If you need an MRI scan or are looking for a basic cholesterol test in Chattanooga, it pays to shop around. A review of claims data locally shows the charges for several basic medical procedures vary by as much as 1,500 percent, raising questions about how medical providers set their prices.
A survey by Castlight Health, a health-care management company, examining the amounts paid for eight common medical procedures, reported wide differences nationwide in prices. In New York City and northern New Jersey, for example, the price of an MRI ranged from a low of $334 to a high of $3,939.
In Chattanooga, the biggest monetary discrepancies were for MRI and CT scans, procedures in which expensive scanners are used to produce images of the inside of the body. The lowest price for a CT scan was $247, with a high of $1,461. The low for an MRI was $484, while the highest price was $2,599.
On a percentage basis, other procedures had an even wider range of prices. For example, prices for a test for the human papillomavirus, a common sexually transmitted disease linked to cervical cancer, ranged from $32 to $504 – 15 times higher. That $504 price in Chattanooga was higher than the price in any other nearby city, including Atlanta, Memphis, Nashville, Knoxville and Birmingham.
And the bills locally for a basic cholesterol test, a lipid panel, ranged from $18 to $253.
Eric Mann, vice president for product marketing for Castlight, said the data shows that consumers need to ask medical providers in advance how much they are going to charge for a procedure and consider shopping around. That’s becoming especially important as more and more consumers opt for high-deductible health care plans that require them to pay several thousand dollars annually before their health insurance kicks in.
But shopping around is often hard to do.
“Consumers don’t have transparency [as to health care costs],” Mann said, “and therefore they can’t make decisions easily.”
One option would be for more employers to guide their employees to lower-cost providers, said Steve Johnson, Erlanger hospital’s vice president of payer and government relations.
“Most employers let you go to any hospital you want,” he said, “whereas if employers steered employees to low-cost providers, they could save a lot of money.”
“For consumers, this is a new era; they are in the midst of extraordinary change in the health-care system,” said Robin Gelburd, president of FAIR Health, a nonprofit group that tracks health-care costs. FAIR Health offers a website, www.fairhealth consumer.org, that provides calculators to help consumers determine the likely cost of various medical procedures.
But Gelburd warns that the process of figuring out the best health care plan can be complicated.
“Sometimes consumers focus on the premium associated with the plan,” she said, “and less on what the deductible is, what the co-pays are, whether there is an out-of network benefit and how that is calculated, which can be very different under different plans.”
If consumers don’t comparison shop, they may not realize the costs of even common procedures vary so widely, and may decide against getting care.
“A lot of people don’t get care because they think they can’t afford it,” Castlight’s Mann said.
Consumers also have very limited access to data on the quality of the medical procedures.
“If you want to buy a television, you can go to Amazon, look for the exact price, look at the star ratings from users, push a button and you’d be done,” he said. “With health care, you don’t have that info and don’t have access to quality info.”
The Castlight data is taken from the actual amount self-funded employers paid for the procedures listed, plus the employee’s deductible. Mann emphasized that the data is for medical procedures done in-network, and that out-of-network costs would have been even higher.
The report does not reveal the names of the medical providers. Castlight works with employers to lower their health care costs, so it had firsthand access to the payments its clients made.
Not all of the procedures showed a wide range of prices. The price of a mammogram in Chattanooga, for example, ranged from $213 to $219; a preventive gynecological exam costs from $101 to $155; a follow-up visit to the gynecologist, $67 to $87; and a physical exam, $96 to $186. Those same procedures showed wider variations in price elsewhere.
In New York City, for example, the lowest charge for a mammogram was $130, while the high was a whopping $1,898.
Other major cities near Chattanooga showed similar ranges in prices. In Knoxville, the lowest price for an MRI scan was $693, more than $200 higher than in Chattanooga; while in Jackson it was $1,973 and in the Johnson City-Kingsport-Bristol area, $2,910.
The Castlight data was from the following basic procedures:
* Preventive mammogram
* A test for the human papillomavirus virus,
* A preventative gynecological exam for ages 18-39,
* A follow-up visit to the office with a gynecologist and an obstetrician,
* A lipid panel cholesterol test,
* A preventive physical exam for ages 18-39, first visit,
* A CT scan of the head and brain without the use of dye,
* An MRI scan of the lower back without the use of a dye.
Contact staff writer Steve Johnson at 423-757-6673 or sjohnson@timesfreepress.com.