FORT WAYNE, Ind. (WANE) — How consumer-friendly are hospital and insurance websites in Northeast Indiana? Is price shopping for health care possible?
Gary Shearer, president at Physicians Health Plan of Northern Indiana, Inc., was shocked by the money he saved on one of his prescriptions simply by using his company’s new medication pricing tool.
“I was getting it home delivery for $165. I could go to a local Kroger and get it for $35. That’s why it’s so important to use this tool to shop for the lowest price.”
Cases like Shearer’s are exactly why state and federal lawmakers want to make health care prices more transparent and easy to shop.
(Scroll down for shopping tips.)
Health insurance companies are required by the federal government to offer price tools beginning July 1, 2022.
The mandate for hospitals is slightly older. At the start of 2021, hospital websites were required to provide “clear, accessible pricing information” online about the items and services they provide in two ways:
- As a comprehensive machine-readable file with all items and services.
- In a display of shoppable services in a consumer-friendly format.
Most sites offer price estimates of 300 services ranging from an ultrasound to a urine test to an emergency room visit. WANE 15 went shopping on area hospital websites to discover the price of a vaginal baby delivery with no complications.
Prices can change drastically. Add an epidural or an extra day in a hospital bed and the patient’s cost will climb.
Every website was filled with disclaimers to remind consumers of the difficulty. Adams Memorial warns “the charges listed provide only a general starting point… Many factors may influence the actual cost of an item or service, including insurance coverage, rates negotiated with payors, and so on. The cost of treatment also may be impacted by variables involved in a patient’s actual care, such as specific equipment or supplies required, the length of time spent in surgery or recovery, additional tests, or any changes in care or unexpected conditions or complications that arise.”
WANE 15’s search results were mixed. Lutheran Health Network did not offer an online estimate for vaginal delivery at either Lutheran or Dupont Hospital, requiring an email or phone call to receive an estimate. Both Adams Memorial in Decatur (county owned) and Cameron Memorial in Angola (independent, not-for-profit) showed their prices compared to a regional average. Parkview Health allowed site users to find a procedure and easily switch from location to location.
WANE 15 also shopped mycareinsight.org, a site created by the Indiana Hospital Association in 2015 to compare hospital charges and quality of care. While the site was easy to use, the prices shown were “sticker prices” which a hospital might bill, knowing an insurance company will sharply negotiate the sticker price down. These prices are less helpful for consumers but the hospital quality scores might sway a shopper’s decision.
Much like car shoppers use the Kelley Blue Book, healthcarebluebook.com can be used to show a “fair price.” The fair prices in a WANE 15 search for a standard birth were $6,354 for the hospital, $2,714 for the physician and $1,856 for the anesthesia. The site showed total prices in the area ranged from $8,739 to $27,997.
Most hospital sites feature a custom price estimate for users who input their insurance information. WANE 15 searched for cash prices only. Some industry observers believe the “self-pay” price is often the lowest. However, some hospital systems fear customers who pay cash are uninsured and more likely to default, which results in a write-off for the hospital. Those providers may offer further discounts for “prompt payment,” which is not always reflected in the search results.
|Hospital||mycareinsight.org||Hospital website (cash price)|
|Dupont Hospital||$26,066.75||$3,459 (via phone call)|
|IU Health Jay||$21,305.68||$2,336.40|
|Lutheran Hospital||$23,995.75||not available|
|Parkview Randalia||not available||$15,074|
|Parkview Regional Medical Center||$19,884.03||$15,074|
While individual price estimates are good tools for consumers to shop for themselves, no site revealed the universe of hospital prices. Hospitals do not show the charge for each different insurance payer, which some observers say would bring better price competition. If that was the intention of lawmakers, additional work remains.
The Centers for Medicare & Medicaid Services audits hospital websites for non-compliance, imposing fines of up to $300 a day. Hospitals in northeast Indiana tell WANE 15 they have never been cited for non-compliance.
Parkview, Lutheran and IU Health all declined on-camera interviews. However, each emailed WANE 15 to say a phone call is even better than an online search.
Parkview reported over 500 procedures at mychart.parkview.com and also pointed shoppers to its growing team of financial counselors who can help calculate costs.
At Parkview, we believe that healthcare value includes much more than just cost. Metrics like quality, utilization of services and the patient experience also contribute to value and should be considered when shopping for services. We recommend looking at quality information on sites such as hospitalsafetygrade.org. Reviews and ratings related to patient experience with providers are available on Parkview.com.– Parkview Health
Lutheran Health Network also suggested the website and patient access staff who “will provide a personalized estimate on a service cost and help people understand their health insurance by reviewing benefits, including required deductibles and copays. They can also provide information on several financial assistance programs we offer to patients without insurance, such as qualified charity care, discounts and extended payment plans. Our patient access staff will also check a patient’s eligibility for programs that cover medical services, such as Medicaid. All Lutheran Health Network hospitals also offer an online price estimator tool on our website here: https://www.lutheranhealth.net/pricing-information.”
IU Health emailed that “the IU Health price estimator, in use since 2015, provides patients with meaningful estimates of cost of care and has proven to be timely and accurate. Fully 80% of our estimates are provided the same day as requested and 95% within 24 hours and they are accurate to within 5% of the actual patient cost. The estimator provides more useful information to consumers than price charge listings, which don’t take into account patients’ unique needs and their specific insurance coverage.”
Why it’s important to shop for more than ‘out of pocket’ costs
Many consumers know their health insurance will either negotiate or pay the bulk of the hospital bill so why worry?
Shearer with PHP said employee groups who cut costs are rewarded with immediate savings and again when they renew their plan. If employees spend less, the cost to insure them is less. Shearer has heard of employers who reward workers with cash incentives to choose a less expensive hospital but said PHP does not offer any plans like that.
He predicted a time when patients would automatically receive an estimate before a procedure. “That facility can send us the diagnostic codes for the treatment that they’re going to have and we’ll have to send back a pre-explanation of benefits that would give that member a really good estimate for what that’s going to cost them. That’ll be the next step.”
That “diagnostic code” is the key for shoppers. Dr. Eric Bricker, who hosts healthcare finance videos on YouTube and offers insider information at ahealthcarez.com, told WANE 15 that “every procedure has a five digit code that is referred to as a CPT code, which stands for Current Procedural Terminology.”
The CPT code is the key to getting the cost estimate right since “if you just say ‘MRI,’ well, there’s a ton of different MRIs and it might not be the actual type of MRI that you’re going to have.”
Bricker said you can get the CPT code from your doctor. Once you have that, you need to tell the hospital your insurance carrier and ask them for the “allowed amount.”
“If they can’t tell you, then it is highly likely they’re not compliant with the transparency law,” said Bricker. “When they say, ‘Well, I can’t tell you that, they’re actually breaking the transparency law and paying the fine.
“It is a perfectly reasonable expectation for a person to know what a healthcare service is going to cost in advance. We as consumers should be able to request and the hospital or the doctor’s office should be able to tell us. That’s completely normal. The fact that they can’t do it, that’s abnormal, and that’s why it needs to change.”