While a consumer may drive out of his or her way to save a few dollars on a tank of gas, many people disregard comparison shopping for their health services: Most likely because they do not realize that they could save a substantial amount of money by shopping around.
One of the main reasons that employees neglect to shop around for their health care services is because finding out how much a medical procedure costs can be a time-consuming process. In fact, a study published by the Journal of the American Medical Association (JAMA), found that of the nearly 150,000 workers who were offered a comparison-shopping tool for their health care services only about 15,000 (10 percent) took advantage of the tool. However, the rising out-of-pocket costs has many employees taking the time to shop around.
1. Employee Incentive Programs
Recently, some employers have begun implementing incentive programs to encourage their employees to comparison shop for their health care services and, in return, employees receive a portion of the savings.
Employees Need to Check with Their Employers
Some of the best examples of how employees can comparison shop involve the states of New Hampshire, Kentucky and the Jackson Health System in Florida. These employers are offering new tools designed to assist employees as they comparison shop for common procedures, including blood tests and magnetic resonance imaging scans (MRIs).
Jenny Goins, the commissioner of the state of Kentucky’s department of employee insurance says that in an attempt to contain rising health costs, in 2013, Kentucky began to offer its employees a health-shopping service. Around the same time, Kentucky began offering employees the high-deductible plans. The commissioner states that from 2013 to 2015 the state saved $10 million and employees who participated in the rewards program receive $1.1 million of those savings. Employees around the country should ask their employers if these kinds of tools are available.
2. Skyrocketing Deductibles Encourage Comparison Shopping
The Affordable Care Act (ACA) has caused deductibles to increase dramatically. These increases have led to many individuals taking the time to comparison shop. Some consumers are discovering that paying cash for services may be less expensive than actually going to providers who have a contract with their insurance carrier.
Dr. Neeraj Sood is the lead author of the study, Association Between Availability of Health Service Prices and Payments for These Services. Dr. Sood states that individuals who have a high-deductible health plan now have the financial incentive to compare prices for health services, including MRIs. According to his study, consumers who know the price of a medical procedure save money on their overall health care costs: This may be because they take the time to comparison shop and then choose the practitioner or facility offering them the most competitive pricing.
3. Health Care Services Provided by Hospitals Are Expensive
It is not uncommon for hospitals to charge a substantial amount more (thousands of dollars) for the same procedure that is available at a clinic or imaging center. Patients may find that it is less expensive for them to pay cash to have an MRI at an out-of-network than it is to have the same procedure at a hospital that is contracted with their insurance company.
Comparing MRI Costs
Health insurance companies generally have a range that they will pay for an MRI. For example, an insurance company may pay anywhere from $500 to $3,000 for an MRI of the foot and ankle. A patient who has a co-pay of 20 percent for services received through a contracted facility that charges $700 for an MRI will be responsible for $140 (after his or her deductible is met); whereas, the identical test at a contracted hospital may cost $2,500, thus, costing the patient $500 (after his or her deductible is met). It may be beneficial for the individual to have the MRI performed by an out-of-network provider.
Year-End Deductible is Coming to a Close
For example, if the deductible year is coming to a close and the consumer has not already met his or her deductible, it may be beneficial to go to an out-of-network provider that offers the same procedure at a more reasonable price.
Consider that the total cost for an MRI of the ankle and foot from an out-of-network provider is $500, as opposed to the $700 through a contracted facility. In a case such as this, it may be in the best interest of the consumer to receive services from the out-of-network facility. This is especially true if there is no way that the consumer will meet that year’s deductible.
If you are experiencing pain in your ankle and/or foot, contact Nilssen Orthopedics in Pensacola, Fla., today. Dr. Erik Nilssen is an orthopedic surgeon who is certified by the American Board of Orthopaedic Surgery and the American Academy of Orthopaedic Surgeons. He provides his patients with in-office, state-of-the-art diagnostic imaging equipment and the highest quality care available in, and around Pensacola, Fla.