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Patient Finds Shopping For Low-Priced CT Scan Doesn鈥檛 Pay Off

Douglas White knew high-deductible insurance is supposed to make patients feel the pain of medical prices and turn them into smart shoppers. So he shopped.

He called around for price quotes on the CT scan his doctor ordered. After all, his plan鈥檚 $2,000 deductible meant paying the full cost out of pocket. Using information from his insurer, he found a good deal 鈥 $473.53 at Coolidge Corner Imaging in Boston, a half hour from his house.

But the bill he got later was for $1,273.02 鈥 more than twice as much 鈥 from a hospital he had no idea was connected to the imaging center.

鈥淚 was shocked,鈥 said White, a doctor of physical therapy who thought he knew his way around the medical system. 鈥淚f I get tripped up, the average consumer doesn鈥檛 have the slightest chance of effectively managing their health expenses.鈥

A basically comes to the same conclusion, suggesting that there are millions of Douglas Whites lost in the medical billing maze.

Nearly one in three Americans with private health insurance surveyed by the research group got a surprise medical bill in the past two years 鈥 defined as when a plan paid less than expected and doctors and hospitals tried to recover the balance from the patient.

Of those with surprise bills, nearly a fourth got bills from doctors they had no idea were involved in their care and nearly two-thirds were charged more than they expected.

鈥淲hen we talk about transparent health care and the need for consumers to shop around, it鈥檚 just not possible in many situations,鈥 said Blake Hutson, a senior associate for Consumers Union, the policy arm of Consumer Reports. 鈥淓ven if you work for a big company and have what you think is a good health insurance plan, you can get a surprise medical bill.鈥

The deductible is what patients pay before insurance kicks in. The higher the deductible, the more you pay out of pocket. Deductibles of $3,000 or $5,000 are not unusual these days, although the health law caps out-of-pocket costs at $6,600 for individuals and $13,200 for families.

Making plan members pay more in this way is supposed to prompt them to check prices and put competitive pressure on medical providers.

The problem is that you can鈥檛 buy medical services the way you buy a phone plan. Doctors, hospitals and other providers generally don鈥檛 advertise their prices and often keep them confidential, even when asked by patients about what to expect. Providers charge different amounts for the same service depending on the insurance.

One episode of treatment can generate bills from multiple caregivers, especially in the hospital.

A new shows that members of high-deductible plans have higher incomes and are more educated on average than the typical American. But a post-grad degree from MIT might not be enough to figure out some bills.

The system is so complicated that one patient in three who got a surprise bill in the Consumers Union study didn鈥檛 investigate or fight it.

鈥淚 didn鈥檛 think it would make a difference,鈥 or 鈥淚 was confused about what to do鈥 were common reasons for inaction.

That鈥檚 the wrong response, said Karen Pollitz, a senior fellow at the Kaiser Family Foundation who studies how the health system affects consumers. (Kaiser Health News is an editorially independent project of the foundation.)

鈥淚t鈥檚 always advisable to ask questions if you receive a surprise bill or if insurance pays less than you expect,鈥 she said. 鈥淢istakes happen and following up can save you money. If it gets too confusing or frustrating, ask for help.鈥

for finding the relevant agency in your state and its contact information.

White鈥檚 billing problems were cleared up 鈥 many months and phone calls later and after a reporter started inquiring.

His plan, Harvard Pilgrim Health Care, said it had given him an incorrect quote for the CT scan last fall. The plan eventually paid the imaging center the full $1,273, saying it wasn鈥檛 White鈥檚 fault that the plan鈥檚 quote was wrong.

The bill had come from Brigham and Women鈥檚 Hospital, which owned the radiology center, even though White said there was no indication of that when he went to get the scan.

Harvard Pilgrim said it didn鈥檛 know Brigham and Women鈥檚 was affiliated with the center, either. Hospital-owned facilities are often far more expensive than independently owned doctors鈥 offices.

So how does he like the transparency revolution in health care, boosting competition and empowering patients?

鈥淭here is nothing transparent about most health care billing,鈥 White said.

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