Why We Need Health Care Price Transparency

Consumers have no idea how much they pay for health care, so it’s not surprising they often overpay, but 683 percent?! Patients pay as much as 683 percent more for the same medical procedures, such as MRIs or CT scans, in the same town, depending on which doctor they choose, according to a new study by a national health care group, reports USA Today. For a pelvic CT scan, they found that within one town in the Southwest, a person could pay as little as $230 for the procedure, or as a much as $1,800. For a brain MRI in a town in the Northeast, a person could pay $1,540 — or $3,500. Howard McClure, CEO of Change:healthcare says health plans are moving toward “reference-based pricing,” in which they look at the average price of a procedure for a region, then say that’s all they’ll reimburse. But if a patient does not know how much a procedure costs, he or she gets stuck with the remainder of the bill if it goes above that average price. Providers, he said, often don’t know real costs, either. When asked by patients for the cost of a procedure, providers often say they need to check with the insurer. The patient only learns the real cost when the bill arrives, McClure says.

Georgia could easily take the claims data from the State Health Benefit Plan and provide a market average cost for a wide variety of procedures and tests for every geographic area in the state. This could serve as an important benchmark for consumers trying to stretch their dollars. With Atlanta as one of the leading cities in the world in health information technology, there is no excuse not to be a leader in this area.

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