How Much Will it Cost? Here's How to Find Out

 

There's one question in health care that hardly anyone will ever answer.

It's not "Will it hurt?" Or even, "How long will I live?" 


It's even more basic: "How much will it cost?

For years, people with health insurance and low co-pays have paid little attention to the question of cost. 

But as the employee's share of the bill has gone up, and as more people realize their healthcare costs are rising, there's increased interest -- and need -- for a better understanding of charges. 

Average deductibles are going up all the time. Co-insurance rates -- the percentage of the bill that you have to pay -- are typically between 20% and 40%. Many of us want to use the doctor of our choice, rather than go to someone just because they're in our "network," as long as we can keep the cost down. And some services just aren't covered by insurance.
 
Complicating things is the fact that we  typically have some options about what treatment or procedure we get -- and where -- and we often want to know the relative value of the choices we make.


I've just stumbled upon a promising resource you might want to try. It's called Healthcare Blue Book.

Healthcare Blue Book is a free guide to healthcare pricing. It also offers guidelines about how to negotiate price and information for those of us who want to get our out-of-pocket costs down.

Just as cars have a blue book price, doctor visits, medical tests, treatments, procedures and surgeries have average insurance-paid and self-paid prices in every zip code. 

The blue book price is calculated based on industry data from many providers, payers and employers across the country. The information is analyzed to identify the dollar amount that many providers accept as payment in full. 

You can compare prices in a wide range of categories, from physicians' services to surgeries, dentistry, lab tests and even hearing aids. Interested in comparing the cost of cosmetic surgery in different towns or where you live? Check it out.


According to Healthcare Blue Book:"Blue book prices are generally much lower than billed charges. Hospitals and doctors keep track of their services with two different fee schedules: 1) billed charges and 2)negotiated rates. While providers are generally able to set billed charges to whatever amount they would like, they typically have a range of acceptable negotiated payment rates that they agree to accept as payment in full from insurance companies." 

If you're a cash paying customer, you may ask your hospital or doctor to charge you a fair price.
If you don't have health insurance, you can call a doctor, hospital or laboratory and see if they offer discounts for self-pay patients. If you have insurance, ask the in-network providers listed in your directory what the in-network rate is for the service you need.

Sometimes, just by traveling to a nearby town you can save money. Healthcare Blue Book says that some imaging centers charge three to five times more than others. This is true for both patients using insurance networks and those paying cash.

Here's something I tried on the site. I was wondering what a knee MRI (with and without contrast media) would cost. I compared the charge between two locations. Here's what I found comparing the two cities:

In the more urban community, the cost was $1,006.
In the less urban town, the cost was $866.  

What about quality factors? Cost and quality are not always linked. Just because a healthcare service, procedure or test is priced higher, it doesn't necessarily mean the professionals, equipment, or outcomes are better.


This is just the beginning. Gradually we'll have the data we need to make truly informed choices that allow us to figure in cost, quality, risk and benefit before we make a significant healthcare decision for ourselves or our family.


 I'd like to hear what you discover.

Health Care is Sick: What Does This Mean for You?

If you've ever had to leave a family member or a dear friend who was in the hospital, you may know the feeling. 

People look awfully vulnerable sitting in a hospital bed or on a gurney. 


It turns out they are.


Even in the best facilities, people really need an advocate there for them 24/7.

That has been validated by a poll released May 21, 2012 by the Robert Wood Johnson Foundation, NPR and the Harvard School of Public Health. 

Called "Sick in America," the study found, for example, that 11 percent of Americans who had a serious illness, medical condition, injury or disability requiring significant medical care or who had been hospitalized overnight in the past year said they were given the wrong diagnosis, treatment or test.

People feel they aren't told what was going on. In fact, 25 percent of patients who had been seriously ill said a physician, nurse or other healthcare provider failed to provide the necessary information about their treatment or prescriptions. 

