Welcome to the New Era of Health Care

03/26/2015 11:00

by Jud Anglin

Last week, my good friend Thomas called me and told me his lower back was in tremendous pain and that he was unable to get a good night’s sleep.

Naturally, I told him he should schedule an appointment with his doctor to find out what’s going on.  But then he explained that his company had converted his health benefit into a high-deductible plan. And with a new deductible of $6,000, he decided to wait it out instead.

The deductible, if you recall, is the amount you must pay out of pocket before your insurance kicks in and pays the remaining portion.

Thomas is not alone. Unfortunately, his experience is becoming ever more common.

USA Today recently reported that Americans are increasingly putting off doctor visits, avoiding needed procedures, and even splitting their pills due to higher insurance deductibles. In the past several years, insurance deductibles have been skyrocketing for most Americans. Last year, in fact, saw the largest one-year increase in high-deductible plan enrollment. For covered employees, the number rose from 18% to 23%. And get this, “the size of the average deductible more than doubled in eight years, from $584 to $1,217 for individual coverage,” the USA Today article goes on.

“Add to this copays, coinsurance, and the price of drugs or procedures not covered by plans -- and it's all too much for many Americans.”

Under Obamacare, health plan deductibles are even higher.

According to HealthPocket, the Bronze plan deductible is $5,081 for individuals and a whopping $10,386 for families.  What this all means is that the majority of Americans are now paying a lot more for health care than they expected.

Given that so many of us are now paying for health care out of our pockets and unable to rely on third parties like insurance, Medicaid, or Medicare, it makes sense to shop around for the best price. And if you’re not going to rely on your health insurance, this means you can even shop outside of your network.

Discover How to Find the Price

One of the most important pieces of information when shopping for any product or service is, of course, finding out what the price is.  In terms of health care, this has been a major sticking point. Due to the complex relationship between insurance providers and medical billing departments, the actual price has often been swept under the carpet in order to hide the negotiated lower prices paid by the insurers.

This problem is truly maddening for the uninsured and underinsured. Finding out the cost of a surgical procedure like a hernia repair has been nearly impossible.

Unfortunately, what has typically happened is that after the surgery’s conducted, uninsured patients are billed tens of thousands of dollars more than what the large insurance companies pay, because they don’t have any negotiating leverage. However, there are several new online services available today that can help you determine a fair price for medical procedures in your area before you make contact with the provider.

Health Care Price Search Tools

Healthcare Bluebook -- “Our free Fair Price search tool makes it easy to find the price you can expect to pay for medical services in your area. With answers at your fingertips, you can now make fully informed decisions to get the right care at the right price -- whenever you need it.” The Healthcare Bluebook website is comprehensive, allowing you to search for hospital, physician, imaging, labs, cosmetics, hearing aids, dental, and medications.

Guroo.com -- This new Web service provides pricing on conditions and treatments. Once you find the procedure that’s needed, the site provides you with the average cost in your area. It is a new service, so they have only 78 treatments listed at this time. However, they do state that they are expanding very rapidly.

Pricing Healthcare -- An open, independent, online marketplace for cash-pay health care. You will first have to create a free account with a username and password. Once you are registered, you can begin searching their available states, hospitals, and procedures. At the time of this writing, only 15 states offer listed pricing, so you will have to see if you reside in, or are close to, one of these states

 Surgery Center of Oklahoma -- The Surgery Center of Oklahoma, based in Oklahoma City, is the nation's first doctor-owned hospital. They don’t work with insurance or deal with bureaucracy, so they are able to provide care at approximately one-fifth the national average. This link goes to their actual price list.

Among these four different options, I found Guroo.com to have the best user interface. Their procedure search bar was very simple and easy to use, and the search results provide you with robust and clear pricing data. I look forward to seeing this service develop with more listed procedures.

You’ve Got Some Prices… Now What?

Once you’ve found the average price of your required procedure, I recommend then doing the following:

  1.     Determine if the procedure price is above your deductible amount, and, if so, by how much.
  2.     If it doesn’t meet your high deductible, then it’s time to shop around. This will be far more fruitful since you are now armed with pricing information.
  3.     Call your local hospital or care provider and ask to speak with their billing department.
  4.     Tell them that you require a surgical procedure and that you will not be using your health insurance, and as such, you want their lowest price.
  5.     Then inform them that you have the average fair price for your area, which you obtained from one of these online sources.
  6.     Next, tell them that you also have the price from the doctor-owned Surgery Center of Oklahoma.
  7.     Ask if the procedure can be performed as an outpatient service as opposed to an inpatient service, because inpatient services are much more expensive.

Now that we are paying a lot more out of pocket for our health, it’s time to shop, negotiate, and demand a better price.  By knowing average prices ahead of time and then negotiating from this baseline, you’ll be surprised at how much you can save.

Wishing you a happy and healthy day.



© 2015 by Laissez Faire Books LLC.