MONEY Health Care

New Ways to Handle the High Costs of Infertility

Empty crib with stork and baby on wall
Onur DAngel—Getty Images

Even with health insurance, couples face daunting expenses when they have trouble conceiving. Now a few organizations are stepping in with creative financing options.

Infertility treatment is a numbers game in some respects: How many treatments will it take to conceive a child? And how much can you afford?

Even as insurance plans are modestly improving their coverage of such treatments, clinics and others are coming up with creative ways to cover the costs to help would-be parents reduce their risk for procedures that can run tens of thousands of dollars. Some even offer a money-back guarantee if patients don’t conceive.

Shady Grove Fertility, a large center with sites in Maryland, eastern Pennsylvania, and Washington, D.C., has a number of programs to help people afford infertility treatment. The center pioneered a “shared-risk” program for in vitro fertilization (IVF) treatment years ago that offered a 100% refund if a couple didn’t have a baby. Now the center offers a similar program for couples who use donor eggs to conceive. Other fertility centers offer versions of these programs.

Both Shady Grove shared-risk programs allow couples to try up to six cycles of IVF or donor eggs for a flat fee. If they don’t have a baby, they get the full amount back; couples can also stop at any point in the process and get a full refund. The program costs twice as much as a single cycle—$20,000 for shared-risk IVF and $30,000 for shared-risk egg donor.

“In reality, patients who get a baby on the first cycle are subsidizing those who don’t get a baby,” says Michael Levy, president and IVF director at Shady Grove. “We see this as an opportunity to give patients security regarding the financial risk that they face.”

Tina and Jimmy Stone opted for the $30,000 shared-risk egg donor program. Tina’s uterus was healthy but her ovaries weren’t producing viable eggs. The Hollywood, Md., couple became pregnant with twins on the third try. The twin boys are now 2, and their daughter, who is adopted, is 8.

“For us, it was worth it,” says Tina, 35, who says the couple financed the shared-risk program through a private personal loan. “It kept our options open if it didn’t work, whereas if you pay per cycle, you’ve paid for nothing if it doesn’t work.”

A report by the ethics committee at the American Society for Reproductive Medicine found that shared-risk programs can be acceptable if patients are fully informed about the criteria for success and program costs, among other things.

Shared-risk and other programs are popular in part because health insurance coverage for infertility treatment, while slowly improving, is still sparse. Fifteen states require insurers to cover infertility treatment to varying degrees, according to Resolve, an infertility advocacy group. Among employers with more than 500 workers, 65% cover a specialist evaluation, 41% cover drug therapy, and 27% cover in vitro fertilization, according to human resources consultant Mercer’s 2013 employer benefits survey. Thirty-two percent of large companies don’t cover infertility services at all.

Glow is one of the most recent companies to offer a program to help address the financial uncertainties around infertility and treatment. The company, which is best known for an app that helps women track ovulation and other pregnancy-related health data, started Glow First last August for couples worried about infertility.

Participants pay $50 monthly for up to 10 months. The money is pooled with contributions from people who also started the program that month. At the end of 10 months, those who haven’t become pregnant split the pot of money; Glow will pay their share to an accredited infertility clinic once they submit their bills for fertility testing or other services.

The program isn’t open to people who’ve already received treatment for infertility.

The first group that began contributing in October 2013 has just ended. Roughly 50 people participated, according to the company. The average age was 34, and the typical participant had been trying to get pregnant for a year. The payout to those who didn’t become pregnant was $1,800.

“This relatively minimal contribution will help to offset those downstream and very high costs” of fertility testing and treatment, says Jennifer Tye, Glow’s head of marketing and partnerships.

There are other ways to manage the cost of infertility treatment. In addition to shared-risk programs, many fertility clinics offer other discounts and financing options to help couples afford treatment. Other companies also offer financing and/or infertility insurance to help cover the costs for couples who are working with a surrogate to have a baby, for example, or for IVF treatments.

“I think it can be confusing for people,” says Barbara Collura, president and CEO of Resolve. “There’s no one place to go to learn all the different financing options.”

Most fertility clinics have someone on staff who will sit down and and talk with prospective patients about the costs they’ll be responsible for and financing options that are available, says Collura.

