How Much Will That MRI Cost? Depends on Who You Ask

Price transparency may be one welcome element in healthcare reform legislation. The proposed bipartisan bill written by Senator Max Baucus (D-MT) and his Senate Finance Committee includes a provision that will require hospitals to list standard charges for their

As the system currently works, insurance companies enter into agreements with hospitals and physicians to determine how much they will pay for hip replacement surgeries, cataract procedures and MRIs — all long before the patient enters the scene.  Hospitals and doctors tend to charge the uninsured significantly higher rates than they do the insured.  Medicare sets its own rates, which typically are lower than commercial rates.

“The pricing model is ridiculous,” said Brad Myers, a founder of Pensacola, FL-based NewChoiceHealth, Inc., an online tool that allows consumers to compare healthcare prices.  Myers bases his information on estimates gleaned from Medicare data.

The states of Maine and New Hampshire have addressed this partially with online cost comparison websites that are accurate because they are based on insurance claims paid for real procedures.  Consumers can use the information posted to shop around or to get the best deal possible.  A visit to the Maine website finds that one hospital charges the uninsured $1,326 for a colonoscopy.  The insured pay the hospital between $800 and $950 for the same procedure, depending on who carries their coverage.  Medicare pays the same hospital just $793.

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