Price Transparency

Finding out how much an X-ray costs sounds like a simple question. But it is actually very difficult to get an answer. In Massachusetts, a new state law requires insurers to be able to tell members how much a test, treatment or surgery will cost.

price-comparison-taggI threw out my back in September playing squash and went to the doctor. She sent me down the hall for X-rays. I may need more. I’m curious about what my costs will be, so I call my insurer, Blue Cross.

Blue Cross wants the procedure codes for each X-ray I may need, my doctor’s national ID number and the name, address and ID number for my hospital or lab, so it can consolidate all the charges into one estimate.

Jamie directs me to a form online. I call my doctor and get the info. If I want to compare prices, I’ll have to fill out separate forms for each X-ray lab. Then Blue Cross has 48 hours to get me an estimate. It takes me 20 minutes to fill out the form, so I only fill out one.

I went back and forth several times with my insurer, Blue Cross, and then it took two days to find out my X-ray would cost $147. So we in Massachusetts can find out in advance, how much everything from a blood test to open heart surgery costs. But in these early days at least, it isn’t quick or easy.

Martha Bebinger, KHN.

Comments (24)

Trackback URL | Comments RSS Feed

  1. Billy says:

    “I threw out my back in September playing squash”

    That’s one of the most rich, white-person ways of hurting yourself that I can imagine.

  2. Wilbur says:

    “Finding out how much an X-ray costs sounds like a simple question.”

    It would be if insurance wasn’t involved.

    • Billy says:

      Or government manipulation.

    • Wiliam says:

      That’s why we need to simplify the system.

    • Alisa LeSueur says:

      There are several Price Transparency websites to help facilitate this research, but most charge the healthcare provider to list pries and/or charge the consumer to see the prices, with a minimum requirement of a “free registration” for the consumer to see the pricing – which is a way to create a mailing list to sell…
      The only site that I have found that is totally free for both parties with no consumer registration is which is the
      site for cash-only pricing so there is no insurance interference with the doctor-patient relationship. They get my vote to turn this whole thing around.

  3. Tom G. says:

    “Blue Cross wants the procedure codes for each X-ray I may need, my doctor’s national ID number and the name, address and ID number for my hospital or lab”

    Oh, is that all?

    • Jackson says:

      Let me just give you my doctors blood type and social security number, that way you can give me an accurate estimate.

  4. Kilian says:

    Looks like Massachusetts made a step in the right direction.

  5. Bob Hertz says:

    Kilian is right, the rest of you guys should hold the levity.

    This is revolutionary. Once patients find the price, they can challenge the price by looking elsewhere.

    Hospital revenue from overpriced outpatient care could dry up overnight.

    In the long run that is a good thing but we had better be prepared to stop them from price gouging on everything else.

  6. Anthony Perry, MD says:

    What should be asked along with the price, and would probably be asked if payment for the X-ray was out of pocket, is why is the X-ray needed at all. What are the chances that something will be found that will make a difference in how things will go with my getting better. It sounds to me from the description of the event that the answer would almost certainly be “no difference”. Many times doctors order tests, like plain X-rays for acute back injuries,in order to be doing something. And why not. It costs nothing and pleases the patient who also likes to have the feeling that something is being done as long as it doesn’t cost anything.
    The other aspect is that in the free market with patients paying out of pocket a plain X-ray of the lumbar spine would cost not $147 but perhaps 10-20% of that amount.

  7. Jimbino says:

    Massachusetts and others would perform a great public service by publishing the Medicare dollar allowances for all procedures by CPT code. I had to file a FOIA here in Texas to get the full list.

    I decided to get cataract surgery in Rio de Janeiro after finding out that it costs half as much as here in Texas. The Brazilian gummint requires several labs before any surgery and they carry these prices:

    – Hemograma completo – R$28,00
    – Coagulograma – R$45,00
    – Glicose – R$12,00
    – Uréia – R$12,00
    – Creatinina – R$15,00
    – Eletrocardiograma – R$30,00
    – Raio X de tórax – R$40,00

    – Total: R$192 = $85

    Here in Texas, those tests would cost a fortune. Anyone who submits to health care in the USSA, or even worse, health insurance, has to have run out of good sense or options.

    • A. M. Perry says:

      None of those tests are required for a cataract procedure by our local ophthalmologists. Even if they were, Healthnet Laboratories in my office building posts prices for any of the blood tests for those paying out of pocket. They offer a screening package which should be considerably cheaper. Shop around. Do your medical tourism in the U.S. and save money.