“Exhaust all the obvious choices with your insurance and whatever financing programs the clinic might participate with,” says Collura. “Then do research to fill in.”

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

TIME Health Care

Louisiana Following Judge’s Order on Abortion Law

Ala. abortion clinic law unconstitutional
Reproductive Health Services is shown in Montgomery, Ala., on July 30, 2014 Brynn Anderson—AP

Clinics in Shreveport, Bossier City and Metairie sued the state, seeking to block the law

(BATON ROUGE, LA.) — The Louisiana health department will follow a federal judge’s order and refrain from immediately penalizing doctors who are trying to comply with a new abortion law that requires them to obtain admitting privileges at a local hospital, a spokeswoman said Monday.

U.S. District Judge John deGravelles issued a temporary restraining order late Sunday that blocked enforcement of the new law that took effect Monday. The law requires physicians at all five abortion clinics in Louisiana to obtain privileges to admit patients to a hospital within 30 miles of the clinic where the doctor works.

State Department of Health and Hospitals spokeswoman Olivia Watkins told The Associated Press on Monday that the agency won’t take action against any provider who shows he or she has applied for such privileges.

“The department’s policy is in accordance with governing precedent from the U.S. 5th Circuit Court of Appeals and is in line with what the state offered the plaintiffs previously,” Watkins said in an email.

It was not immediately clear whether doctors from all five clinics have applied for hospital privileges.

Clinics in Shreveport, Bossier City and Metairie sued the state, seeking to block the law. The lawsuit claims doctors haven’t had enough time to obtain the privileges and the law likely would close all five clinics. Clinics in New Orleans and Baton Rouge were not plaintiffs in the lawsuit.

The judge said he will call a status conference within 30 days to check on the progress of the plaintiffs’ applications and to schedule a hearing to consider a request for an order blocking the law while the case is in court.

Admitting privileges laws have been enacted in several states across the South.

Supporters say the laws are designed to protect women’s safety by providing continuity of care in case a patient is hospitalized. Opponents say complications from abortion are rare, and hospitals are already obligated to treat people seeking emergency care. Opponents also say admitting privileges laws give hospitals the power to decide whether an abortion clinic can stay open.

Some hospitals will not grant the privileges to out-of-state physicians, such as those who work at someabortion clinics in the South. Some religious-affiliated hospitals will not grant privileges to abortionproviders.

A panel of the 5th U.S. Circuit Court of Appeals upheld a Texas admitting privileges law that’s similar to the one in Louisiana. But in July, a different panel of the 5th Circuit voted to block Mississippi’s law, which would have closed the state’s only abortion clinic, saying every state must guarantee the right to anabortion.

The 5th Circuit is one of the most conservative federal appeals courts in the nation. It also handles cases from Louisiana.

MONEY Health Care

Why a Trip to the ER Could Cost You More Than You Expect

If a holiday weekend mishap sends you to the emergency room, watch your wallet. You shouldn't owe more if the hospital is outside your insurance network. But that could change if you're admitted.

When you need emergency care, chances are you aren’t going to pause to figure out whether the nearest hospital is in your health insurer’s network. Nor should you. That’s why the health law prohibits insurers from charging higher copayments or coinsurance for out-of-network emergency care. The law also prohibits plans from requiring pre-approval to visit an emergency department that is out of your provider network. (Plans that are grandfathered under the law don’t have to abide by these provisions.)

That’s all well and good. But there are some potential trouble spots that could leave you on the hook for substantially higher charges than you might expect.

Although the law protects patients from higher out-of-network cost sharing in the emergency room, if they’re admitted to the hospital, patients may owe out-of-network rates for the hospital stay, says Angela Gardner, an associate professor of emergency medicine at the University of Texas Southwestern in Dallas who is the former president of the American College of Emergency Physicians.

“Even if the admission is warranted, you are subject to those charges,” she says.

If you live in a state that permits balance billing by out-of-network providers, your financial exposure could be even greater. In a balance-billing situation, a hospital may try to collect from the patient the difference between what the hospital billed and what the health plan paid for care. Such practices aren’t generally allowed if a consumer visits an in-network provider.

Consumers shouldn’t expect that the hospital will inform them of potential out-of-network coverage issues, so they need to inquire, says Gardner.

