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Health Care Is Broken, Here's How to Fight Back

Like a lot of people, I use a high deductible health insurance plan. As we near health insurance sign up season I thought I’d share a story that illustrates the importance of cost comparison. Health care is a service where pricing is rarely asked about and can be difficult to uncover in advance. It takes persistence and a bit of extra time, but it can save you money. 

There is very little cost transparency in health care. The landscape is further complicated by health care being regulated state by state. In the ACA marketplace, some health systems contract with only one insurance company. No other insurance companies can list their doctors and facilities as in-network. In exchange, the insurance company that has exclusive access agrees to higher prices charged by this health system. The insurance company just charges a higher premium to the policyholders. It’s a win-win for the insurance company and the health system, and a lose-lose for consumers (higher premium and higher out-of-pocket before meeting one’s deductible). One way to even the playing field if you are a patient that requires a procedure (beyond a normal office visit), is to use one of the cost estimators to shop for the best price.

Earlier this year my daughter required an MRI on her knee following a lacrosse injury. I used the Blue Cross Blue Shield cost estimator tool to evaluate the price differences between various imaging providers near us. 

The cost varied between $1230 - $1850 for the same procedure. Since we were paying that amount as part of our deductible I asked the doctor if we could order it at the lowest cost facility.

It turned out we saved about $350 just by doing a price comparison after the diagnosis. And often the more expensive the procedure, the greater the cost variance. Be sure to ask your doctor for the procedure code, as there a plethora of options for even the simplest procedures.

Here are two cost estimator websites that may be helpful.

http://www.bcbsnc.com/content/providersearch/treatments/index.htm#/

https://www.fairhealthconsumer.org/medical/select-medical-eoc