Pay­ing cash for med­i­cal care

Web­sites help pa­tients by­pass­ing in­sur­ance find prices for pro­ce­dures

Los Angeles Times - - MONDAY BUSINESS - By Lisa Zamosky health­care@la­times.com Twit­ter: @lisazamosky Zamosky is the au­thor of “Health­care, In­sur­ance, and You: The Savvy Con­sumer’s Guide.”

Vicki Burns was told she needed to­tal hip re­place­ment surgery in 2012 she asked her lo­cal hos­pi­tal for a cash price. She got a $79,000 es­ti­mate for the surgery.

A doc­tor ad­vised her to re­search the fee that the hos­pi­tal ac­cepts from Medi­care and use that as a start­ing point. Her hus­band gath­ered the data and tried to ne­go­ti­ate.

“They wouldn’t even talk to him about it,” she re­calls.

Des­per­ate for an al­ter­na­tive, the New Mex­ico cou­ple took to the In­ter­net and found a Ten­nessee web­site they liked called MediBid. For $4.95 a month or $25 for a year of un­lim­ited re­quests, pa­tients can post the med­i­cal ser­vices they need, and doc­tors bid for their busi­ness.

“I felt a lit­tle like I had been put on EBay or Craigslist,” Burns says. “Within two days, I had two quotes.”

The prices in­cluded her hos­pi­tal stay, the anes­the­si­ol­o­gist, pre-op­er­a­tive tests and post-sur­gi­cal vis­its.

She set­tled on a sur­geon in Glen­dale who of­fered to op­er­ate for $13,400. In­clud­ing the cost of trav­el­ing to Cal­i­for­nia, she fig­ures she spent $18,000 for the surgery she got in 2012.

MediBid, which has been in busi­ness since 2010, has re­turned up to 17 bids from doc­tors na­tion­wide for knee re­place­ment surg­eries and of­ten six or seven for com­mon pro­ce­dures, such as colono­scopies, says founder and Chief Ex­ec­u­tive Ralph We­ber.

Dr. Peter Le­Port, a gen­eral sur­geon prac­tic­ing in Foun­tain Val­ley, par­tic­i­pates with MediBid. He says he’s seen a rise in the num­ber of pa­tients with high-de­ductible health plans look­ing for cheaper al­ter­na­tives. Pay­ing cash in­stead of us­ing in­sur­ance of­ten helps them get lower prices.

“The de­mand is out there. Peo­ple in gen­eral know how to shop, and they are just learn­ing how to shop in the med­i­cal mar­ket­place,” Le­Port says.

With ris­ing out-of-pocket ex­penses, pa­tients are in­creas­ingly de­mand­ing in­for­ma­tion about price and qual­ity that his­tor­i­cally has been un­avail­able.

En­trepreneurs, states and em­ploy­ers now of­fer such tools. A num­ber of newly formed coali­tions made up of in­sur­ers, phar­ma­ceu­ti­cal com­pa­nies and other in­dus­try in­sid­ers are also vow­ing to push for the re­lease of price in­for­ma­tion long held as trade se­crets.

There’s a race un­der­way to de­velop use­ful tools pa­tients can put to prac­ti­cal use.

San Fran­cisco-based Pok­itDok (pok­itdok.com), co-founded by CEO Lisa Maki in 2011, op­er­ates in 44 mar­kets, in­clud­ing Los An­ge­les. You can search the 50 most shopped med­i­cal pro­ce­dures among 40,000 providers who have sub­mit­ted their cash price.

If Pok­itDok does not have the price for the pro­ce­dure you’re look­ing for, you can ask it to re­trieve up to five quotes for you.

If you upload your in­sur­ance in­for­ma­tion, Pok­itDok will tell you if it’s cheaper for you to pay cash or use your in­sur­ance pol­icy. In­sur­ance claims can be sub­mit­ted through the site. You can also make an ap­point­ment to see a doc­tor.