“At least being informed and knowing what you’re getting into can set you up to handle it with your insurer,” she says.

And while you’re at it check into being transferred to an in-network facility if it’s feasible.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

TIME

Oregon Sues Oracle Over Failed Health Care Website

Attorney general candidate Ellen Rosenblum makes remarks during a debate with Dwight Holton at the City Club Friday, April 27, 2012, in Portland, Ore.
Attorney general candidate Ellen Rosenblum makes remarks during a debate with Dwight Holton at the City Club Friday, April 27, 2012, in Portland, Ore. Rick Bowmer—AP

(SALEM, Ore.) — The state of Oregon filed a lawsuit Friday against Oracle Corp. and several of its executives over the technology company’s role in creating the troubled website for the state’s online health insurance exchange.

The lawsuit, filed in Marion County Circuit Court in Salem, seeks more than $200 million in damages and alleges that Oracle officials made false statements and submitted false claims.

Oracle was the largest technology contractor working on Oregon’s health insurance enrollment website, known as Cover Oregon. The public website was never launched and became a political problem to Democratic Gov. John Kitzhaber, who is running for re-election.

“Today’s lawsuit clearly explains how egregiously Oracle has disserved Oregonians and our state agencies,” Attorney General Ellen Rosenblum, a Democrat, said in a statement. “Over the course of our investigation, it became abundantly clear that Oracle repeatedly lied and defrauded the state.”

Oracle filed its own lawsuit Aug. 8 alleging breach of contract and seeking payment of more than $23 million in disputed bills. The Redwood City, California, company blames Oregon for the website’s failure, saying the state had incompetent and indecisive staff.

Oracle officials could not immediately be reached for comment.

Instead of signing up for health insurance under the Affordable Care Act in one sitting, Oregonians had to use a hybrid paper-online process that was costly and slow, and the state had to hire more than 400 workers to help them. Altogether, about $250 million in federal funds has been spent on Oregon’s exchange, including technology development, salaries, advertising and rent.

Despite the exchange’s technology woes, about 454,500 Oregonians have enrolled in coverage through Cover Oregon using the hybrid process. An estimated 97,000 of those enrolled in private health plans, while about 357,500 enrolled in the Oregon Health Plan, the state’s version of Medicaid.

The state decided to stop building the Oracle website earlier this year and transitioned to the federally run enrollment website.

The FBI and the federal Government Accountability Office are also investigating Oregon’s exchange problems.

MONEY Health Care

How Some Insurers Still Avoid Covering Contraception

Locked up birth control pills
Nicholas Eveleigh—Getty Images

Under health reform, your birth control should be fully paid for by insurance. But even before the Supreme Court gave more employers an out, some insurers have been pushing back.

How much leeway do employers and insurers have in deciding whether they’ll cover contraceptives without charge and in determining which methods make the cut?

Not much, as it turns out, but that hasn’t stopped some from trying.

Kaiser Health News readers still write in regularly describing battles they’re waging to get the birth control coverage they’re entitled to.

In one of those messages recently, a woman said her insurer denied free coverage for the NuvaRing. This small plastic device, which is inserted into the vagina, works for three weeks at a time by releasing hormones similar to those used by birth control pills. She said her insurer told her she would be responsible for her contraceptive expenses unless she chooses an oral generic birth control pill. The NuvaRing costs between $15 and $80 a month, according to Planned Parenthood.

Under the health law, health plans have to cover the full range of FDA-approved birth control methods without any cost sharing by women, unless the plan falls into a limited number of categories that are excluded, either because it’s grandfathered under the law or it’s for is a religious employer or house of worship. Following the recent Supreme Court decision in the Hobby Lobby case, some private employers that have religious objections to providing birth control coverage as a free preventive benefit will also be excused from the requirement.

In addition, the federal government has given plans some flexibility by allowing them to use “reasonable medical management techniques” to keep their costs under control. So if there is both a generic and a brand-name version of a birth-control pill available, for example, a plan could decide to cover only the generic version without cost to the patient.

As for the NuvaRing, even though they may use the same hormones, the pill and the ring are different methods of birth control. As an official from the federal Department of Health and Human Services said in an email, “The pill, the ring and the patch are different types of hormonal methods … It is not permissible to cover only the pill, but not the ring or the patch.”

