Health Care

Price shopping for surgery? Some websites can help

Guroo.com, a website developed by the Health Care Cost Institute, uses claims data from several different insurers that cover 40 million Americans to provide local, state and national cost averages for 295 “bundles” of medical care for everything from acne treatments to X-rays.
Guroo.com, a website developed by the Health Care Cost Institute, uses claims data from several different insurers that cover 40 million Americans to provide local, state and national cost averages for 295 “bundles” of medical care for everything from acne treatments to X-rays.

Raymore resident Dana Fogt couldn’t believe his eyes when he got the bill for his wife’s minor medical procedure earlier this year.

The skin biopsy she had at a local hospital came with a price tag of almost $3,000. When Fogt called a different facility where she had the same procedure in 2009, they said they could have done it for well under $1,000.

Fogt and his wife have a $10,000-a-year deductible on their health insurance, so the cost difference hit them right in the hip pocket.

“The discrepancies are so huge,” Fogt said. “Our complaint isn’t with the price. It’s just that we had no ability at the time to know.”

High-deductible health plans like the Fogts’ are on the rise nationwide, making it all the more important for health care consumers to shop around, even for surgical procedures.

Historically that’s been pretty tough, because the prices for things like biopsies have been less than transparent.

But some websites are trying to provide consumers with tools to at least get an idea of what they should pay for certain procedures.

The first place to start is generally with insurance companies. They have mounds of claims data that show what different facilities have charged for specific procedures in the past, and some companies make data available to members.

UnitedHealthcare, the nation’s largest commercial insurer, has pricing data on about 875 medical treatments that the company considers “shoppable” because they’re things patients can plan for in advance. The company has a mobile app and a cost estimator website that allow members to see what in-network providers in their area charge for the procedures.

If the provider is a hospital, the app and website also provide some safety ratings from the Leapfrog Group, a nonprofit that curates hospital performance data.

“We’re able to give people a really solid estimate of what that service is going to cost them and hopefully some insights on quality,” said Craig Hankins, UnitedHealthcare’s vice president for digital products.

As Fogt found out, prices can vary widely. Hankins sent examples: Within a 25-mile radius of Kansas City, a knee MRI scan can cost anywhere from $745 to $3,210 in UnitedHealthcare’s network, and a lumbar fusion back surgery can cost between $44,655 and $86,474.

Other insurers also have price comparison tools for members. Blue Cross and Blue Shield of Kansas City partnered with Overland Park-based Rx Savings Solutions to develop a tool to compare prescription costs that went live last year. Jason Spacek, Blue KC’s chief innovation officer, said the company is working on a tool for surgery and diagnostic prices.

“That’s still very much under development, but it’s definitely on our roadmap,” Spacek said.

Insurer sites have limitations, though. Nonmembers can’t access most of the data, and out-of-network providers aren’t included.

The Health Care Cost Institute, a nonprofit based in Washington, D.C., is trying to compile a more comprehensive database that’s open to anyone at a site called Guroo.com.

The site uses claims data from several different insurers that cover 40 million Americans to provide local, state and national cost averages for 295 “bundles” of medical care for everything from acne treatments to X-rays.

The site doesn’t have prices for individual providers, but David Newman, the Health Care Cost Institute’s executive director, said it at least gives uninsured consumers some information about what a reasonable cost is if they want to call around. It’s also meant to spur providers that charge way more than the average to see what their colleagues are doing and lower their prices accordingly.

“The purpose as we see the price transparency tool is to change markets and not necessarily consumers,” Newman said.

Fogt said any upfront pricing information is better than what he and his wife had, and he’ll be using whatever he can find in the future.

“If you did nothing more than caution people to shop around, you’d be doing a service to the public,” Fogt said.

Andy Marso: 816-234-4055, @andymarso

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