While myhealthandmoney.com is being designed and put together, we hired several young college students to help us gather facility price information on diagnostic tests.  We didn’t go for physician pricing since this can be extremely complex to figure out, and we wanted to be as accurate as possible. This didn’t seem like a terribly difficult assignment. We sought to get the rack rate (or retail price) for certain frequently prescribed tests that you would pay if you didn’t have insurance.  We also have published Medicare rates for these tests by region. The purpose of this exercise was to be able to show you how variable costs can be, and the range of pricing between Medicare and retail.  Insurance companies negotiate different prices with different providers so we knew this would be too complex to undertake.  Besides, insurance companies keep their prices very close to the vest lest a competitor know what they pay.

Here are a few lessons we learned:

Very few health service providers are comfortable giving out pricing information to consumers
Billing personnel get very nervous when a consumer calls for pricing.  Often, they don’t want to give it over the phone, but would prefer that you make a trip to their office so they can sit you down, look you in the eye, and then give you an estimate.  The other option is to give it to your doctor who can then turnaround and give it to you.

Even staff don’t always understand their pricing structures
Besides debt collection, it’s unusual for a service provider to have to detail prices for patients before any procedure has been done.  Yes, you have to sign a waiver that you’ll pay for the treatment, but notice there isn’t a price tag associated with the waiver.  To be fair, service providers have hundreds of prices for each procedure based on government and private insurance plans.  And it’s easier to give out a price for a Blue Cross/Blue Shield PPO with a group number, then to come up with a price for the cash patient. I’d like to suggest that they give everyone who doesn’t have coverage the same rate as Medicare patients, but it’s doubtful since Medicare has the lowest reimbursement rates of any insurer.

Finding out pricing information is often a game of phone tag
First, you have to find the right phone number, and then you have to find the person in.  Connecting with a human on the other end of the phone is a universal problem when trying to reach a business, but finding the right person in a large hospital setting can be very time consuming.  Is it the billing office I need to speak to?  The practice office?  The specific testing area?  Obviously,  start with the main number and work from there.  Most of the time you’ll speak with a real person who can direct you.  If all else fails, call your physicians office and find out who you should speak with for pricing information for your test or procedure.

Healthcare consumerism is new to healthcare facilities
Health service companies, including hospitals and clinics, were built to care for patients, not to do business with them.  All of the financial operations are separate from patient care, and geared toward working with insurance companies and self-insured employers.  When an individual patient wants to cross the line and take a more active role in the financial aspects of their care, it can be difficult for companies to provide satisfactory customer service.  There is movement in this direction, but make sure you are preemptive in getting the pricing information you need before the care is provided.  Insurance websites now are making pricing information more available as well.  It’s much easier to make decisions if you know what the cost is, not to mention plan for payment.  Don’t wait for the bill to arrive and then the collection agency to contact you before you know what you owe and make arrangements to pay.

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