Several years ago I decided to switch to a high-deductible health insurance plan (HDHP) for myself and my family. I pay 100 percent of my own health insurance premiums and one of the factors that influenced my decision to switch was how expensive my insurance premiums were getting even though I basically made no insurance claims over the past five years, other than annual check-ups. After my accountant suggested I look into high-deductible plans, I calculated that I could save $7,000 in premiums every year and use my HSA to help pay for my medical expenses. With my HDHP I have become a cost-conscious consumer of health care services, and I shop around for the best value, just like I would shop around for a car or electronics. The only problem is there are no Consumer Reports for health care where I can easily find the best value for health care services. I have no meaningful tools to help me make informed choices about where to find the best value for routine health care services like MRIs, X-rays, vaccinations, mammograms, and office visits. How do I avoid the overpriced providers with poor performance ratings? Now that I pay out of pocket for these services (up to $5000), how do I shop for value? How do I find out what other patients think of a physician that is listed in my plan’s network?
I was a competitive runner for more than twenty-five years, and recently I started to experience a severe pain in my knee that just would not go away. No matter how much ice, rest, and physical therapy—the pain was persistent. So I finally made an appointment to see a sports doctor. After the doctor spent ten minutes with me, he suggested I have an MRI on my knee—which is a very expensive test for someone that has to pay for the entire bill out of pocket. I mentioned to the doctor that I had a high-deductible insurance plan and he gave me several diagnostic facilities to contact. Being the savvy consumer that I am, I called every single facility. In fact, I even called my health plan provider. I called diagnostic facilities in and near my neighborhood. I learned that an MRI is an expensive test that can cost anywhere from $500–$2,500, depending on where I decide to go for the test. And to make matters worse, not a single provider, or insurance carrier could tell me what my out of pocket cost would be for an MRI with my health current insurance plan. I learned that my health insurance plan negotiated discounts with providers. Some discounts were more substantial than others and this could make a big difference in MY PRICE. Every health care provider and health insurance representative I talked to would not share price information with me. This rude awakening was the beginning of a journey for me. I realized first hand that consumers need easy access to meaningful tools to help them make informed decisions about where to find the best value. To be honest, I was not shopping for a complicated surgical procedure; I was just looking to find the best price and quality for an MRI so I could find out why I am in so much pain when I run. I did not want to be overcharged—I just wanted to pay a fair price. Is that asking too much?
I think most consumers would be outraged if they knew the true cost of health care services. There are so many different prices for the exact same service. How are consumers expected to know the difference? I learned about experiences from many other consumers that had similar stories of “the priceless MRI,” so I decided to do something about this problem. Using the power of the internet and social-networking, I built a portal where consumers could share prices and personal recommendations on providers, with other consumers. If enough consumers participate to share prices, consumers will end up creating a powerful tool to help make informed health care purchasing decisions. Until the industry catches up, consumers are going to have to be creative and resourceful when researching providers and facilities to make the most out of their health care dollars. I encourage everyone to check out the website, www.outofpocket.com. Be sure to tell your family and friends about this project, and let me know what you think. The best part about this initiative is that is benefits all consumers, including the insured and uninsured, without having to wait for legislation to pass, complicated programs to be initiated, or wait for the country to decide how to reform our unsustainable health care system.
The next time you need to look-up and compare prices for routine services like MRIs, x-rays, mammograms, vaccinations, and dental or vision services—use www.outofpocket.com to look up what other consumers paid, where they went, and what they though of the provider.
Be Healthy,
Mona