Surgery Price Shopping with a High Deductible

Understanding Cost Shifting

• Definition: Cost shifting in healthcare refers to transferring expenses from insurers and employers to patients.
• High Deductibles: These plans require patients to pay more out-of-pocket before insurance kicks in, theoretically encouraging cost-conscious behavior.
• Lack of Transparency: Despite the push for cost awareness, insurers and providers rarely disclose prices, complicating efforts to shop for affordable care.

Perspectives on Cost Shifting

1. Patient Viewpoint: Patients feel the burden of high deductibles without access to necessary pricing information, making it difficult to manage healthcare expenses effectively.
2. Provider and Insurer Viewpoint: Providers and insurers often cite confidentiality agreements and competitive concerns as reasons for not sharing detailed pricing.

Online Medical Price Shopping

Available Resources

• HealthcareBlueBook.com: Offers target pricing for uninsured patients but lacks detailed information for those with high-deductible plans.
• NewChoiceHealth.com: Focuses on high-deductible patients but relies on estimated fees, which may not reflect actual out-of-pocket costs.

Limitations

• Sticker Prices vs. Insurance Rates: Websites often provide "sticker prices," which don't account for negotiated insurance discounts.
• Inaccurate Estimates: For example, NewChoiceHealth.com lists a colonoscopy in Cincinnati at $1,850, while actual costs can be significantly lower (source: Healthcare Bluebook).

Why Online Price Shopping Falls Short

• Confidentiality Agreements: Providers and insurers are bound by contracts that prevent sharing specific pricing.
• Complexity of Insurance Plans: Different plans have varying deductibles, copays, and coinsurance, making it hard to provide a one-size-fits-all price.

The Path Forward: Effective Price Shopping

Steps for Patients

1. Direct Communication: Contact providers directly to inquire about costs. Providers can calculate out-of-pocket expenses if given details about the treatment and insurance plan.
2. Benefit Verification Specialists: Many providers have staff dedicated to verifying insurance benefits and estimating costs.

Ideal Solutions

• Insurance Company Tools: Insurers could offer tools to compare provider costs, but currently, most do not provide detailed pricing information.
• Transparency Initiatives: Encouraging insurers and providers to disclose negotiated rates could empower patients to make informed decisions.

Conclusion

High-deductible plans aim to make patients more cost-conscious, but without transparent pricing, this goal remains elusive. By advocating for better tools and direct communication with providers, patients can navigate the complex landscape of healthcare costs more effectively.

For more insights on healthcare cost transparency, visit KFF and CMS.