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Why shop for docs in the dark?

By Jay MacDonald ·
Tuesday, June 5, 2012
Posted: 10 am ET

Would you shop at a supermarket, clothing store or gas station that didn't post its prices?

Probably not.

Yet we think nothing of shopping blindfolded when it comes to choosing our health care providers and services, according to Consumer Reports.

"It may be difficult, if not impossible, to find out the price of health care ahead of time, especially for complex services such as elective surgery," Consumer Reports says in its July issue.

That's because the prices for most medical services are negotiated between the health insurance companies and the service providers and "have little or nothing to do with the actual quality of services provided," CR found. As a result, "health care prices are all over the map, even within your own plan's network."

Healthcare Blue Book, which collects prices paid by large group health plans, found that the in-network price for a colonoscopy in one Midwestern city ranged from $840 to $4,481, or more than five times as much for the same procedure. What would be a reasonable price? Healthcare Blue Book puts it at $1,110 nationwide.

Using its own fair-price scale as a basis, Healthcare Blue Book found that large employers nationwide paid as much as $2,520 for a $560 brain MRI, $42,750 for a $19,791 knee replacement and $255 for a $44 chest X-ray – prices you'll only see after the fact in most cases.

Consumer Reports also investigates the out-of-network benefit that PPOs typically tout as an advantage over HMOs. While consumers may think that their PPO will cover 60 or 70 percent of whatever the out-of-network provider charges, the actual amount, "what's often called the UCR ("usual, customary, and reasonable") price, is often much less than the bills that come from the non-network providers. That can leave patients on the hook for the balance – the amount not reimbursed by their plan."

Consumer Reports recommends the following to avoid unpleasant surprises:

  • Read your health insurance policy to understand the rules and cost-sharing features of your plan.
  • Stay in network: These providers have agreed to accept your plan's negotiated price as payment in full.
  • Compare network prices online, by phone or through providers directly if necessary.
  • Don't pay until all the bills are in, including the explanation of benefits, or EOB forms.
  • Negotiate with out-of-network providers beforehand, using fair prices in your area found on, or both.

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