Until recently you were more likely to solve a Rubik’s Cube than figure out what you might pay for a health care service.
These days those costs are less puzzling. As consumers shoulder more of their health care bills, insurers, government officials, and private firms are starting to provide the tools to allow you to research and compare.
“There is a shift to make consumers more conscientious purchasers of health care,” says Matthew Coffina, senior equity analyst at Morningstar.
While the information out there is still far from complete, knowing where to look can help you select a provider, budget for expenses, and possibly negotiate for a lower tab.
FOR IN-NETWORK CARE
Where to look: The website of your insurer or HR department, or Healthcare Blue Book’s site.
What you’ll find: Large insurers Cigna, UnitedHealth, and Aetna offer web tools to estimate your out of pocket for hundreds of local providers and services, given your specific health plan (some company HR departments offer this as well). The sites calculate associated bills; for example, a knee replacement will require payments to a surgeon, an anesthesiologist, and a facility.
If your insurer and employer don’t offer pricing data, you can at least find out about what insurers pay for a given service in-network in your area at healthcarebluebook.com, then calculate your potential out of pocket.
How to use it: Know in advance you’ll be getting some work done and you’re on the hook for some or all of the bill?
The info allows you to budget for that expense and/or stockpile funds in your flex spending account.
The data on the insurers’ sites can also help you decide which doc to see. “The spread between in-network providers is more pronounced now,” says Jeffrey Rice, CEO of Healthcare Blue Book.
FOR OUT-OF-NETWORK CARE
Where to look: fairhealthconsumer.org
What you’ll find: If you are covered for, say, 60% of an out-of-network specialist, your insurer will base its share on what it deems a reasonable and customary charge. That is usually far lower than the doctor’s actual fee, says Robin Gelburd, president of FAIR Health.
The site will calculate your likely out-of-pocket charge for thousands of procedures based on your co-insurance rate and insurers’ definition of reasonable and customary (call and ask — it’s often based on the Medicare reimbursement rate).
How to use it: Knowing what you’d pay can help you decide whether you should stray from your network. Feel certain you’re better off under the care of an out-of-network physician? Call the office ahead of time to ask if he’ll be willing to accept the local customary rate. Says Gelburd: “Or go in and show them the tool if you have to.”