How a New Law Could Cause Price Wars Between Doctors

Written by Courtney Subramanian

The Affordable Healthcare Act created marketplaces to expand affordable healthcare and to underscore that promise, Massachusetts is now requiring private health insurance companies to use price tags on anything from an MRI to a general check-up.

Beginning Oct. 1, all heath insurers in the Bay State arerequired tolist prices in real-time, outlining the otherwise hidden costs of healthcare, much like an online shopping site. While it’s unclear if every insurer met the deadline, there is no penalty if they failed to do so, according to90.9 WBUR.

By using an online calculator on their insurer’s website, users can find out how much they’ve spent this year towardtheir deductible. If coverage does not include a deductible, the calculator will add up the balance toward the out-of-pocket maximum. Blue Cross customers can find the calculator under”Find a Doctor,” Tufts is under”Empower Me” and Harvard Pilgrim’s is under “Now iKnow.”

While the mandate underscores asea change in health care practices, Massachusetts first began the process two years ago when the state passeda law to increase transparency among hospitals and health insurers.

“This is a very big deal,” saysUndersecretary for Consumer Affairs and Business Regulation Barbara Anthony. “Let the light shine in on health care prices.”

But the new law has its flaws, and though it’s still early, WBUR points out a few glaring issues with the newhealth careprice tags.

No standard price: There is no standard price and no list of priced tests and procedures. Pricing out a visit depends on the insurer and canrange in price drastically. For instance, an MRI for the upper back can cost between $614 and $1,800 on the Harvard Pilgrim“Now I Know” tool. The prices are also listed in real-time, which means they can change day-to-day.

Prices are ambiguous: Since insurers negotiate their rates with hospitals and physicians, they may entail hidden costs. For example, a listed price tag may not include the cost of reading a test or a facility fee.

Prices focus on outpatient care: The information is not comprehensive and encompassesfew prices outlining what it would cost for inpatient care or an overnight stay at the hospital.

However, asTufts Health Plan Director of Commercial Product Strategy Athelstan Bellerand notes, the new prices”are a major step in the right direction.”

By adding price tags, state officials are forcing us to think more about our health spending and how much a procedure actually costs, rather than leaving it to our private insurance. Anthony is also hoping by illuminating the price difference, more physicians will become sensitive to where they fall on the scale and ultimately encourage more competition and drive down costs.

“I’m just talking about sensible rational pricing, which health prices are anything but,” she adds.

MORE:

The Checklist That Can Reform Healthcare

This War Hero Uses His Trauma Skills to Treat Veterans at Home

This post originally appeared on NationSwell.

Photo credit: Thinkstock

71 comments

Joseph Glackin
Joseph Glackin4 years ago

Jennifer H.

Contact your state insurance administration office. It may well be.

SEND
Jennifer H.
Jennifer H4 years ago

I have to admit after being seen by a doctor for a couple of years and then his "practice" was bought out by a major hospital group I discovered every time I would see him I received a bill from the doctor (high) and then another bill from the hospital for a room charge; even though I did not see him at the hospital! and for every visit. One appointment to see him would cost me over 400. So I did go "price shopping" to make sure I would not be double billed by the new doctor. I did, however, choose the new doctor on friends recommendations. I feel this double billing practice should be illegal.

SEND
Patti Ruocco
Patti Ruocco4 years ago

it's a good start--but standardized pricing for procedures would help, as well as addressing the issues mentioned---but a good start.

SEND
Jonathan Harper
Jonathan Harper4 years ago

noted

SEND
Joseph Glackin
Joseph Glackin4 years ago

Rosemary D.--

What that bill is telling you is that the doctor's cost was probably about $15. Medicare probably paid about $18. A big insurance co. got it for $20.

And the poor shlub with ho coverage got hit for $50.

SEND
Rosemary Diehl
Rosemary Diehl4 years ago

Sherrie S cars are that way

SEND
Rosemary Diehl
Rosemary Diehl4 years ago

Sure would help if we did know the real costs of our healthcare. I am sick of statements that say the doctor charged $50 and insurance paid $20

SEND
Lori Hone
Lori Hone4 years ago

About time!!!! We demand to know the price for everything else before we buy. "Medical" businesses have done what ever they wanted for so long, with no one having the courage to say "what's that going to cost". Would you buy a car without knowing what your bottom line price???

SEND
Sherri S.
Sherri S4 years ago

Think about it....is there any other thing we purchase where we don't know the price up front?

SEND
Darren Woolsey
Darren Woolsey4 years ago

Crazy world!

SEND