Not too long ago, I was recommending an ultrasound for a child with suspected appendicitis, when the father asked me what it was going to cost. I no longer find this terribly surprising, as it seems to occur more and more (albeit still pretty infrequently). But as usual, I had no idea. Not only because in general I’m unaware of what our standard charge is for most procedures and treatments. But also because even if I did, it wouldn’t answer his question – I’d still have no idea what it was going to cost him. To answer that, I’d need to know what his insurance is, what our negotiated rates are with that insurer, his deductible and co-pay, etc. I couldn’t answer his question even if I wanted to. So I basically pleaded ignorance.
There has been a lot of publicity lately about the disconnect between the so-called “chargemaster” price and what insurers and individuals actually pay, as well as the huge variation in both standard charges and actual prices between hospitals even in the same city. This has generated call calls for more transparency, in response to which providers have typically done what I did, citing the complexity of answering that for a given individual. But that is increasingly unacceptable to our families, who have to pay increasing out-of-pocket costs. A few things on the horizon are making it harder for us hide behind that excuse. A hospital in Miami announced recently that it would publish not only its sticker price, but also its negotiated rates with various payers. Insurers are also making it easier for individuals to look on line to see what it will actually cost them to have various procedures from different providers. In our own region, United Healthcare has billboards advertising their health cost calculator, and the GE Health Choice plan (their AACN product) has a similar Web site.
I’m not a huge fan of rank consumerism in health care. But we have to start being prepared to think about how we’re going to answer that question “What’s this gonna cost?”