Price Shopping For Hospital Procedure

Robert Neubecker
Last week, I started on what I figured might be a tedious but straightforward task: calling local hospitals to get a price for the thyroid biopsy my doctor ordered. My insurance coverage is skimpy, so I wanted to shop around. But, holy phone tree—wrangling prices from our city’s hospitals turned out to be no ordinary errand. It was a journey, an adventure, a safari! I’m still dreaming about CPT codes.

I was transferred to the emergency room at Bellevue, the admissions department at Long Island College Hospital and the insurance claims department at a third institution. I made 45 calls and was transferred or put on hold an additional 56 times. I took 19 pages of typewritten notes. I spent more than five hours on the phone. And, despite all this, I managed to score quotes from only six of 10 hospitals contacted.

The situation is, as they say, ironical. In recent years, the number of workers covered by high-deductible health plans has tripled to 34%. These plans are designed to lower health-care costs by encouraging folks to shop for the best price. But good luck with that!

I first called Bellevue Hospital Center in Manhattan. Following transfers to the ER and the voicemail of a bureaucrat who never returned my call, I was delivered to the business office. There, an impatient lady told me the office was short-staffed due to the snow storm and would be busy the next day and closed for Presidents Day. “Call back on Tuesday!” she said. When I did, a scolding attendant said things were still hectic: “If you want to call back you can, but I don’t know if we’d be able to give you a price.”

Bellevue spokeswoman Evelyn Hernandez said I should have been directed to a financial counselor in the business office. Uninsured patients and those with limited coverage may pay on a sliding scale based on income and other factors. “We are reviewing the process with our operators,” she said.

At Brooklyn’s Long Island College Hospital, it took seven calls before I was told the embattled institution wasn’t taking patients, but a final call to the hospital’s press office revealed otherwise: “We are doing limited, simple procedures, which include thyroid biopsies,” said a spokesman.

Even some top-rated hospitals sent me on wild goose chases. While Mount Sinai Hospital eventually quoted a bargain price ($700), it first had me calling its collections and billing contractor up in Queensbury. At Lenox Hill Hospital, I got stuck in the world’s craziest phone tree. Another prominent hospital said no one gets a price quote unless he or she has already made an appointment for a procedure.

At New York Methodist Hospital, meanwhile, the ultrasound department mistakenly quoted an ultra-high price, $3,000. I should have been directed to an expert in the financial services office, says hospital spokeswoman                                     Lyn Hill.

It’s unusual for the hospital to get price queries, she says, but it’s anticipating more as high-deductible insurance plans grow commonplace. “Based on your experience, we clearly need to do more planning and employee education to prepare for these questions,” she said.

There were a few bright spots. At Memorial Sloan-Kettering Cancer Center, the operator transferred me straight to the billing department, where a helpful rep quoted the correct price. If it’s this good with the little things, imagine what it can do with a brain tumor!

But on the whole, the experience felt like more like a bizarro odyssey than a straightforward errand. I started to wonder if there was something deeply eccentric or even subversive about requesting the price of a procedure.

To get some perspective, I called Suzanne Delbanco. She’s the executive director of Catalyst for Payment Reform, a nonprofit dedicated to price transparency in health care. I told her about my adventure.

“I’m impressed you got six out of 10,” she said.

The problem isn’t that hospitals are secretive, she says, it’s simply that demand for price information is a relatively new phenomenon. Hospitals aren’t ready for these calls.

That’s starting to change as new laws require more disclosure. In some states, public websites provide quotes based on your insurance plan and desired procedure. Catalyst for Payment Reform rates all 50 states based on their transparency laws. New York, alas, gets an F.

There is some information available online for New Yorkers. Last December, the state’s Department of Health listed hospital charge data for 1,400 conditions on its Health Data NY site. While the figures are a bit outdated, it does provide some eye-popping stats, proving that it pays for the underinsured to shop around.

At many upstate hospitals, for example, the median charge for repairing a fractured femur ranges between $2,000 and $3,000. In the city, meanwhile, many hospitals charge $20,000 or more to fix a busted leg.

Prices vary just as much for common procedures like an appendectomy or baby delivery. You could really save a bundle by taking a JetBlue flight to Buffalo, the only drawback being the difficulties of traveling while one is in labor or nursing a burst appendix.

There are good reasons for the price differences. Teaching hospitals, for instance, must cover higher expenses. In areas where one hospital dominates, prices are high due to lack of competition.

But that’s not the story in New York City, where prices are often high thanks to the excellent reputations of the hospitals—they attract patients from around the world. They list high fees for the same reason Harvard and Yale quote high tuition rates. The crazy figures only add to the allure, never mind that hardly anyone actually pays the sticker price.

Ms. Delbanco did have some suggestions for frugal patients who want to shop around. There are a number of private companies that collect hospital price data and sell it to large employers. Your workplace might be a client. It’s worth calling HR to see if these tools are available to you.

Some insurers, meanwhile, provide price information through their websites, or upon request. I called mine and was instructed to fax an individual price information request form for every hospital and doctor I’m researching. Within 10 business days, I’ll get a snail-mail reply with a quote, which may or may not include all the associated expenses. The journey begins anew…

—anne.kadet@dowjones.com

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