      • Jimbino says:

        I have checked for prices here in the USSA. Just the fact that everyone first asks, “Do you have insurance?” is enough to set me against him. Just like Walmart, Amazon, eBay, Costco and Home Depot, the healthcare suppliers in other countries don’t insult me with the insurance question.

        So why don’t you post those prices of your Healthnet Laboratories?

        “Shop around” in Amerika is a joke. Everybody is conspiring to hide the pricing, and even the new law in Massachusetts isn’t much practical help. As every economists knows, price signalling is crucial to proper functioning of a market.

  8. Linda Gorman says:

    In less regulated states, one just calls a free standing imaging center, describes what has to be done, and asks for the cash price.

    • Jimbino says:

      Well Linda Gorman,

      It’s not that easy. Our local clinic that runs blood and urine labs doesn’t do x-rays. I called them: they charge $127 for a blood test.

      Urine extra. ECG extra. X-ray $200 somewhere else.

      If you really wanted to be helpful, you might quote what prices you found in your corner of the cave in the USSA for all those tests.

      Texas regulates booze worse than surgery, labs and drugs. The big thing Texas has going for it is its proximity to Mexico, where cataract surgery, for example, costs $1400 total, about one-third the best price in Austin.

  9. Bob Hertz says:

    Jimbino raises a good point. Millions of Americans live in small towns where there is only one clinic.

    The price of tennis shoes and pocket calculators and clothing has fallen because the goods can be produced in cheap labor countries and shipped to the USA.

    Whereas health care tourism requires that the buyer actually go to the cheap labor country! This adds travel costs of course and time costs if one must take time off the job.

    Medical tourism right now is a good option for people with some extra time and money. That leaves millions of Americans still at the mercy of medical monopolies

    This is not an attack on medical tourism. I would just love to see ideas to make it better.

    • Jimbino says:

      Actually, Bob Hertz, you need very little extra time and much LESS money than you would need in Amerika.

      Nuevo Laredo is only a 4-hour ride from Austin, and you can overnight on this side of the border and walk and take a taxi to your clinic in Mexico.

      Cheap and nice buses leave every day for Nuevo Laredo and Monterrey, so you don’t even need to drive. True, you need some time, but cataract surgery, for example, requires a down time of several days, anyway, no matter where you are.

      Would you rather have cataract surgery and sit around in Houston, than in Cancun, Budapest, Prague, or Rio de Janeiro, for less?

  10. Bob Hertz says:

    I live near the Canadian border, so traveling to Mexico is not automatically a money saver.

    But I like the energy with which you approach this. I still am looking for examples of good domestic medical tourism.

    A few large employers will now fly an employee to Cleveland for heart surgery to save several thousand dollars. I am not sure why this has not caught on more.

    If it does catch on, the economic disruption will be just like the disruption in US manufacturing in the 1980’s. Many thousands of highly paid nurses and technicians in expensive hospitals will lose their jobs and not find other employment. Economically the cure may be worse than the disease, though comments are welcome if I am wrong.

    • Jimbino says:

      I agree with you that Medical Tourism should be the way of the future, but our insurance-medical system would collapse like Detroit did if we opened it up to competition, even domestic.

      There are powerful forces lined up to fight liberalization: insurance, labs, clinics, hospitals, docs, nurses, drug manufacturers and pharmacies.

      Consider Medicare Part D. It wasn’t created by our Republican leader in order to serve the ‘Merican people, but to protect drug companies from the drug tourism of seniors to Canada and other places. Just like Obamacare, you can’t use your Medicare chits across the border.

      I think only two measures are needed to rationalize Amerikan medicine: (1) eliminate the favorable tax treatment of employer-provided insurance and (2)force all healthcare providers to publish all prices by CPT code on the WWW.

      The first measure would effectively force Amerikans to spend their own healthcare dollars on their health care and the second would show them what a ream-job they are getting domestically compared with what’s available throughout the world.

      Of course, it would also have the positive side-effects of relieving young males of their current obligation to support breeding females and incentivize females to return to the workforce instead of breeding on the dole.

  11. Jake Spencer says:

    Texas has had this kind of law for years.

    The question really is – who the heck shops for medical care on price? No one. I hired/paid the insurer to negotiate and create networks. All of that “shopping” should be DONE ALREADY.

    If not, then why the heck am I paying an insurer to create a network?