How Much Is That MRI, Really? Massachusetts Shines A Light
The kids are asleep, and I've settled into a comfy armchair in the corner of my New England living room, one of my favorite spots for shopping online. I've got my laptop open and I'm ready to search for a bone density test.
Hmmm ... looks like the price that my insurer pays for that test varies from $190 at Harvard Vanguard to $445 at Brigham and Women's Hospital.
Really? I'm calm, but this is a seismic moment. In most of the country, it is still nearly impossible to compare the price and quality of anything in health care. Ten years ago, I tried filing Freedom of Information Act requests to get this information and got nothing. Occasionally, sources would leak me spreadsheets from one hospital or another.
Websites that mine such data are springing up to fill the void, revealing price tags on everything from an office visit to a cesarean section. But thanks to a law enacted in October, Massachusetts health insurers now have to make all their prices public — in advance.
"This is a very big deal," says Barbara Anthony, undersecretary for consumer affairs in Massachusetts. "We're letting the light shine in."
The online tools also calculate your cost, based on your plan. Anthony's office has launched an ad campaign, urging patients to shop around. She says doctors and hospitals are becoming frequent users of the online cost tools, too.
"They're already saying, 'I don't want to be the highest priced provider on your website — I thought I was lower than my competitors.' That's exactly the kind of reaction we want to see," she says.
It's key to getting at why one hospital charges three, four or five times more than its competitors, she says, and to seeing if exposing these differences will drive down prices.
"I'm just talking about sensible, rational pricing," Anthony says, "and right now, health prices are anything but that."
Take, for example, the cost in Boston of an MRI of the upper back, which the numbers show can range from $614 to $1,800.
"That to me is a very big range," says Sue Amsel, who oversees the shopping tool at the insurer Harvard Pilgrim Health Care.
In this case, the most expensive MRI is at Boston Children's Hospital — and the option of lowest cost is at New England Baptist, a hospital that specializes in orthopedics. The total cost of most surgeries is not yet available, but Amsel says you can now search for hundreds of tests, procedures and office visits.
"It's eye-opening," she says. "I'm always surprised at the difference between providers."
Now, most of us don't have a strong incentive to shop. We pay the same $25 or $30 copay no matter where we get an MRI. But more and more people have high-deductible plans, says Amsel, where patients pay the full cost of an office visit or test, up to the amount of their deductible.
The benefit's not just in getting to choose, Amsel says. "It's primarily for getting you the information about whatever you're having done, so you can plan for it."
After spending a lot of time window shopping for common tests, I have some tips: There are no uniform prices; they vary from one insurer to the next. And you have to read the fine print on these sites to know what is and is not included in the dollar figure you'll see online.
This story is part of an NPR partnership with WBUR and Kaiser Health News.
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Transcript
ROBERT SIEGEL, HOST:
Massachusetts, the first state to mandate health care coverage, is way out ahead again. It's begun requiring insurers to make public what they pay for many health services, everything from an office visit to a C-section. It's revolutionary because this information has been very hard to ferret out. WBUR's Martha Bebinger went online to test out this new world of health care shopping.
MARTHA BEBINGER, BYLINE: The kids are asleep and I've settled into a comfy armchair in the corner of my living room, one of my favorite spots for shopping online. I've got my laptop open and I'm ready to search for a bone density test - put in my location - Boston, Massachusetts - and hit the search button. It looks like the price that my insurer pays varies from $190 at Harvard Vanguard to $445 at Brigham and Women's Hospital.
BARBARA ANTHONY: This is a very big deal.
BEBINGER: Barbara Anthony, undersecretary for consumer affairs in Massachusetts, says it's a big deal because for the first time patients can see how much a test or procedure will cost in advance.
ANTHONY: What we're doing here is we're letting the light shine in on health care prices in Massachusetts.
BEBINGER: The online tools also calculate your cost based on your plan. Anthony's office has launched an ad campaign urging patients to try shopping for health care. Doctors and hospitals are becoming frequent users of the online cost tools, too. Says Anthony...
ANTHONY: Providers, hospitals, they're already saying I don't want to be the highest priced provider on your website. I thought I was lower than my competitors. That's exactly the kind of reaction we want to see.
BEBINGER: Because, says Anthony, we need to understand why one hospital charges three, four or five times more than its competitors and see if exposing these differences will drive down prices.
ANTHONY: I'm just talking about sensible, rational pricing. And right now health care prices are anything but that.
BEBINGER: Take, for example, the cost of an upper back MRI, says Sue Amsel, who oversees the shopping tool at the insurer, Harvard Pilgrim Health Care.
SUE AMSEL: The range here is $614 to $1800 - so three times. That, to me, is a very big range.
BEBINGER: In this case, the most expensive MRI is at Boston Children's Hospital and the lowest cost option is at New England Baptist, a hospital that specializes in orthopedics. The total cost of most surgeries is not yet available, but Amsel says you can search for hundreds of tests, procedures and office visits.
AMSEL: Its eye opening. I'm always surprised at the differences between providers.
BEBINGER: Now, most of us do not have a strong incentive to shop. We pay the same $25 or $30 co-pay no matter where we go for an MRI. But Amsel says more and more people have high- deductible plans, where patients pay the full cost of an office visit or test up to the amount of their deductible.
AMSEL: It's not just for choosing. It's primarily for getting you the information about whatever you're having done - how much that's going to cost so you can plan for it.
BEBINGER: After spending a lot of time window shopping for common tests, I have some tips for my fellow health care bargain hunters. There are no uniform prices, they vary from one insurer to the next, and you have to read the fine print on these sites to know what is and is not included in the dollar figure you'll see online. There are kinks to work out as Massachusetts becomes the first state to require that insurers put price tags on health care. For NPR News, I'm Martha Bebinger in Boston.
SIEGEL: And that story is part of a reporting partnership of NPR, WBUR and Kaiser Health News. Transcript provided by NPR, Copyright NPR.
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