"Annus Horribilis" For Healthcare Costs? — Here’s A Must-Have New Tool To Price Health Services

“Annus Horribilis” For Healthcare Costs? — Here’s A Must-Have New Tool To Price Health Services

Mary Johnson, Editor

Last year was my “annus horribilis” (Latin, meaning horrible year) for healthcare costs. Including premiums, I spent more than $10,030. Normally, I'm hale and hearty. But I blew through my health plan’s deductible just a few months into 2014, and went right on burning through co-pays for pricey high-tech tests and services.

Almost every major procedure I received ended with "scope" – endoscopy, laparoscopy, bronchoscopy. Nurses mostly, and occasionally doctors, inserted tiny thread-like probes, tubes, scopes, tools, video cams and other major equipment through my nostrils, mouth, lungs, esophagus and through tiny incisions. A lung-function test took place in a piece of equipment that suspiciously resembles a Plexiglas port-a-potty, and there was a CT scan, and blood work. By September, after one night in the hospital, I hit my annual out-of-pocket maximum of $4,250.

But alas, all good things come to an end, including good health plans. Mine ended December 31, 2014, and I enrolled in a new Obamacare plan effective January 1, 2015. My premiums this year even though I qualify for a small subsidy, are 48% higher than what I paid last year ($513 versus $347 per month), and I'm in an HMO with a more restrictive provider network.

While it’s too early to tell how well the new plan will work, I have checked a new tool that could help save money. Your health plan probably has something similar, whether you get coverage through Medicare or whether you are under the age of 65.

Your health insurer most likely has an online tool that allows you to compare prices of healthcare services in your area, like lab work, CT scans, surgeries, endoscopies, etc. Costs vary greatly depending on where you live, your specific health plan, whether you have satisfied your annual deductible, and other factors. If you don’t have online access, call the customer service number of your insurer and ask for someone to help you do this.

Here's an example of costs for CT scans in Charlottesville, Virginia, based on my health plan in 2014. While the full price that the facility charged my insurance company was $2,198, insurers negotiate a discounted price. Using the online comparison tool, I found the discounted costs for five facilities in my area range from $332 to $1,023 for chest CT scans. I was referred to the second least-expensive facility, where the negotiated price was $569. Because I had satisfied my deductible for the year, and I had 30% co-insurance, my out-of-pocket portion was $170.70. However, had I used the same facility that I used two years ago, I would have been charged $1,023 instead of $569, and my co-insurance would have been, $306.90 — $136.20 more! Two years ago I was satisfying my deductible and painfully paid more than $1,000 for the CT scan. Now I know better.

This year I intend to do a lot more health cost comparisons. Before confirming appointments, I’ll be checking the cost of services, providers, and facilities ahead of time. It will require more effort, some reshuffling of appointments with good reason, but there’s an excellent return for the time invested. I’ll report on the success of these efforts as we go through the year. If you’re worried that it will be an “annus horribilis” (horrible year) for your healthcare costs, contact your health plan and ask for help comparing costs in your area.