JournalistBlood test: $522 or $19? We’re New Orleans journalists digging into the murky waters of health care pricing. Ask Us Anything!
Aug 24th 2017 by NOLAnews • 11 Questions • 384 Points
We’re Jed Lipinski, a reporter for NOLA.com | The Times-Picayune, and Lee Zurik, a reporter for WVUE Fox 8 News.
For the past few months, we’ve been writing about the cost of health care in Greater New Orleans as part of our “Cracking the Code” series. With help from ClearHealthCosts, a New York-based journalism start-up, we’ve exposed how the cost of common medical procedures varies dramatically depending on your provider or health insurance.
Routine blood tests, for example, can be had at Touro Infirmary for $522, or for just $19 half-a-block away at Clinical Pathology Laboratories. At one local radiology facility, United Healthcare pays $1,005 for an MRI of the spine, whereas Blue Cross and Blue Shield of Louisiana pays just $464 – a difference of $541.
Through our reporting, we learned that the cost of most medical procedures is intentionally hidden from the public. As a result, most patients have no idea what they will pay prior to visiting the emergency room or undergoing an operation. This directly benefits insurance companies and health care providers, whose prices often have no relationship to the cost of the service itself. Overcharging is the norm.
Our goal throughout has been to enable consumers to make educated cost decisions about their health, the same way they can about food at the grocery store or fuel at the gas station.
Thanks for having us. Ask us anything!
Edit: Stories call, so we're stepping away from the keyboards. We'll be back to answer your questions throughout the day though, so keep posting them if you have them.
Are prices are fudged depending on the number of unprofitable services that the hospital provides? For instance if a hospital needs to pay for a lot of elderly folks or medicaid folks or people that simply don't pay their bills, the hospital would want to charge more for other procedures. Is this a large factor in the price discrepancy?
Jed: Great question. It's something we addressed in a May story about facility fees, where a clinic affiliated with a hospital charges an extra fee for the "facility" -- as if medical procedures would take place anywhere other than a facility. (Outside?) In this story, a woman was hit with a $137 facility fee because the sports medicine clinic she went to was affiliated with Tulane Medical Center across town. Tulane Medical Center has a busy 24-hour ER that takes in a lot of people who can't afford to pay. So they (and other hospitals in similar situations) will try to justify charging extra fees, like a "facility fee," because they lose money by providing services that small clinics without pricey ERs don't have to bother with.
As we wrote in the story: "Federal law allows hospitals to charge facility fees for outpatient services at affiliated clinics, regardless of whether the clinic is anywhere near the hospital. The clinics may have the same equipment, staffing and operating expenses as a private practice, and may look much the same as a private practice, but the simple fact that they're connected to a hospital entitles them to charge that extra fee."
when looking for sources and tipsters within health care for a story, where is generally the best place to look? doctors? recently-fired insurance company employees?
Jed: Good one. Having just gone through a months-long project about health care pricing, I can say an excellent way to find tipsters and sources is to do what we did: Publish a few stories about the drastic disparities in health care costs in your region. It's an enormous problem that most people are reluctant/embarrassed/ashamed to talk about, but once you start airing it in public, people rush to tell their story. For weeks, we received dozens of emails and voice messages per day from a wide variety of people -- including MDs and former health insurance employees -- who often spoke to us on the condition of anonymity but pointed us in the right direction. It took gathering some eye catching data -- A $522 blood test could be had for $19 across the street? -- to get the ball rolling.
This was the story that kicked it off for us: http://www.nola.com/health/index.ssf/2017/04/new_orleans_health_prices.html. Allowing the community the opportunity to post their medical costs and bills and stories anonymously was also very helpful in gathering sources and tips
Speaking to your point about consumers asking questions: my GP sent me to a dermatologist to have a small cyst removed. I spoke with the office beforehand and said that I do not wish to have it tested, it is just a fatty cyst and they said ok. When I got the bill it was $1,000 and a big part of that was the testing I asked them to leave out. When I went to question this they said that is standard policy and made me go on a payment plan to pay the bill. In an instance like this, does the consumer have any path of recourse? I felt like I didn't.
From Jeanne Pinder:
We tell people to get price quotes in writing in advance. That makes it easier to appeal. Here's our story about 10 questions to ask in advance.