Posted: 4:50 p.m. Friday, Nov. 8, 2013
By Martha Bebinger, WBUR
Finding out how much an X-ray costs sounds like a simple question. But it is actually very difficult to get an answer. In Massachusetts, a new state law requires insurers to be able to tell members how much a test, treatment or surgery will cost.
But while the new law pulls back the curtain on prices of health procedures to some degree, the burden is still on the patient to ask for information. And, as a recent test drive of the new law showed, there are quite a few hoops for patients to jump through.
I threw out my back in September playing squash and went to the doctor. She sent me down the hall for X-rays. I may need more. I'm curious about what my costs will be, so I call my insurer, Blue Cross.
The recorded menu option doesn't mention health care prices, so I press zero, for all other inquiries.
Eventually, I connect with Jamie D. (customer service reps at Blue Cross don’t give their last names). I explain that I'd like to compare the price of lower back X-rays at a few facilities.
She starts in with the questions: What's the doctor's name? What's the facility where I want to have the X-ray? I have the doctor's name and facility, but I’m stuck on the next question. Blue Cross wants the procedure codes for each X-ray I may need, my doctor's national ID number and the name, address and ID number for my hospital or lab, so it can consolidate all the charges into one estimate.
Jamie directs me to a form online. I call my doctor and get the info. If I want to compare prices, I'll have to fill out separate forms for each X-ray lab. Then Blue Cross has 48 hours to get me an estimate. It takes me 20 minutes to fill out the form, so I only fill out one.
This doesn't feel very much like shopping. The point of this new requirement is to help patients make smarter choices so that they start behaving more like consumers of health care. Insurers aren't thinking that way. They all sound a little overwhelmed by trying to put a price tag on medical care.
"Health care is very complex and so it's difficult to make things simple, straightforward and precise," says Derek Abruzzese, the vice president for strategy and product development at Tufts Health Plan.
So many things can change when patients go in for treatment, explains Bill Gerlach, director of member decision support at Blue Cross.
"You know, they needed an extra lab, an extra MRI or some sort of diagnostic that we, nor the member or the provider for that matter, couldn't have foreseen at the time that estimate was requested," Gerlach explains.
Insurers are also worried about getting the price right because the new state law puts insurers on the hook if they are wrong. Sue Amsel is working on a shopping tool that insurer Harvard Pilgrim Health Care is developing.
"If we show an estimate that is lower and someone goes and pays more, then we are liable," she says.
She shows me a demo that ends up revealing the range of costs for a brain MRI is between $372 to $1,223.
Amsel says that kind of range is not unusual, which is one reason it's important for people to know how much health care costs.
"We know that people are frustrated," Amsel says. "They go to the doctor not knowing, they come back with a big bill that they didn't expect, they weren't able to plan for it, they weren't able to prepare for it. So I think this will help them quite a bit."
Harvard Pilgrim will spell out what's included and what's not in its estimate. I went back and forth several times with my insurer, Blue Cross, and then it took two days to find out my X-ray would cost $147. So we in Massachusetts can find out in advance, how much everything from a blood test to open heart surgery costs. But in these early days at least, it isn't quick or easy.
This story is part of a partnership that includes NPR, WBUR, and Kaiser Health News.
Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communications organization not affiliated with Kaiser Permanente.