Guidance from the federal government clearly states that the full range of FDA-approved methods of birth control must be covered as a preventive benefit without cost sharing. That includes birth control pills, the ring or patch, intrauterine devices and sterilization, among others.

But despite federal guidance, “we’ve seen this happen, plenty,” says Adam Sonfield, a senior public policy associate at the Guttmacher Institute, a reproductive health research and education organization. “Clearly insurance companies think things are ambiguous enough that they can get away with it.”

If you are denied coverage, your defense is to appeal the decision, and get your state insurance department involved.

“The state has the right and responsibility to enforce this law,” says Sonfield.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

More on the Affordable Care Act and contraception coverage:

 

 

 

 

 

MONEY Health Care

What It Really Means When Your Doctor Says He Doesn’t Take Insurance

A denial may not be as straightforward as it seems. Here's what your doctor's policy could be—and what that could mean for your medical bills.

Some doctors really mean it when they say they do not take health insurance. For others, it is more of a nuanced statement.

Consumers trying to decipher the difference have to ask a lot of questions to figure out how to manage their bills.

Here are the three key scenarios facing consumers:

1. “I do not take your insurance, but I will work with you on the price.”

A growing number of doctors simply are not taking contracts with insurance companies, although the concentration varies by region and by specialty. That leaves patients to pay the market rate the doctor charges, and then submit a receipt to get reimbursement for out-of-network coverage, if they have it.

In some cases, the pickings can be slim for in-network docs. For example, 45% of psychiatrists do not participate in insurance networks, according to JAMA Psychiatry.

“The burden of getting the forms right and getting all the paperwork is placed on the physician,” says Dinah Miller, a psychiatrist who practices in Baltimore and co-authors a blog called Shrink Rap. “If you’re seeing eight or nine patients a day, and several bounce, it’s a lot of uncompensated time.”

Primary care physicians are opting out, too. Some are moving to a concierge model, in which patients pay a subscription fee like $150 a month to see their doctor.

Membership in the Association of American Physicians and Surgeons, a conservative-libertarian group of private-pay doctors, increases by about 10% a year, says Jane Orient, executive director of the organization, which has 5,000 members.

Many doctors who say they don’t take insurance will make deals with patients on an individual basis. One key negotiating tip is to know what your in-network rate would be, typically a discount of about 40%, suggests Joe Mondy, a spokesman for insurer Cigna.

You can get this information through your provider’s online tools or by calling the customer service line. But Mondy says to be aware that the private provider is not bound to accept that price.

2. “I will submit the receipt for you, see what I get from the insurance company and work with you on the difference.”

This process is typically referred to as balance billing. It is largely frowned upon for in-network charges, and even restricted in some states. But it still goes on in the private-pay world, and often results in a confusing morass of paperwork.

Even insurance executives find themselves negotiating the fray. Chris Reidl, director of product for national accounts at insurer Aetna, paid an up-front fee to one doctor and then submitted the bill to the insurance company. When the insurance company reimbursed the doctor for the visit, the office refunded the fee she had paid.

Consumers need to be on top of this process and pour over their benefits statements to track the various payments. They also need to keep after their doctors’ offices to get their money back.

3. “I will try to negotiate a better rate with your insurance company.”

Some providers have back-channel communications with insurance companies, trying to get a better reimbursement so their patients end up paying less out of pocket.

Amy Gordon, a lawyer focusing on benefits issues at McDermott, Will & Emery in Chicago, facilitates some of these discussions, trying to get everyone on the same page.

Gordon gives the example of a chiropractor who has a number of patients on one employer’s plan. The going rate for a visit is $200, and the out-of-network reimbursement offered is $50. The provider has to choose whether to charge the patients the remainder or discount it.

“Being out $150 for one person is bad, but being out that much for 10 people is worse,” she says. So the provider tries to get more from the insurance company, and the insurance company tries to get the provider to join its network. The insurer and the doctor may end up settling on an $80 reimbursement, and the patients only have to pay the equivalent of a $20 co-pay.

“A lot of this can be avoided with planning, and finding if there is an acceptable in-network provider,” Gordon says. “If you still want to go out of network, you can ask the insurance company to give you an estimate of what they would pay, and then you can at least make a more informed decision.”

