More Frustration in Medical Cost-Shopping

Apart from the challenge of knowing what’s good medical advice from any medical advice, few things are as aggravating about the provision of health care as not knowing ahead of time what it will cost.

We’ve addressed how medical procedures can be surprisingly unknowable – see our blogs, “The Cost Creep of Pap Smears” and “Medicare Study Exposes Wildly Divergent Hospital Charges.” Now, as a recent experiment in Massachusetts demonstrates, even when the law says medical consumers should know what they’ll be paying for, they often don’t, despite their best efforts to find out.

Since the beginning of the year, hospitals and doctors in Massachusetts have been required to inform patients of the costs of their care, if they ask. So NPR, in collaboration with WBUR in Boston and Kaiser Health News, tested the law by way of a pregnant woman trying to find out what childbirth would cost. “[I]s it possible to actually list prices for medical procedures? And will patients armed with the information look for bargains when they seek care?” the journalists asked.

Caroline Collins’ health plan has a deductible of $3,000. She wanted to know how much her pregnancy and delivery would cost beyond that, and tried to compare prices for a vaginal delivery. She called the main number at Health Alliance Hospital and was transferred to the hospital’s obstetrics department, where a receptionist referred her to the billing office at UMass Memorial Medical Center in a different town. It’s part of the same hospital network as Health Alliance.

Collins called and explained her situation to a customer service rep, who directed her to the extension of someone named Cathy, who apparently had the price list for services at UMass member hospitals. Cathy was out of the office for two weeks, so Collins left a message, tried another number in the billing office and left another message.

Then she called Emerson Hospital, and was transferred from the main switchboard four times. Finally, she left a message for a woman who had not returned her call after two days, which is the interval Massachusetts law requires for a callback.

She was able to reach human being at a third provider, the Birth Cottage, a natural birth center, who told her that the cost would range from $3,000 to $5,000 for a normal vaginal delivery.

On the third day, UMass Memorial contacted Collins, and was told that the average cost for a vaginal delivery was “between $10,000 and $16,000.” If an emergency C-section was necessary, the cost would be between $20,000 and $30,000, “depending on the operation and how it went,” Collins was told.

She was also told that she probably would have to pay only her $3,000 deductible of whatever the cost turned out to be, but she’s not sure because of conflicting information about her coverage from her obstetrician, the hospitals and her insurer.

What seems like a simple question – approximately what will this procedure cost? – is complicated because individual hospitals negotiate different prices with each insurer.

Sometimes the hospital and physician charges are separate, sometimes not. And different deductibles and coinsurance create variables in what patients pay on top of their premium.

Collins told the journalists that she primarily wanted to know if there would be surprises she might be able to prepare for. “It sounds like I will be OK,” she said, “but you never know until it’s over, so I guess I’ll find out.”

“The experience was pretty frustrating from beginning to end,” she added. “It was definitely surprising how many machines I spoke to within the last few days.”

Both Emerson and UMass Memorial acknowledged the roadblocks Collins faced, and promised that measures were being taken to organize and streamline the cost-handicapping process. Transparency, they said, was paramount.

Maybe, but Massachusetts has no enforcement mechanism to ensure that providers are complying with the law. If there are no consequences for not keeping patients in the loop, what are the chances it will happen?

As Barbara Anthony, undersecretary for the Massachusetts Office of Consumer Affairs, said, “It’s kind of, ridiculous … that we’re actually talking about the pros and cons of whether consumers should know how much their health care costs. …[W]hat other commodity or service do we ever debate whether or not a consumer should know the price of a service before purchasing? You can’t even name one.”

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