For nearly a decade, Kate Carpenter, 38, has been bothered by a cartilage tear in her shoulder that doctors say can only be repaired via surgery. When it started acting up again last summer, she decided to investigate what the procedure would actually entail.
Carpenter met with a surgeon who requested that she get an updated MRI since the one she had was nine years old. The cost for the MRI, which included injecting dye into her shoulder, at the hospital the surgeon recommended was $2,100.
Since Carpenter, a freelance writer, has health insurance with a deductible of more than $3,000, she knew she’d be on the hook for that entire amount, so she decided to shop around for a better price. That process ended up being more difficult than she had imagined.
Her insurer offered an online tool with pricing info, but it didn’t include the specific type of MRI she needed and it was missing some in-network centers in her area. So she started calling the medical providers directly. “No one could give me an answer,” she said. “And no one can even understand why you’re asking. I got so many people who just kept saying that my insurance would cover it.”
But Carpenter’s plan—like millions of others with a high deductible—doesn’t cover any non-preventive procedure until after she has met that deductible. After several hours of phone calls made over the course of two weeks, Carpenter finally got a list of prices that ranged from $400 to $3,000, and she’s still not entirely sure the cheaper places could do the exact procedure she needed.
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The entire experience left her frustrated. “In the end, I decided not to get the MRI last summer,” she says. “I’ll wait until I’m actually ready to do the surgery.”
Carpenter’s experience is not unique. One in three Americans say they have put off medical treatment for themselves or a family member because of the cost, according to a Gallup poll last year. That’s the highest rate recorded in Gallup’s history.
Graphic designer Linda Tutovan, 34, has taken her infant son for wellness visits but is eschewing seeing any specialists herself this year. She’s hoping to switch out of her family’s high-deductible plan next year “I’m avoiding things like physical therapy for my ankle [injury], a chiropractor for my hip, a dermatologist for the scar from my C-section,” she says. “Those things are all on my list, but not high enough for us to tap into our high deductible… It’s so painful to pay off.”
As more and more Americans find themselves in high-deductible health plans, they’ve suddenly got financial “skin in the game” when it comes to making healthcare decisions.
Industry experts say that as Americans start taking costs into account when determining how to spend their medical dollars, this shift is going to tame healthcare spending eventually. “It’s still about getting good, appropriate health care, but that doesn’t always mean the most expensive health care,” says Karen Marlo, vice president of the National Business Group on Health.
The transition hasn’t been entirely smooth. For generations, Americans have been accustomed to healthcare that feels free—that is, they’ve paid a relatively modest copay to see their physician, followed the doctor’s directions and then barely glanced at the explanation of benefits that came a month or so later from the insurer.
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Not only are Americans not trained to consider cost when it comes to healthcare, but the industry is not set up to make doing so simple. Doctors and hospitals charge patients different rates based on who insures them, and getting a straight answer on what those rates are is difficult. While employers, insurers, healthcare providers and a growing number of startups are hard at work creating an array of digital tools aimed at creating price transparency, there’s no one-stop shop for easily comparing the costs of various doctors or medical procedures.
Still, there are a few useful tools out there and some important best practices that consumers can follow to keep costs down. Follow these steps to move in the right direction:
1. Start with your insurer’s website. Even though Carpenter had a difficult time with hers, many insurers and employers now offer web portals you can use to evaluate physicians based on everything from cost to treatment outcomes and patient reviews.
The site will also tell you whether a potential provider is in or out of network. “That can make a huge difference in terms of what the consumer will end up paying out of pocket,” says Caroline Steinberg, the American Hospital Association’s vice president of trends analysis.
If you’re scheduling a hospital procedure, you’ll want to make sure that not only the hospital is in your network but that the physicians are as well.
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2. Avoid the hospital if possible. Unless you’re facing a true emergency, there’s probably a lower-cost option for treatment than visiting the emergency room. If you can’t wait to get an appointment with your doctor, an urgent care center can handle illnesses and relatively minor injuries that occur during off hours, and typically do so at a much lower price.
For procedures like colonoscopies or outpatient surgeries, an in-network ambulatory care center or specialized clinic often offers cheaper service than a hospital.
3. Use your HSA. Anyone with a high-deductible health plan is allowed to open an HSA. This year, individuals can put up to $3,350 into the tax-deductible accounts, and families can put in $7,650. Money grows tax free, can be withdrawn for any qualified medical expense and rolls over year-to-year.
4. See if your doctor will negotiate. Once doctors understands that you’re going to be paying the cost of a visit out of pocket, they might be willing budge on the price, set up a payment plan or to give you a discount for paying the entire bill upfront. “Doctors are turning to these techniques because otherwise they know they’re going to have to write it off or call a collections agency,” says Boston-based benefits consultant Pat Haraden.