MONEY Health Care

How to Pick a Health Plan That’s Right For You

Picking a card with medicine on it
David Emmite—Getty Images

HMO, PPO, EPO? The alphabet soup of insurance plans may leave you dazed and confused. Here's how to make sense of your choices and get the coverage you need.

What’s in a name? When it comes to health plans sold on the individual market, these days it’s often less than people think. The lines that distinguish HMOs, PPOs, EPOs, and POS plans from one another have blurred, making it hard to know what you’re buying by name alone—assuming you’re one of the few people who know what an EPO is in the first place.

“Now, there’s a lot of gray out there,” says Sabrina Corlette, project director at Georgetown University’s Center on Health Insurance Reforms.

Ideally, plan type provides a shorthand way to determine what sort of access members have to providers outside a plan’s network, including cost-sharing for such treatment, among other things. But since there are no industry-wide definitions of plan types and state standards vary, individual insurers often have leeway to market similar plans under different names. In general:

  • Health maintenance organizations (HMOs) cover only care provided by doctors and hospitals inside the HMO’s network. HMOs often require members to get a referral from their primary care physician in order to see a specialist.
  • Preferred provider organizations (PPOs) cover care provided both inside and outside the plan’s provider network. Members typically pay a higher percentage of the cost for out-of-network care.
  • Exclusive provider organizations (EPOs) are a lot like HMOs: They generally don’t cover care outside the plan’s provider network. Members, however, may not need a referral to see a specialist.
  • Point of Service (POS) plans vary, but they’re often a sort of hybrid HMO/PPO. Members may need a referral to see a specialist, but they may also have coverage for out-of-network care, though with higher cost sharing.

Although insurers identify plans by type in the plan coverage summaries they’re required to provide under the health law, one PPO may offer very different out-of-network coverage than another.

“You have PPOs with really high cost sharing for out-of-network services, which from a consumer perspective seem a lot like HMOs,” says Corlette. Some plans labeled as PPOs don’t offer out-of-network services at all, experts say. On the other hand, some HMOs have an out-of-network option that makes them seem similar to PPOs.

Then there are EPOs. “People have no idea what an EPO is,” says Jerry Flanagan, lead staff attorney at Consumer Watchdog, an advocacy organization that recently filed a class action lawsuit against Anthem Blue Cross in California. They claim, among other things, that the insurer enrolled people in EPO plans with no out-of-network coverage who believed they were being enrolled in PPO plans that provided such coverage.

“Materials at the time of enrollment and in member’s Explanation of Benefits have clearly stated that the plan was an EPO plan which may not have out-of-network benefits,” said Darrel Ng, a spokesperson for Anthem Blue Cross, in a statement.

This year, HMOs and PPOs dominated the plans offered by insurers on the health insurance exchanges. According to an analysis of plans sold in the 36 states for which the federal government runs the online insurance marketplace as well as the plans sold on the California exchange, HMO offerings made up 40% and PPOs another 40%. POS plans made up 12% and EPO plans 7%.

Higher premiums didn’t necessarily correlate with better out-of-network coverage, says Caroline Pearson, vice president at Avalere Health, a research and consulting firm. HMO plan premiums, in fact, were slightly higher on average than those for PPOs, according to the Avalere analysis.

Pearson says the explanation may be that insurers anticipated that people who bought a PPO would probably want to use out-of-network providers. Since out-of-network spending doesn’t count toward the out-of-pocket maximum that people are responsible for before insurance picks up the full tab, these people were likely to be cheaper to insure, she says. (Next year, the out-of-pocket maximum will be $6,600 for single coverage and $13,200 for a family plan.)

Based on the 18 states that have released their proposed products and rates for next year, it doesn’t appear that plan types are likely to change significantly, says Shubham Singhal, leader of the health care practice at management consultant McKinsey & Co.

“Perhaps a few more EPOs will emerge,” he says. “Some of the health plans that might have introduced metal-level plans through the HMO are viewing the EPO as way to introduce a non-gatekeeper product.”

Since you can’t rely on plan type to provide clear guidance on out-of-network coverage, there are three basic questions to investigate when evaluating a plan, says Pearson:

  • Is there out-of-network coverage?
  • Does that out-of-network spending accrue toward the member’s out-of-pocket maximum? Legally it doesn’t have to, but some plans include it.
  • Do members need a primary care physician gatekeeper?