"Listening to the experiences of sick people provides a good barometer of what's happening in health care in America," said lead researcher Robert Blendon. "What is most striking is the significant number of people whose care has not been well-managed and who have been turned away from care."

Respondents revealed how serious the problems are:

• 8 percent reported getting an infection while in the hospital
• 30 percent of those hospitalized noticed poor communication among doctors, nurses and other healthcare providers involved in their care
• More than 40 percent said the cost of their medical care over the last 12 months had caused a "very serious" problem for them or for their families
• 17 percent said there was a time in the last 12 months when they could not get the medical care they needed; the majority of those people said it was because they couldn't afford the care.
• 24 percent said they couldn't get care because their insurers wouldn't pay for it.
• 11 percent said they were turned away by a doctor or hospital for financial or insurance reasons.
• 72% of sick Americans want their doctor to spend time with them discussing other broader health issues that might affect their long-term health. They don't want to just talk about their specific short-term problems.

The study includes a wide range of data and is worth reading if you're interested.

What do the survey results mean for you?

If you've felt put off by the concept of taking control of your own health care or learning to be the "CEO" of your own body, think again. 

It's more important than ever that you learn as much as you can about your diseases or condition and master the art of asking tough questions. 

You've got to explore a wide range of treatment alternatives with your healthcare providers. Consider all the potential risks and benefits to you based on the hard data, when it's available. 

If you love someone who is dealing with health issues, help them learn what they need to know to feel like they're in a position to make good decisions. If they can't, perhaps you can help them. 


And if you're in the hospital, it really can't hurt to have someone who loves or likes you sitting at your side as your advocate.

Drug Management 101

It's so easy to make a mistake when you're taking just about any medication.

•  Could your Claritin be interacting with your antibiotic? (Probably not.)  

•  Can you take Motrin when you're pregnant? (Not in the last three months of your pregnancy).  

•  Did you forget to take your birth control pill? (Take it as soon as you remember; read this for more detail).  

•  Is it too early to grab another Tylenol? (Generally can take it every 4 hours; make a note of what time you're taking each dose).

If you're juggling several medications, it can be especially challenging. It’s easy to forget when you're supposed to take each drug. And the more medications you have,  the greater the chance of drug interactions creating side effects or diminishing the effectiveness of a medication.

But there are a variety of things you can do to simplify your situation and make it easier to manage your medications:

• First, always be sure you understand a prescription when a healthcare provider writes it for you. Whether it’s a brand new medication or a revised dose of one you’ve been taking, read it out loud back to the doctor or nurse and make sure you know what is being prescribed. When you receive the medication from the pharmacy, double check to make sure it’s right.

• If your medication dosage changes, put a post-it note on the container with the previous dosage to remind yourself not to use that bottle. Of course, you may want to keep the bottle, if it hasn’t expired, since there’s always the chance you’ll be switched back to the previous dose. Be sure you don’t accidentally revert to the older prescription.

 

• Keep an updated list of all your prescription and non-prescription (over-the-counter) medications.  Write down the name of each drug, the dosage, and the purpose. Bring a copy with you to health appointments and to the drug store when you pick up the medications. It’s not a bad idea to keep a copy in your wallet or purse just in case you end up at an urgent care clinic or emergency room, too.

 

• Try using a simple 7-day pill organizer to help you avoid missing a dose or accidentally taking a pill when you shouldn’t. You can find them with sections for several times during the day. You can organize all your pills at the beginning of the week and then easily see if you forgot to take something. 

•  You can also check out a variety of free tools, all available online:
  

• MyMedSchedule.com offers free systems to set refill reminders, maintain medicine schedules for you and for others in the household, print your schedule in English or Spanish, and create a wallet-size schedule to keep with you.

• Surveyor Health provides a personalized drug assessment tool designed to show users not only drug-drug interactions but also the much more common and often dangerous adverse drug side effects.

• Vitality offers a “smart” pill bottle that uses sound and lights to help remind you to take your medications.

