Entries for January 2009

Estimating the cost of a medical procedure or service ought to be as straightforward as pricing a used car—or at least that's the idea behind a new website, www. healthcareblue b ook.com . You pick a procedure, type in your ZIP code, and, presto, the site tells you the average fee accepted by providers in your area for that service. If you're uninsured or if your plan has a high deductible or coinsurance amount, you may be able to use this information to negotiate a lower rate similar to what typical insurers pay, according to the site. It even provides a handy "binding price estimate agreement," which spells out the estimated charge, that you could present to the doctor or hospital to sign before you receive services.

If only it were that simple. While it may be reasonable to shop for uncomplicated services like an MRI by comparing prices, most medical care isn't that clear cut. Take brain surgery. According to the website, in the Boston area, adult brain surgery to remove a tumor costs $42,827, on average. That price includes $4,490 for the surgeon's fee, $36,671 for the hospital, and $1,666 for anesthesia services. The site notes that if someone spends more than the estimated 13 days in the hospital or requires more than three hours of surgery, the figures could change. Talk about understatement. Anyone who's ever examined a hospital bill knows they often contain hundreds of moving parts that affect the cost. Because of all those unknowns, providers aren't likely to sign any agreement before the fact that limits how much they can charge, as my colleague Avery Comarow noted last week. (Here are four steps you can take to lower your medical bills, however.)

The bill reauthorizing the State Children's Health Insurance Program that the House of Representatives passed yesterday will extend health coverage to an additional 4 million lower-income kids over the next 4 1/2 years, bringing the total to 11 million. The Senate expects to take up a similar measure today, paving the way for Barack Obama to sign the bill soon after taking office.

The present bill is an important first step in making good on Obama's campaign pledge to cover all Americans. It allows states to waive the five-year waiting period for children of legal immigrants that has prevented an estimated half million from getting coverage. And the bill provides for $100 million in grants to encourage states to streamline and simplify outreach and enrollment. This is critical. Yearlong waiting periods and onerous documentation requirements have discouraged eligible kids from obtaining coverage in some states. "We need to get rid of barriers to getting enrolled and staying enrolled," says Susan Gates, general counsel for the Children's Defense Fund.

Consumers can soon expect to see fewer surprise charges on their medical bills when they visit a doctor outside their health plan's provider network, New York Attorney General Andrew Cuomo announced today. The happy change will occur thanks to the settlement of an ongoing investigation into UnitedHealth Group's Ingenix, a medical billing information company whose data are used to determine reimbursement amounts for consumers.

Most consumers know that it's going to cost more out of pocket to use an out-of-network provider, typically about 20 percent of the total bill. But what people don't expect is that they may be hit up for a much larger amount if the provider's fee (say, $160 for an office visit) is higher than the prevailing rate for a similar service in the area (perhaps $85), as determined by Ingenix. So, instead of $32 (20 percent of $160), the unwitting patient gets a bill for $92, because the insurer pays only 80 percent of the prevailing $85 rate rather than 80 percent of the $160 billed charge.

A report released today spells out in hard numbers what we all already intuitively knew: There's no way most laid-off workers can afford to hang on to their employer's health insurance on the strength of their weekly unemployment checks. The math just doesn't add up. According to the Families USA report, the average monthly premium for family health coverage under COBRA, the federal law that allows laid-off workers to continue with their former employer's health insurance, is $1,069. The average unemployment benefit, meanwhile, is $1,278 a month. That means that COBRA family coverage eats up 84 percent of a worker's unemployment check, on average. Single workers are somewhat better off: The bite for COBRA coverage is "only" 30 percent of their check. Either way, it's easy to understand why only about a quarter of those who are eligible for COBRA coverage take it.

In a handful of states, the average COBRA premium for health coverage actually exceeded the average unemployment insurance benefit, according to the report. "Conceptually, it's not so surprising," says Ron Pollack, executive director of Families USA. "But seeing the numbers compiled together, it's much starker than most thought."

The eastern seaboard will soon be awash in free antibiotics, as Wegmans yesterday announced the 72-store supermarket chain will make a 14-day supply of nine generic oral antibiotics available at no charge.

Giant Foods and Stop & Shop had already announced similar programs.

Wegmans says the program is aimed at helping people get through cold and flu season and will end March 31.

The closely watched annual health spending figures released today by the federal government were published, fittingly enough, in the January/February issue of the journal Health Affairs. Fittingly, because this month's issue is devoted to chronic illness, and about 75 percent of the $2.2 trillion the United States spends on healthcare goes toward treating chronic conditions like diabetes, heart disease, and cancer. That $2.2 trillion works out to $7,421 per person. The out-of-pocket cost, which is what individuals are most concerned about, comes to $889 apiece, 5.3 percent higher than it was in 2006, according to the Centers for Medicare and Medicaid Services, which released the figures.

That overall out-of-pocket spending figure is interesting, but how does it vary if someone has a chronic condition, as nearly half of people do? A study in the same Health Affairs issue reports that people with one chronic condition spent an average $655 out of pocket in 2005, while those with two chronic conditions spent $1,039, and those with three or more spent $1,865. While it's true that many people, especially elderly ones, have more than one chronic condition to contend with, lumping together costs faced by cancer patients with those who have much less expensive conditions like high blood pressure isn't all that helpful.

Southerners and snowbirds, take note: Donate blood between now and March 31 and you could be eligible to win a pair of airline tickets to anywhere Delta flies domestically. The American Red Cross's southern region will award 15 pairs of tickets to blood donors in Georgia, North and South Carolina, Alabama, Puerto Rico, southern Mississippi, and northern Florida (panhandle and Jacksonville area) as part of a promotion to shore up their supplies following the holidays.

You don't have to be a resident to be eligible, according to April Phillips, a spokesperson for the Red Cross's southern blood services region. Vacationers and business travelers in participating regions who stop by to donate are welcome as well. "In times like this, people don't have a lot of extra money," and this is a way to get something back while doing something good, says Phillips.