Less than 24 hours before Audrey Nichols was scheduled to undergo a cardiac stress test at a local community hospital, she received a phone message telling her to bring along payment for her portion of the bill. The amount, according to Nichols: $2,191.39.
Nichols, 58, of Barberton, has a high-deductible health plan that requires her to pay the first $5,000 of her medical bills. So she and her husband, Gary Nichols, opted to put the test on hold and shop around for a better price. They succeeded, but it wasn’t easy.
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Unlike comparing the price of a new car or refrigerator, health-care consumers are discovering it can be nearly impossible to comparison shop for elective medical care. The state requires hospitals to share the amount they charge for the most common procedures. These so-called ”sticker prices” typically are available online, but they don’t reflect any of the steep discounts negotiated by insurance companies.
Patients with insurance pay the discounted rate their insurers have negotiated for care before they reach their deductible. It can be challenging for patients with insurance to find out those discounted, in-network rates. ”There is really not an easy way to get this information,” said Nancy Metcalf, senior program editor for Consumer Reports magazine.
In Nichols’ case, her husband, a retired Barberton police officer, started investigating the prices first by calling her insurance company, Medical Mutual of Ohio. ”A consumer ought to be able to call and find out,” Gary Nichols said.
But when he asked for the contracted rates for a stress test at several Akron-area hospitals, he said, a customer service representative responded, ”I don’t have that.”
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It’s ”a lot more difficult than it seems” to provide consumers accurate estimates for the out-of-pocket costs for procedures before they take place, said George Stadtlander, executive vice president and chief managed-care officer for Medical Mutual. A simple test, for example, can become a lengthier, more complicated procedure depending on what is found.
”Our customer service people, while it may seem to be uncooperative, really were trying to avoid creating a false expectation of what the final price is going to be,” he said.
Frustrated, Gary Nichols called local hospitals to find out their contracted rate for the procedure with Medical Mutual. He then faxed follow-up letters to ask whether the hospitals were willing to give a ”prompt pay” discount off the insurance rate if the couple paid for the test ahead of time.
Summa Barberton Hospital, where Audrey Nichols was first scheduled to have the test, refused, he said. Patients at Summa Health System hospitals with financial hardships can qualify for reduced-rate or free care, said Kevin Theiss, Summa’s vice president of revenue cycle. ”We try to base all our discounts on financial need.”
Otherwise, he said, the health system’s policies ”strongly discourage” any discounts beyond those already negotiated with the patient’s insurer. ”Part of that is the insurers are pricing their premium based on the expectation that out-of-pocket expense is involved,” Theiss said.
Several hospitals, however, offered to let the Nicholses pay less than the already discounted insurance rate if they paid ahead of time. In the end, Akron General Medical Center won Nichols’ business after agreeing to cut the contracted rate of $991.10 to $600 if Nichols paid ahead of time for her stress test.
”I guess you have to bargain, just like when buying a car,” Audrey Nichols said. Her husband added, ”It’s just hard for me to understand how one hospital can have it at one price and then it goes down at another.”
Akron General offers prompt-pay discounts to patients who pay their portion of the bill at the time of service on a case-by-case basis, spokesman Jim Gosky said. ”We definitely have discounts for the self-pay part of the bill,” he said. For Nichols, he said, ”we reviewed the charges for this procedure and applied all our discount policies and came up with the fact that the patient would owe $600.”
Patients should make sure their insurers still credit the amount they pay toward their deductibles if they negotiate their own, steeper discounts, Consumer Reports’ Metcalf said.
In recent years, deductibles have climbed substantially as employers look to curb rising premiums by sharing some of the out-of-pocket costs for medical care with employees. The average deductible last year for the most common type of health insurance through an employer was $634 single coverage and $1,488 for a family, according to an annual survey by the Kaiser Family Foundation and Health Research & Educational Trust.
Some insurers are launching Web-based tools to help consumers determine their estimated out-of-pocket charges. Anthem last week announced it is offering cost estimates for 39 common procedures and tests on its Web site for its nearly 1 million Northeast Ohio enrollees.
Patients can use the Anthem Care Comparison tool to find an estimated cost range at in-network hospitals and other facilities for everything from a diagnostic colonoscopy to a knee or hip replacement. The Web site also includes links to compare hospital quality, Anthem spokeswoman Kim Ashley said.
Likewise, UnitedHealthcare offers an online cost estimator that compares costs from physician to physician. The tool uses regional averages — not hospital-specific data — to calculate the estimated treatment cost. ”Our next step is to get actual costs by facilities,” said Kyle Pettersen-Scott, product director for UnitedHealthcare. ”It’s on our road map.”
 Cheryl Powell can be reached at 330-996-3902 or [email protected].
Cheryl Powell is a health reporter for The Akron Beacon Journal, the daily newspaper in Akron and a syndication partner of MedCity News.
