Trying To Find The Cost Of A Medical Procedure? Good Luck

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As soon as Gov. Deval Patrick signs it, which he's said he'll do soon, a sweeping plan to hold down health care costs in Massachusetts will become law. It's partly designed to get patients to help drive down prices by shopping for the best medical care. By chance, WBUR reporter Martha Bebinger, who covers health care, needs an MRI this week to try to figure out why she's been having migraines lately. As she scheduled that scan, she learned first-hand that even though this new state plan says health care providers will soon have to make price information readily accessible to patients, we're a long way from that. Martha spoke with WBUR's All Things Considered host Sacha Pfeiffer to explain.

Sacha Pfeiffer: Martha, first, I'm very sorry to hear about your headaches, and I hope they go away soon.

Martha Bebinger: Thanks. I do have some conflicting feelings about whether I should get an MRI. It's a very expensive test, and maybe the headaches will just disappear. But my doctor is recommending it, so I'm going ahead.

You're following doctor's orders. So it's expensive, as you said, and you tried to find out in advance how much your MRI would cost. How did that process go?

Well, I started at Newton-Wellesley Hospital, which is where my doctor sent me, and it's been six hours since I first started making calls and I don't have an answer yet. My doctor didn't know, I got transferred to radiology, I got transferred to billing. Billing said they would call me back. I've called them back three times now and I just get a machine.

You couldn't even get a ballpark estimate?

I couldn't get a ballpark.

Now you do have insurance, we should clarify, through your job.

I do. I have insurance with no deductible, so wherever I go this is going to cost me $25. Sorry to all of you with high-deductible or tiered plans out there. But I thought, 'You know, I'll try to be an engaged patient.' I mean, they're telling me this is what I'm supposed to be doing, so I'll start looking for the price. So when I couldn't get through to Newton Wellesley, I tried Mass General, which is what we usually hear is the most expensive, best place, best hospital in the country to go to. They were $5,315, I think. That's for an uninsured patient.

For one MRI — five grand?

For one MRI. Because they couldn't tell me what my rate was going to be as an insured patient. They said they didn't have that information.

That's kind of like the private-pay equivalent?

Yeah. If you don't have any insurance at all and you walk in the door, that's the bill they're going to eventually send you. They said, 'Call your insurer.' I called my insurer. My insurer said, 'We don't have that information, either.' So I'm kind of hitting a wall. So I call Shields, which is an independent lab. They were $600 for the MRI without the dye, and $1,200 for the MRI with the dye.

Does that change depending on whether you have insurance?

Yes. They could, for some reason — I don't know why, Sacha — they could give me the rate with insurance, with my HMO Blue Cross plan.

So one place, MGH, tells you $5,000. Shields tells you $600. Massive disparity.


Overall, how difficult would you say it has been for you to try to find this price?

I can't imagine anyone doing this, Sacha. I was on the phone or on hold for two hours. Very nice people, and this is new. I mean, the bill is not law yet. This requirement does not exist. It will be several years before it's starting to happen. But we're hearing so much that this is going to be an answer to high prices, and so I'm thinking, really? I mean, you can't get them.

And this is a key piece of state health care reform, because we want patients to be able to be knowledgeable and informed — and even you, who covers this industry, can't get these numbers.

I can't find them.

You spoke this morning to Gene Lindsey. He's a doctor who runs Atrius, the state's largest physicians group. It includes Harvard Vanguard. Let's hear what he said to you about how far we are in Massachusetts from the day when patients can go to their doctor, get a referral for a test or procedure, and right away look at the price and quality options:

Gene Lindsey: We're a long way from it, but now that we've been given the goal and the charge, I can tell you that Atrius Health will, in a very, very focused way, begin the work that's necessary to try to deliver what the bill asks for in terms of cost transparency."

So Martha, where is Atrius starting?

Atrius and a few other physicians groups have started putting some price information in the record that doctors can see when they are speaking to a patient, for things like lab tests or the MRIs and such that I'm trying to get a price for. They're a long way from being able to say, 'You're going in for an appendectomy and here's what it's going to cost,' because there are so many variables when you go into a hospital for a procedure. But Atrius — they're just starting to shop for software that'll pull all the information like my health insurance data together so that they can say, 'OK, oh, you're an HMO patient, here's what you'll pay' or, 'You have a high deductible, here's what you'll pay.'

Martha, since you're someone who covers health care, what advice do you have for listeners and other patients who want to try to be smart health care shoppers?

One really practical piece of advice: Get the code. So my MRI code? 70551 without the dye, 70552 with the dye. That's a number I had to drill into my head today to be sure I kept giving it. So that's the very practical advice. Then the broader advice is: If you really have to pay attention to price because you have a high-deductible or high-tiered plan, then do a lot of deep breathing. Just be ready for a long struggle that will take some patience.

This program aired on August 2, 2012.


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