• Consider getting a medical alarm watch for medication management. For example, the reminder watch offers up to 12 daily alarms that beep and show a visual message at pre-scheduled times. The watch also serves as an electronic medical alert/ID bracelet.
  

• Use one pharmacy for all your medications if you can. That way your pharmacist will have the complete list of what you're taking all in one place. Ask your pharmacist to check the list and alert you of possible drug interactions.  

It's wise to review your total list of medications with your healthcare provider at every visit . Be sure each doctor, including your dentist and eye doctor (ophthalmologist),  is aware of your medications. Be certain any healthcare provider knows if you're on a blood thinner or are a diabetic.  If you're taking pain killers or drugs for a chronic condition, be sure everyone is aware. 

Also, if you've ever had a bad reaction to a drug -- even if it was never officially labeled an "allergic" reaction -- make sure your healthcare providers know that and document it clearly in your medical record. 

The bottom line:  the drugs designed to improve your health can end up working against you if you don't take them as directed. They can also sometimes cause problematic interactions. It's critical that as CEO of your own body you understand that you're ultimately the one most responsible for managing your total drug regimen. 

Our Lives, Our Data

There's a push-pull happening right now in the evolution of health care and it's all about you. 

The question under debate is simple: can you handle being the first to know your own test results? 

Are you smart enough to read the results? And are you emotionally capable of handling the situation?

Do you need someone next to you when an over-the-counter test tells you whether or not you have a disease? Can you manage your emotions when you open up the results of last week's blood test when you find out your total cholesterol level has hit 250?

Today, a U.S. Food and Drug Administration advisory panel voted to recommend approval of the first in-home HIV test. The test, OraQuick, only involves using a larger version of a Q-tip to swab outer gums. Twenty minutes later, you find out if your immune system is gearing up to fight HIV. The decision is now up to the FDA.

Those arguing against allowing people to take the test at home are worried that they will freak out when they get their results. They say we need a professional at our side to interpret the results, point us to counseling and help ensure we feel supported. 

With almost every healthcare test we get, there's a wall that instantly goes up between us and our data. If you have a mammogram or a Pap smear, your doctor will typically get the results before you do. If you get an ultrasound, you'll be the last one to know whether it's normal or not.

It's not because you have to be a physician to understand the basics. At the top of most test reports the key finding is clear: "Normal." Or "Abnormal." Then you can read on for more details.Home tests, like pregnancy tests and the new HIV test, usually turn a certain color to tell you the results.


With blood tests, there are usually two columns: your results, and "normal limits." If your data is out of bounds, it's often automatically highlighted. If you don't know what the test means, you can Google it. Then you can go see your doctor and talk about next steps. 

Some laboratories will send you your test results at the same time they send the results to your physician. Some won't. 

The labs and diagnostic centers that will not send you a copy at the same time say that it's your physician's job to review and explain the results to you. And some states actually prohibit it.

Your healthcare provider may have been the one to order the test but you're the one paying for it. Even if you have health insurance and there is no direct cost to you for the test, it's your insurance that covers the cost. The data is YOURS.

Granted, many people may not be interested in being the first ones to see their healthcare data and have some time to consider their questions before talking with their physicians. That's fine. As long as it's their choice.

But those who consider themselves the "CEOs of your own bodies" should have the option. You should be able to review your lab work or test results as soon as they are available. 


What can you do?  

Some labs, like Quest Diagnostics, offer to email you your test results or make them available directly to you, even on your smartphone. You can phone labs and ask them their policy about communicating test results before you get your blood drawn or have a diagnostic test.

You can ask your healthcare provider to specify on the lab order that the results be sent directly to both you and your doctor. 

Instead of waiting for a phone call from the doctor with your test results, you can tell the office staff you'd like an appointment. Tell your healthcare provider something like, "My total cholesterol has gone up. I'd like to talk with you about it." 

 
Be sure to routinely file the test results in your own "Health Data" folder for future reference.

Beware of the Emergency Department: What You Can Do

If you're heading to the emergency department, prepare for a long wait and potentially a slew of problems. 



