Worcester County patients pay less for MRIs, health care cost study finds
An analysis by the nonprofit public policy research organization of insurance claims data filed with the state
Looking at insurance claims for a single common imaging procedure, MRI of the knee, Pioneer researcher
The highest average out-of-pocket cost,
The study looked only at payments for charges from the imaging facility and did not include radiologists' charges for interpreting the knee MRI images.
Out-of-pocket costs are what consumers pay for health care services not paid for by their insurance company. These costs typically include fixed co-payments for a service; co-insurance that requires a patient to pay a percentage of health service costs; and deductibles, the amount of health care costs to be paid by the patient until the insurance coverage kicks in, up to an annual maximum.
With more people having high-deductible insurance plans these days in exchange for lower premiums, consumers can find themselves paying thousands of dollars out of pocket for care.
Consumers would not only save themselves money when choosing lower-cost providers, according to
The Pioneer analysis shows wide variation across the state for a routine procedure in allowed charges -- the amount agreed to by an imaging facility and the insurance company -- as well as the out-of-pocket costs, which may reflect the design of different insurance plans.
The allowed amount for an MRI in
The highest maximum allowed amount in the state,
A state law, Chapter 224 of the Acts of 2012, was intended to make health care costs more transparent so market forces, through price-conscious purchasers, could slow the rate of cost increases. The law required disclosure of pricing information by all medical providers and insurers in the state, and set up quasi-independent state agencies such as the
A consumer can telephone a medical provider beforehand to get at least a standard estimate of a procedure's cost, under the law, or use tools provided by their health plan to find out what costs may be incurred at different providers.
"The big problem is, consumers just don't know that these tools exist,"
Regional health insurance companies are amping up their cost tools to help members comparison shop when choosing medical providers.
"Fallon is also unique in
Fallon's consumer cost tools, Smart Shopper and Smart Choice, are available to commercial members to help them decide how to spend their health care dollars and where to have services performed, according to
MyHealthMath, offered to Harvard Pilgrim employer customers, helps employees select the plan that gives them the best value. It starts with one-on-one personal health usage interviews, and then uses a proprietary algorithm to identify the financially optimal health plan for consumers, he wrote in an email.
Estimate My Cost lets members estimate health care costs for more than 800 services in Harvard Pilgrim's network of providers -- before they receive services.
Reduce My Costs, known formally as SaveOn until September, is a voluntary program that lets members save money by finding care at a lower-cost facility for elective, outpatient medical procedures and diagnostic tests. This is a phone-based service. If a member chooses to and receives care from a lower-cost provider, he or she will earn a cash reward.
In particular, members who have called SaveOn found, "It really does help you shop around in a more intimate setting,"
___
(c)2018 Telegram & Gazette, Worcester, Mass.
Visit Telegram & Gazette, Worcester, Mass. at www.telegram.com
Distributed by Tribune Content Agency, LLC.
The last last-ditch plea for Notre Dame?
Advisor News
Annuity News
Health/Employee Benefits News
Life Insurance News