Team has researched what web sites and resources are available for the healthcare consumer to use when attempting to secure a healthcare price for a service or procedure. In addition, the Team reviewed the process the healthcare consumer should use to secure a price. The following pricing section will:

1. Explain what information the consumer needs prior to starting the price search process;
2. Identify resources and web sites to be used to secure a price;
3. Explain what the web sites provide and how it can benefit the consumer; and
4. Steps the consumers can use when utilizing web sites.

What information a consumer needs prior to starting a pricing search

The healthcare consumer will need certain information to start their healthcare price search.

1. Your Health Insurance Card and the basic benefits of your plan; annual deductible; co pay amount; co insurance percentage and if available, the amount of money already applied to your annual deductible. Several web sites require this information.
2. The specific name of the healthcare test or procedure you are “Shopping”. The ordering doctor or the office staff will have the information.
3. The CPT Code. THIS IS CRITICAL. The ordering doctor or the office staff will have the information.
4. What are CPT Codes?

Current Procedural Terminology (CPT) is a medical code set that is used to report medical, surgical, and diagnostic procedures and services to entities such as physicians, health insurance companies and accreditation organizations. These codes identify the specific test or procedure the consumer is receiving.  All healthcare facilities use CPT codes to help identify the price.

The Web Sites Available and the Steps Consumer will Need to Follow

Established Pricing Web Sites

Established pricing  web sites are sites developed by healthcare related companies.  They are the easiest to follow and are designed to guide consumers.  Make sure you have the three documents listed above before you start your research.

Hospital Web Sites

Hospital web sites may or may not have pricing information.  These web sites can be confusing and finding price information can be very difficult to locate.   The following will help guide consumers to locate the location of price estimation information on a hospital web site.

1. Make sure you have the three documents listed above before you start your research.
2. Look under Patient Information. Price estimation designation can be found.
3. If a price estimation tab is not found when selecting Patient Information, select either Business Office or the Pre-Registrtation tab.
4. In some instances, a price estimation designation will appear. Select the designation.
5. There are up to four options hospital will offer consumers;
   1. Use an online tool;
   2. Call the hospital;
   3. Email the hospital; or
   4. Visit the hospital and talk to a financial representative.
6. If you cannot locate any information about price estimation on the web site, call the hospital Business Office.

Insurance Company Web Sites

Most large insurance companies have price information on their web site.  Your will be required to create an account with a Login ID and Password. When you are logged in, search the site for a “Cost of Care”, “Price Estimation” designation or something similar. Once located, the process is simple.  Remember you will need the specific name of procedure or test and possibly a CPT Code (See Above).

State and Sate Hospital Associations Web Sites

A limited number of states have healthcare price information on their web sites.  In addition, the state hospital association may have healthcare price information.  The consumer should check both sites.  Make sure you have the three documents listed above before you start your research.

When accessing a state or hospital association site, type in the browser “State Of ____________Healthcare Pricing” or “State of_________Hospital Association Healthcare Pricing”.  This will start you in the correction direction.

Prescription Drug Web Sites

Prescription Drug web sites help consumers compare  the price of drugs and direct the consumer to the cheapest pharmacy.  The prices are retail prices and do not reflect any healthcare insurance payment.  In addition, many insurance company web sites have drug pricing capabilities.  These are very helpful, since they may reflect the  the insurance payment and what your out of pocket will be for the drug.

Healthcare Pricing Research Web Sites and Resources

The following grid has identified specific web sites or resources for the healthcare consumer to access when searching for a healthcare price.  The grid has three(3) columns that will help guide the healthcare consumer.

Lastly, if all research fails, call the Hospital, Doctor, Laboratory, Radiology, or Out Patient Center, and ask for the price.