A new study  this week from HealthLeaders Media shows that almost half (46%) of healthcare executives say their emergency departments are overcrowded. More than half worry the situation jeopardizes patient safety. 

There are lots of reasons for the overcrowding. Hospitals are advertising their emergency departments to compete with other community facilities. (A significant percentage of hospital admissions -- critical to hospital revenue -- come from the emergency department, according to the report). 

Now, even doctors on call  often just tell patients to "go to the ER" rather than meeting them in their clinic or office on weekends and off-hours as they once did. And people can't count on urgent care centers since many are closed after 9 pm on weekdays and are not open on Sundays. For those without a primary care physician or who work during the day, the emergency department may be their only choice.


The report comes from a survey of about 300 respondents in hospital management, patient care, finance and information technology. Forty-three percent said that re-thinking emergency department "flow" was their biggest strategic challenge. Almost all say they're working to improve their systems, including developing fast-tracking zones for less acute problems. 


In the meantime, here's what you can do:

• If possible, find a primary care provider who takes being on call seriously and doesn't just tell you to go to the emergency department or urgent care center when you phone with a problem in off hours. That may not be easy.
• If you have a choice of healthcare insurance programs, evaluate the HMO in your area. Some have excellent extended-hours clinics that work efficiently and even include convenient pharmacy services.
• Especially as you approach the weekend, don't postpone problems that could get worse. Make an appointment with your physician if you can; if you can't, get to urgent care before the weekend. 
• If you're unsure about your problem, know that many health insurance programs have nurses available through a call center. You can ask them, based on your symptoms or concerns, if you need immediate care. 
• If your problem needs attention but is not an emergency, consider driving a little farther to a hospital if its emergency department has a reputation for better service and shorter waiting times.
• If your hospital's emergency department offers "appointments," consider using the service. Some charge for it, but it may be worth it to you.

And, without a doubt, if you have any serious health concern, call 9-1-1 or get to the emergency department immediately. Don't let the fear of a crowded waiting room worry you so much that you fail to get the help you need.

A Free Genetic Test

Haven't you ever wondered if you're likely to have a heart attack? Get diabetes? Cancer? An aortic aneurysm?

It turns out your family tree holds a wealth of information. So much, in fact, that Francis Collins, the Director of the National Institutes of Health, calls your family medical history "a genetic test that's free."

The trouble is, most physicians don't take the time to review your family history with you in any detail. Frequently, patients are unsure of many of the specifics. It's often hard to remember what exactly your father's mother died of, or when. You say your grandfather died of lung cancer. Was he a smoker? How old was he when he died? Was it Type 1 or Type II diabetes? Was your mom's breast lump biopsied in 1958 or just removed? Are you sure it was breast cancer? If you can't recall key information most physicians move on.

Why bother documenting your own family medical history? The information you gather can help guide you and your health provider in deciding what prevention strategies and screening tests are most important for you and your family. 

There's an easy-to-use, free tool on the Surgeon General's website. It allows you to put in the names of your parents, grandparents, aunts, uncles, sisters and brothers, along with their cause of death, age at death, and other related factors. Once completed, you can take it to your healthcare provider and say, "Given this family history, are there things that I should be doing or tests I should have?"

It only takes about 15 to 20 minutes to create a basic family health history. The information you provide is not stored on the site. You're only making use of the software. After you complete the information, the health history is available only to you to download.  A detailed question and answer section is available on the website.

As you fill in the blanks, you may realize that there are gaps in your knowledge. Now is a good time to ask your living relatives what they know about the health issues and cause of death of your family members. 

For example, my father's father died of a heart attack -- I think -- at about 60 -- and had adult-onset (type 2) diabetes -- I think. I wish I knew for sure, and no one who would know is alive today. But even some information is better than nothing. If you find gaps, don't worry. Most people will have some unanswered questions.

