Are you paying too much for your healthcare services?

In March, we wrote about the difficulty patients face when attempting to receive cost estimates before receiving services from hospitals. To make matters worse, research has indicated that there is sometimes a weak correlation between price and the quality of service from your healthcare provider.  Consumers need a way to gain control over their medical spending.

Growing efforts have been made to help consumers make more educated decisions about their healthcare providers with greater price transparency information.  Here are a few of the organizations leading the way with resources for healthcare consumers.

  • Some states have enacted price transparency legislation that requires providers to give better cost estimates in advance of performing services.  Massachusetts rolled out a price transparency law in January 2014 according to Mass Medical Society.  This law requires physicians and hospitals to provide cost information per the patient’s request. Since providers establish the pricing structure, each state needs to work directly with providers to bring costs under control.
  • Health Care Incentives Improvement Institute (HCI3) has a tool to show individual states’ progress in the area of pricing transparency.  They give each state a grade (A-F).  For the 2015 Report Card, Health Care Incentives Improvement Institute has given 90% of the states, including Massachusetts, an F grade because they fail to provide adequate price information to consumers.
  • American Hospital Association (AHA) has created a price transparency toolkit for hospitals.  This will help influence the providers to let down their barriers.  Like the AHA and HCI3, many organizations are getting involved to raise price transparency awareness.   These organizations are working with the state and providers to develop tools for consumers.
  • Online healthcare sites such as Healthcare Bluebook use employees’, employers’ and providers’ knowledge to share ratings, reviews and prices on some procedures.
  • Some insurance companies have health plans that offer a cost sharing benefit. Blue Cross Blue Shield has the Hospital Cost Sharing benefit.  This allows the consumer decide on their comfort when balancing between cost and quality.  On the website, BCBS has grouped hospitals into lower or higher cost sharing levels. They have a tool for searching for your current hospital cost level and checking BCBS’s benchmark for quality.  This helps the consumer decide if they are comfortable with the level and quality of their current hospital.

With these efforts from any organizations and individual states, the price transparency trend will keep moving forward.  Consumers should use the tools that are available to educate themselves.  Everyone wants the right balance between service, care and cost.

To learn more about healthcare price transparency please contact us.


Contact Block (Blog)

Recent Comments

    Newsletter Signup

    Signup to start receiving the latest newsletters from StopLoss right to your email.
    Stay up to date on insurance trends and insights.

    Back to Top

    In 2011, the top 5 most expensive medical conditions treated in US hospitals were: Septicemia, Osteoarthritis, Complication of device, implant or graft, Liveborn, and Acute myocardial infarction

    From 2010 to 2013, the number of claims that were individually $1 million or above rose by 1,000%

    In 2017 approximately 18% of the American public will purchase insurance through exchanges, radically transforming the health insurance landscape.

    In 2014, 98% of large firms (= 200 Workers) offer 1+ wellness programs to their employees.

    The most costly 1% of patients account for 20% of national health expenditures – accruing average annual expenses of nearly $90,000 per person.

    6% of firms offering fully-insured plans report they intend to self-insure because of Obamacare.

    In 2014, PPO plans remained the most common plan type, enrolling 58% of covered workers.

    In 2012, 93% of businesses with 5,000+ employees and 80% of companies with 1,000-4,999 employees were self-funded

    Massachusetts has the third-highest prevalence of self-funded insurance in the small-group market (Fewer than 50 employees).

    In 2013, the average deductible was $2,906 for individuals selecting plans from marketplaces. This compares with average deductibles of $1,135 for an individual with employer coverage.

    In 2013, the average annual premiums for employer-sponsored health insurance are $5,884 for single coverage and $16,351 for family coverage, up 5% and 4% respectively from 2012.

    From 2010 – 2013, cancer followed by chronic/end stage renal disease and leukemia accounted for the top 3 costliest illnesses.