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Health Care Reform:

Health Insurance & Affordable Care Act

In Mass., Getting Prices in Advance Not Easy

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A Big Range

Into her third day shopping by phone, Collins gets a return call from a woman at UMass Memorial.

“She did give me an average price,” Collins says. A vaginal delivery would cost “between $10,000 and $16,000.”

If her delivery turned into an emergency C-section, the cost would be between $20,000 and $30,000 “depending on the operation and how it went,” Collins says. For a more exact price, Collins is told she will need a CPT code — a number assigned to any test or treatment you may need. Collins called her obstetrician, but a woman in the front office said she didn’t have the CPT codes and suggested Collins call the hospital back.

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.”

Fri, Feb 7 2014

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