It may be helpful to know a few key features of a family history that can increase risk:

• Diseases that occur at an early age than expected (10 to 20 years before most people get the condition). Think heart disease, stroke or prostate cancer, for example
• Diseases in more than one close relative
• Diseases that don't usually affect a certain gender such as breast cancer in a man
• Certain combinations of diseases within a family, such as heart disease and diabetes, or breast and ovarian cancer

Not only can the family health history open up a good discussion with your physician, be sure to talk about it  with your family, stimulating ideas about ways everyone can take a more active role in prevention where it may be especially effective.

The written family medical history is also a good thing to pass on to your children and grandchildren. You can store a copy with your will and trust or fold it into an envelope in your Safe Deposit box at the bank to help ensure the information will be passed on. 


Your genes won't change, but your behaviors -- such as exercise, smoking, diet -- and screening priorities can.

Are You Afraid of Being Labeled a Difficult Patient?

There's a wonderful episode in Seinfeld that showcases Elaine grappling with the implications of being labeled a "difficult" patient. She's sitting on the examining table, waiting for the doctor, and picks up her chart. She sees that her doctor has previously described her as "difficult." Through several scenes, we watch her reacting to a harsh reality: the label is passed from one physician  to the next through her medical chart. Her reputation precedes her, and she gets crummy care as a result.


The fear of being labeled "difficult" affects many of us, even we who consider ourselves self-confident and capable in other arenas of our life outside of health care. We're a nation of pleasers when it comes to health care. 

Unfortunately, wanting to please your healthcare providers and their staff can negatively affect the quality of your health care.

A study from the Palo Alto Medical Foundation Research Institute and the Dartmouth Center for Health Care Delivery Science shows patients often surrender their authority to physicians because they're afraid of getting the "difficult patient" label. 

The researchers conducted six focus groups, involving 48 people from Palo Alto, California. Most participants were Caucasian, well educated and had above average incomes, characteristics that could  make you assume they would be comfortable and self-confident dealing with physicians. The researchers were surprised to discover that the participants said they frequently hold back from challenging their physicians or asking questions out of fear that it might damage their relationship with them.

"Although our study doesn't allow us to draw conclusions about how common these concerns are, it is difficult to imagine that people who are less well-off would not share these concerns," said Dominick Frosch, lead author of the study. 

The research showed most participants see their physicians as authoritarian and don't feel they could rely on them to help them understand treatment options. People are afraid of displeasing or disappointing their physicians. They're stepping on egg shells. 


Have you ever felt this way? If so, here's what I recommend. 

Let's say you want to hear more about the pros and cons of going one way or another with a diagnostic treatment, procedure or surgery. You're feeling concerned that pushing back a bit to get more information  might hurt your relationship with your doctor. 


Say something like this: "I want you to know that I really respect you and appreciate having you as my physician. That said, I hope you realize that I'm really the 'CEO' of my own body, the one most responsible for the decisions we make together about my health. I see you as my consultant. Can we work together to help me understand, in the light of your recommendations, what is my best choice, and why?"


If you physician steps back, grumbles, resists, or worse, scribbles "difficult patient" in your chart, you should seriously consider finding another physician to consult with you.

There's a shared decision-making effort underway, supported by organizations like the Informed Medical Decisions Foundation and the Patient-Centered Outcomes Research Institute. Some are trying to help physicians know that patients often find it difficult to express their preferences to their doctors.  They say doctors need to explicitly tell patients that their opinion matters and that it's "OK to disagree." 

The Palo Alto Medical Foundation Research Institute says previous studies have found that lack of physician reimbursement for shared decision-making is a significant barrier. Honestly, I hate to think doctors are saying they need more reimbursement to involve people in decisions. 

Change is going to take time. In the meantime, see your physician as your consultant. Develop thoughtful questions and ask them. Listen. Interact. And then, ultimately, decide.

Don't worry about being called "difficult." If asking questions earns you that label, know that your inquiring behavior will ultimately help you make the best choices for you and your family. That's worth it.