Whether you get your health insurance from your employer, Covered California or the open market, more of you are picking — or being forced into — high-deductible plans.
Although these plans come with relatively cheap premiums, you must spend thousands of dollars out of pocket before your coverage kicks in.
The price tag for the same medical procedure can vary from provider to provider, sometimes by thousands of dollars. If you want to be a savvy consumer who shops around, it is very difficult, if not impossible, for people to know with any precision what prices will be in advance.
Q: I have lower back pain and my doctor ordered an MRI. My health insurance has a $6,500 deductible. Should I go to the imaging center my doctor recommended or search for a better price elsewhere?
A: A survey by Castlight Health last year found that the price of a lower back MRI ranges from $589 to $3,076 in San Diego, depending on the provider. In Fresno, it costs between $636 and $921.
The potential for savings is great. But whether you should shop around depends on several factors.
Some health plans lend themselves to price-shopping more than others. You may have more flexibility if you have a PPO (Preferred Provider Organization) instead of an HMO (Health Maintenance Organization). I’ll explain below.
Second, price-shopping isn’t for medical emergencies. It’s most appropriate if you need what Jeanne Pinder calls a “discretionary procedure” that allows you choice in providers and time to research.
Pinder is a former New York Times journalist who started ClearHealthCosts.com in 2011 when she realized that people were being told to be active healthcare consumers without having the tools – or reliable price data – to do so.
She warns consumers not to assume that high prices equate to better quality. “Study after study has shown that price and quality are not linked,” she says.
In California, ClearHealthCosts has partnered with NPR radio stations in Los Angeles and San Francisco to create PriceCheck sites where consumers can report – and search – costs for several common procedures, including mammograms and colonoscopies.
Before you start shopping, ask your doctor for the exact name of your treatment and the accompanying procedure codes. There may be more than one, and you’ll need them all for an accurate estimate.
Once you have that information, dive in:
And remember, this isn’t foolproof. You may come across conflicting information in your search or contend with providers who won’t tell you the exact cost of a procedure.
Darrell Fryer Insurance Advisor of Capistrano Premier Insurance Services and can be reached at 949-248-3112