Calculating the best price for medical procedures

Hank Hayes • Jun 8, 2013 at 5:42 PM

If you found out the lowest possible price on an expensive medical procedure, would you take that deal?

UnitedHealthcare is betting the answer will be “yes.”

UnitedHealthcare and other health insurers are generating online estimation tools that can give consumers a cost range on numerous medical procedures.

For example, at UnitedHealthcare’s myHealthcare Cost Estimator (www.myuhc.com), the insurer has determined the total cost for a colonoscopy at hospitals in the Tri-Cities area can be between $1,297 and $2,466.

For an MRI (magnetic resonance imaging) scan, the cost ranges from $287 to $2,401 in the region, according to the online tool.

The service is now free to employers and UnitedHealthcare plan participants in Tennessee and includes a “Health4Me” smart phone application able to access the price of 450 individual medical services.

Those services can include surgeries, lab tests, radiology tests and office visits, according to the insurer.

UnitedHealthcare points out the estimates tailored to an individual’s benefits plan can also break down out-of-pocket expenses, employer costs and real-time account balances. There’s also information on alternate treatment options.

“We created this as an innovative tool for our members so they could have more information at their fingertips for comparison shopping, and they can understand what something is going to cost — prior to the service being rendered,” Gregory Reidy, chief executive officer of UnitedHealthcare’s Mid-South Health Plan, said of the online tool in a telephone interview.

UnitedHealthcare, which does business with both Wellmont Health System and Mountain States Health Alliance, stresses the cost estimates are based on physicians’ and hospitals’ actual contracted rates.

Reidy stressed the comparison shopping tool has the potential to lower insurance premiums.

“I think what will happen is consumers will become more educated where they can make the right decision for them and their families to get access to quality care at the most affordable price,” he said. “If that has an impact on their own expenses and the median costs in the marketplace, there could be better premium costs in the marketplace. That’s what we’re all trying for. ... We see a variation in costs by each market, and the power of the tool is to get at the variation in the marketplace.”

The U.S. Department of Health and Human Services (HHS) says that even within the same geographic area, hospital charges for similar services can vary significantly.

Average inpatient hospital charges for services that may be provided to treat heart failure range from a low of $21,000 to a high of $46,000 in Denver, Colo., and from a low of $9,000 to a high of $51,000 in Jackson, Miss., according to HHS.

UnitedHealthcare points to a 2012 Thomson Reuters Healthcare study that says approximately $36 billion could be saved each year if the cost for the most common procedures covered by commercial insurance were reduced to their median prices.

The insurer also says if consumers have questions about the estimates, they can call a number on the back of their health benefits identification card to get more information.

While Mountain States Health Alliance had nothing to say about more transparency in health care pricing, a Wellmont Health System spokesman welcomed it.

“Wellmont Health System welcomes transparency and an informed consumer as part of its mission to deliver superior health care with compassion,” Wellmont spokesman Jim Wozniak said in an email. “We do not have access to the calculator to see the specific results of this new tool, but there is plenty of evidence from other insurance carriers and recently released federal data that shows Wellmont as a high-quality, low-cost health-care provider for Northeast Tennessee and Southwest Virginia.”

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