That’s only the beginning. Once you figure out whether a plan covers out-of-network care, it can be difficult to find out whether your doctor is even in that plan. You can check with you doctor’s office, but sometimes they don’t know. You can also look at provider directories to see who is and isn’t in a plan’s network, however, that information frequently proved inadequate or inaccurate last open enrollment period. But understanding the alphabet soup of plan types is an important first step.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

MONEY Ask the Expert

When Parents Can Say No to Picking Up the Tab for Insurance

140603_FF_QA_Obamacare_illo_1
Robert A. Di Ieso, Jr.

Q. My ex-husband has been responsible for providing health insurance for our kids until the age of majority. My sons are now 21 and almost 18. My ex has family coverage for himself and his new wife, but he wants me to put the kids on my insurance now that they have reached the age of majority. Covering the kids doesn’t cost him anything extra, but for me to switch from a single plan to a family plan is an extra $175 a month and I can’t afford it. Since the age of majority for health insurance is now 26, is it possible he still is required to keep them on his insurance?

A. No, he’s not obligated to keep them on his health plan. Under the health law, insurers must offer to cover young adults up to age 26, but parents aren’t obligated to provide it, says Timothy Jost, a law professor at Washington and Lee University and an expert on the health law.

Further, the requirement to offer coverage isn’t related to the age of majority, which is defined by individual states and is generally between 18 and 21, says Randy Kessler, an Atlanta divorce lawyer and past chair of the American Bar Association’s family law section.

The health insurance coverage arrangement that you describe is pretty typical, says Kessler. You could go back to court and try to get your child-support payments increased to cover the cost of providing health insurance for the kids, but “it would be unusual for the courts to be helpful,” says Kessler. Absent some significant change in your or your ex-husband’s finances, or unforeseen and costly medical expenses for your children, in general “you can’t have another bite at the apple.”

With no legal requirement to compel either of you to cover your kids, it’s something the two of you will just have to work out, says Kessler. In addition to covering your children on your own or your ex’s plan, it’s also worth exploring whether they might qualify for subsidized coverage on the state marketplaces or for Medicaid, if your state has expanded coverage to childless adults. If they’re in college, student health coverage is worth investigating as well.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

TIME Health Care

Your Next Blood Test Could Cost $10,000

That’s how much one Cal. hospital charges for a routine cholesterol test. Others charged as little as $10 for the exact same assay

We’re used to comparison shopping, and we know where we can get a better deal on the exact same box of cereal or the same pair of sneakers. But when it comes to the routine blood test you get every time you see the doctor, how budget-conscious can you be?

Not very, new research shows. In an eye-opening report published in the journal BMJ Open, Dr. Renee Hsia, an associate professor of emergency medicine at the University of California, San Francisco, and her colleagues found that cholesterol panel could cost patients anywhere from $10 to $10,169 — a more than thousand-fold difference. A basic metabolic test for things like blood sugar ranged from $35 to $7,303.

“I was expecting a little variation, maybe two-fold, or even three-fold,” says Hsia, who also studied differences in total costs for procedures like having the appendix or tonsils removed. “But I wasn’t expecting this amount.”

She focused specifically on blood tests because they are automated and not prone to variations in the quality of the technician or other bells and whistles required to spit out results. “It should be like buying a loaf of bread,” she says, with only slight differences in price.

MORE: An End to Medical-Billing Secrecy?

But the thousand-fold range shows just how seemingly random health care pricing can be. “There is probably nothing justifiable [for the high cost] in this case,” she says. Even if the most talented technician were performing the lipid analysis using the most sophisticated machine, it’s hard to imagine those services requiring $10,000 worth of equipment or labor.

And it’s not as if individual hospitals are guilty of overcharging consistently. One hospital may have high fees for one test and lower fees for others. In Hsia’s study of 150 California hospitals, the one that charged more than $10,000 for the cholesterol test was not the same one that billed more than $7,000 for a metabolic test. Factoring in things such as whether the hospital was for- or not-for-profit, whether it was a teaching hospital, and the percentage of patients covered by Medicaid still didn’t explain the gap in pricing.

