What turning off lights and shopping for health care have in common

Why Shopping for Care is Difficult

Many factors make shopping for health care services difficult and not as straight forward as other goods and services.

1. Prices are Personal: Tools that are out there, including the Shop for Care tool, are great at providing estimates of prices, but what an individual will actually pay out of pocket depends on their unique coverage and plan design. Actual service prices can also vary depending on a person’s health status or complications that may arise during a procedure or visit. For example, I recently had a colonoscopy and the facility couldn’t tell me ahead of time how much it would cost because they said it depended on what, if anything, they found and had to do during the procedure.
2. Services are Billed Separately: If you’ve ever had a major health care event, you probably received multiple bills from the various providers you encountered. One from the hospital or facility, and perhaps others from the doctor or doctors who provided the care. Our Shop for Care tool and other tools out there show prices for the facility portion of the bill, but there may be other additional bills from providers that are harder to estimate. Our Provider Payment Tool can help with estimating what you may pay your doctor for services.
3. Not all Services are Shoppable: As I wrote about in a previous blog about my experience with cancer treatment, some services are so complicated and varied that it’s impossible to shop for them. Something straightforward like an MRI is an ideal service to shop for, but trying to determine the cost for more complex care like cancer treatment which may vary as your treatment progresses is much more difficult to estimate.
4. Plan or Provider Limitations: If you have a narrow network health insurance plan, not all facilities may be accessible or in-network. You also may really like your provider, and they may only have privileges to provide services at certain hospitals or facilities which limits your ability to shop around.

Why Price Transparency Still Matters

So why do we even bother with providing a Shop for Care tool given the challenges listed above? In spite of the barriers to shopping for care, there are many benefits to price transparency. Here are the many positive ways the tool can be used by different audiences, including consumers.

1. Starting Point for Selection: Even though prices on the Shop for Care tool aren’t specific to a particular health plan and don’t reflect the exact out-of-pocket costs you may pay, it is a great resource to identify potential facilities to investigate further. If you find a couple of facilities that have reasonable prices and good quality near you, you can determine what your actual costs may be by contacting the facility or your insurance company directly.
2. Understanding and Questioning Bills: We know of at least one instance where a patient saved thousands of dollars on a hospital bill by using the Shop for Care tool to show the facility that the bill was a lot more than the statewide average payment for that same service. Similarly, the tool can be used to understand if a bill you receive is reasonable for the services you received. If you ever need help with a bill, the Colorado Consumer Health Initiative’s Consumer Assistance Program can help.
3. Provider Referral Tool: Providers often refer patients to other providers for services, and the Shop for Care tool can help them understand which providers have the best prices and quality of care.
4. Payer and Provider Benchmarking: Both payers and providers can see what is being paid for services and use this information to understand how their prices and payments compare to their competitors.
5. Employer Cost Savings: Employers in Colorado and across the U.S. are experiencing year over year increases in health care costs. Tools like the Shop for Care tool can be used to negotiate lower prices with facilities or to steer employees towards lower cost, high quality care.

While no tool is perfect, and there are inherent barriers to shopping for health care services, there are instances and ways transparency tools can be used to lower health care costs. Next time you need a shoppable health care service, I encourage you to use the Shop for Care tool or other tools you may have available to you. Oh, and please turn the lights off before you leave your hotel room.