Do you know how much a trip to your physician costs? Most of us don’t. We pay the copay at the physician’s office and don’t think much about it.
If the doctor determines further tests are needed, most patients go where he or she suggests.
When the bill comes, costs may be higher because of the location of the additional testing. Little did you know that the site of care can play a part in the cost of care.
Let’s say your doctor suggests you go to the hospital to get an x-ray. The cost on average could be as much as $500 at the hospital, compared to around $200 in a physician’s office or imaging center.
“There are really significant differences in cost depending on where you have your service done,” Blue Cross and Blue Shield of Nebraska Chief Medical Officer Dr. Debra Esser said. “In general, the hospital is the most expensive place to have surgeries, radiology, lab services and therapies. Looking for alternative outpatient or free-standing places for your procedures can save you money.”
Site of care price disparity is a widespread and systematic national problem. An American Journal of Managed Care study found prices for chest x-rays and MRIs were 21 to 258 percent higher when delivered in a hospital outpatient department.
Why? It’s called “horizontal integration.” Hospital groups are buying physician practices and other hospitals. Consolidated systems may help better coordinate care but may also increase costs. Finding out what those costs are can be difficult, but systems are providing some cost transparency.
Hospitals are now required to post costs for their services. But the details are often difficult to find. The price listed may not be the price you would pay because your insurance company has negotiated discounts with the hospitals.
“It is often better to talk to a hospital financial counselor or call your insurer for what your cost share will be for the services,” Esser said.
In an effort to help consumers understand pricing and give them the ability to shop for health care services, insurance companies have rolled out cost transparency tools.
Still, it’s up to consumers to ask questions at their physician’s office and request routine labs, radiology, and physical therapy be administered at the most appropriate and cost- efficient location.
“When we meet with employers about the benefit plan for their employees, we stress the appropriate site of care,” Mary Barnes, BCBSNE strategic account executive said. “Using their claims data, we can show them how it can reduce costs for their employee and for them.”
With health care spending outpacing the growth of the U.S. economy, becoming a savvy consumer who is more conscious of pricing is imperative. Consumers also have a bigger stake in the cost of care now because they are paying a larger percentage out of pocket.
Esser says it is important for all of us to be engaged shoppers, getting information on the highest quality and most cost- effective place for health care. Find out what tools are available to you through your health plan to help you become an engaged shopper.