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Health Insurance & Affordable Care Act

In Mass., Getting Prices in Advance Not Easy

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Collins is told she will probably only have to pay her $3,000 deductible of whatever the price is in the end, but she’s not sure. She’s getting conflicting information about what is and isn’t covered from her OB, hospitals and her insurer. (By the way, insurance companies had to start providing prices last October.)

Seeking A Human Voice

No one said this would be easy. Each hospital negotiates prices with each insurer. Sometimes the hospital and physician charges are separate, sometimes they are not. And then, what the patient pays on top of their premium varies if they have a deductible or coinsurance.

“The main thing I wanted to find out was whether I would have any surprises,” Collins says. “I kind of wanted to be prepared for that. It sounds like I will be OK, but you never know until it’s over, so I guess I’ll find out.”

Collins is used to the challenge of searching for health care prices because she was uninsured for a while in her 20s. So does she feel like anything has changed now that hospitals and doctors are required to quote patients a price within two working days?

“The experience was pretty frustrating from beginning to end,” she says. “It was definitely surprising how many machines I spoke to within the last few days.”

This is the world in which Collins is supposed to become a savvy health care consumer, making informed decisions about where to get the best care at the best price.

Both Emerson Hospital and UMass Memorial Health Care say they are committed to making prices easily available for patients. A spokeswoman for Emerson says she was dismayed that Collins did not receive a prompt response.

UMass Memorial Health spokesman Robert Brogna says it is “working through some challenges in the early days of the new requirements, and some interactions have clearly been less than optimal. This will change. In the coming weeks we will be providing a phone line and establishing new policies and procedures to support this new requirement.”

“It’s very different from, you go into Best Buy, you want to buy a refrigerator,” says Karen Granoff, the senior director for managed care at the Massachusetts Hospital Association. Granoff says her members are working with insurers to nail down prices that hospitals can quote patients.

“They know they need to do this,” Granoff says. “They are not opposed to the transparency. I think they are worried about the challenge of getting the information to the patient.”

Doctors, Too

Doctors are also now required to give patients the price of anything they need within two days of a patient’s request. Some large physician groups such as Harvard Vanguard have software that can calculate exactly what your expense will be based on the details of your insurance plan. But many doctors, especially those in small practices, aren’t familiar with the requirement. The state has no authority to make physicians participate.

Fri, Feb 7 2014

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