MORE: Bitter Pill: Why Medical Bills Are Killing Us

Master lists at each hospital set these fees, she says, and in recent years, some hospital administrators have admitted that even quantitative factors such as supply, demand or overhead costs don’t factor into these prices. In 2013, Secretary of Health and Human Services Kathleen Sebelius released the prices of 100 of the most common inpatient services at hospitals across the country in an effort to make the process more transparent.

And if you think you won’t have to worry about these prices because you’re insured, you may be feeling these costs the next time your premium creeps up. While private insurers negotiate with hospitals to accept certain fees, that rate is a percentage of the original charge — the higher the charge, the higher that negotiated fee will be. And insurers pass on those costs to their members.

So can a financially responsible patient comparison shop for hospitals with the most reasonable fees? Not really.

California law mandates that hospital report what they charge for any 25 of the most common outpatient tests. But they don’t specify what those tests are, and hospitals can chose which ones they provide to the public. The entire list of fees is also available, but not as easy to navigate for patients who aren’t familiar with the codes for the tests. “It’s not that transparent, and hard for patients to access the information,” says Hsia.

“When people hear about price variation, they say it’s probably just one hospital, or one blood test or one procedure, and they think it’s the exception rather than the rule,” says Hsia. But evidence is mounting that’s not the case. “It’s not a hospital issue, it’s a fundamental problem because there is not a rational way to determine hospital pricing, and that needs to be addressed.”

 

MONEY Health Care

How to Fix Your Finances…By Fixing Your Blood Pressure

Blood Pressure Gauge
Anthony Harvie—Getty Images

High blood pressure is hazardous to more than your health. Here's how to ease the impact on your finances.

High blood pressure affects one in three adults in the United States. It can have a major impact on your health, of course; as a financial planner, I’m also conscious of the negative consequences it can have for your finances, too.

The challenge with high blood pressure is that it does not cause a person to feel ill. With health care costing as much as it does, it is easy to forgo treatment for an illness that doesn’t cause many symptoms. So many people leave their high blood pressure untreated.

The end result of this inaction: greater illness and higher health care costs down the road. Untreated high blood pressure leads to heart disease, strokes, or heart and kidney failure. Not treating high blood pressure is a perfect example of being penny-wise and dollar-foolish.

So given the importance of treating high blood pressure, what can people do to control the current cost of their illness? A couple of actions can go a long way.

Improve Your Lifestyle

An unhealthy lifestyle is the most common way people develop high blood pressure in the first place. Weight loss, regular exercise, salt reduction, and limiting alcohol are cheap ways to potentially eliminate the disease. These aren’t easy changes at first, but by developing a new lifestyle as a habit, the new behavior gets easier with time.

A healthy diet is also important, but a diet heavy in vegetables, fruit, and unprocessed food can cost a lot and require time-consuming amounts of cooking. One way to mitigate this cost is to become an “Iron Chef”: work with the raw material at hand. Go with what’s on sale in the grocery aisle, or even better, hit the farmer’s market. Spend a couple of hours on days off to cook enough to last most of the week.

Manage Your Medicine

Doctors choose medication to treat high blood pressure based on a number of factors. Concurrent illness, other medication, demographics, and potential side effects all play a role. The good news is that most medication used to treat high blood pressure comes in generic form, and the generics work just fine. Generics are cheap. In fact, some pharmacies will provide generic medication for high blood pressure for free! Your doctor will know if these opportunities are available in your area; it’s up to you to ask about the options.

The most important part of medication management is consistency. Medication taken regularly and about the same time everyday results in better blood pressure control. Ideally, people brush their teeth every day, so why not put your medication by the toothbrush and make it part of the routine?

If your blood pressure is too high, the doctor will see you every couple of weeks or so until it is in a good range. If blood pressure is well controlled with lifestyle and medication, doctor visits are reduced to once or twice a year, depending on other health issues. Better control results in fewer doctor visits, which reduces the cost of care.

High blood pressure doesn’t have to be costly. By being forward-thinking about it, you can greatly improve the quality and length of your life — and lower your expenses along the way.

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Carolyn McClanahan is a physician, financial planner, and founder of Life Planning Partners. In addition to running her financial planning practice, she educates financial planners, health care professionals, and the public on the intersections of health and personal finance.

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