In Massachusetts, Health Care Prices Remain Hard To Get
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 of them.
So I'm curious, how much does an X-ray cost? It sounds like a simple question. In most places, it's impossible to find out, but I live in Massachusetts, where a new state law says insurers must be able to tell members, in advance, how much a test, treatment or surgical procedure will cost.
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 a company rep named Jamie, and 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? Where do I want to have the X-ray done? I have the doctor's name and a facility in mind, but then I'm stuck. 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. Why? So the insurer 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 right? That way patients can start behaving more like savvy consumers.
Insurers aren't thinking that way. They all sound a little overwhelmed by trying to put a price tag on medical care.
"The challenge is really about trying to make this information personalized and useful," says Derek Abruzzese, a vice president at Tufts Health Plan. "Unfortunately health care is very complex, and so it's difficult to make things simple, straightforward and precise."
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 [neither] we, nor the member — nor the provider for that matter — could have foreseen at the time that estimate was requested," he explains.
Insurers also worry about getting the price right because the new state law puts insurers on the hook if they are wrong.
"If we show an estimate that is lower and someone goes and pays more, then we are liable," says Sue Amsel, who is working on a shopping tool that insurer Harvard Pilgrim Health Care is developing.
She shows me a demo that ends up revealing that the range of costs for a brain MRI is between $372 and $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 costs.
"We know that people are frustrated," she 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, and 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 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 collaboration among NPR, WBUR, and Kaiser Health News.
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