New York-based Clear Health Costs (clearhealth­costs.com) was started in 2010 by for­mer New York Times re­porter Jeanne Pinder.

Its staff queries in­di­vid­ual health­care providers in eight mar­kets, in­clud­ing Los An­ge­les, for a cash price on up to 35 com­mon med­i­cal pro­ce­dures.

When a provider’s price isn’t avail­able, Clear Health Costs will show you the Medi­care re­im­burse­ment rate for the care you need in your area, along with use­ful notes from other pa­tients about their ex­pe­ri­ence with providers.

“There is some­thing for every­body here. Even if we don’t hap­pen to be in your metro area, we will give you some use­ful in­for­ma­tion,” Pinder says.

The site also part­ners with news or­ga­ni­za­tions around the coun­try, in­clud­ing two public ra­dio sta­tions in Cal­i­for­nia — KPCC in Pasadena and KQED in San Fran­cisco — to col­lect prices of com­mon med­i­cal pro­ce­dures di­rectly from pa­tients. You can con­trib­ute by shar­ing your costs and also search the data­base for in­for­ma­tion at www.scpr.org/ price-check.

New shop­ping tools like th­ese fre­quently en­ter the mar­ket, and es­tab­lished ones are con­stantly evolv­ing.

Still, find­ing ac­cu­rate health­care cost in­for­ma­tion gen­er­ally re­mains dif­fi­cult, and there is no com­pre­hen When sive data­base of health­care prices.

That’s be­cause com­pe­ti­tion has kept health­care providers and in­sur­ers from openly shar­ing cost in­for­ma­tion that would be use­ful to pa­tients, says David Lan­sky, CEO of Pa­cific Busi­ness Group on Health, a non­profit or­ga­ni­za­tion in San Fran­cisco that rep­re­sents the health­care in­ter­ests of large em­ploy­ers.

“The peo­ple who pay and are paid don’t want to dis­close their prices to the public,” he says.

Ex­perts have iden­ti­fied a few things to con­sider when com­par­ing health­care prices.

Price doesn’t equal qual­ity. “You should not as­sume less ex­pen­sive care is worse, and you should not as­sume more ex­pen­sive is bet­ter,” says Suzanne Del­banco, ex­ec­u­tive direc­tor of Cat­a­lyst for Pay­ment Re­form, which works to re­form health­care re­im­burse­ment.

Most pric­ing tools have at least some to­ken qual­ity in­for­ma­tion, Del­banco says, though not typ­i­cally dis­played in ways likely to help con­sumers eas­ily com­pare choices.

Still, she says, “You may not find qual­ity in­for­ma­tion that is par­tic­u­larly rel­e­vant to you, but to the de­gree it’s there it’s worth look­ing at.”

Un­der­stand your health plan. You need more in­for­ma­tion than a sim­ple dollar amount. To re­ally know how much you’re likely to pay for care, you need to un­der­stand what your in­sur­ance pays for, how much of your de­ductible you’ve sat­is­fied, and any other out-of-pocket costs your plan re­quires you to pay.

Read the fine print. Pric­ing data vary widely from web­site to web­site, mak­ing ap­ples-to-ap­ples com­par­isons a chal­lenge.

“Un­for­tu­nately you do have to read the fine print and you have to click on those lit­tle foot­notes so that you un­der­stand what’s re­ally be­ing dis­played,” says Lan­sky of the Pa­cific Busi­ness Group on Health.

Burns, the re­tiree from New Mex­ico, says ne­go­ti­at­ing a cash price did more than just save money on her surgery. With­out it, she says, “we would have used all of our life sav­ings, and it would have pushed us close to the brink of not hav­ing any re­tire­ment.”

Robert Gau­thier Los An­ge­les Times

DR. PETER Le­PORT, a Foun­tain Val­ley sur­geon, says he’s seen more pa­tients with high de­ductible plans look­ing for cheaper al­ter­na­tives. Pay­ing cash in­stead of us­ing in­sur­ance of­ten helps them get lower prices.

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