Patients As Consumers: Shopping Around for Cost-Effective Health Care

Last year, we received word our husband's employer was switching their health insurance offerings. We used to have an HMO where we had a co-pay and the insurance picked up the balance of most services by any provider in their network. If we visited a provider outside of the network, the insurance company still paid 80%. The one disadvantage to the HMO was its high premiums. For a healthy family like ours, it wasn't necessarily the most cost effective.

Our current health insurance plan costs us significantly less in premiums, but each family member has to reach a deductible. Our Well Child Care of Adult Preventative Care visits are totally picked up by our plan, which thankfully are the bulk of our visits. What this new insurance plan has been best about is making me realize the role patients play as consumers of health care.

In the past, when my doctor ordered tests of any kind, he would make a suggestion for where to have the tests performed and I would go there, giving no thought to how much it costs. Now, I realize I am not only a patient, but a consumer. My doctor recently recommended I get an MRI performed on my spine. My jaw hit the floor when he told me how much it costs. That's when the hubby and I got into a conversation about comparison shopping for this service. I wouldn't buy the first flat screen television I found without checking prices at several stores, so why should I automatically go to the first recommended MRI service provider without checking to see how much it costs to have other providers perform it?

In under an hour, I discovered local prices range from $650 to almost $1300 for an MRI Lumber Spine without contrast material. All the providers I spoke with have been in business for years. One mentioned their price as being $550, but the radiologist was a separate fee ranging from $100 to $200. She was the only one who mentioned that, so I asked about it. She explained some providers bill globally, others don't.

I learned a lot today. It's important to look into multiple providers before plunking down hard earned cash for medical services. When checking into the price of medical services, make sure your quote is apples to apples and not apples to oranges--like global billing versus itemized billing. I also got a firsthand glimpse into what could have partially led to the health care crisis. If patients choose higher cost options without shopping around first when the insurance company is paying all or a majority of the bill, the increased cost will eventually be passed on to all consumers in the form of increased premiums. Our new health plan is making me more aware of my role as a consumer of health care services, and my more informed choices could help make insurance more affordable for others too.