With the increasing availability of information regarding healthcare price and quality, you may be wondering how to use this information to effectively shop for healthcare. This post examines this question and provides you with a step-by-step approach that will empower you to take charge of your healthcare spending.
Entrenched interests in the healthcare business regularly contend that healthcare purchasing decisions are just too complicated for regular consumers. In a situation such as a real medical emergency, making an informed healthcare purchasing decision is not going to happen for obvious reasons. Conversely, insured healthcare consumers requiring a major medical procedure such as a coronary bypass or transplant, may pay attention to the quality scores of a provider but procedures such as these are guaranteed to fully exceed the initial health plan cost-sharing responsibilities of a patient. In other words, price sensitivity no longer exists in these situations because the insurer, not the consumer, will be paying for almost all of the procedure.
But for consumers who need a truly shoppable healthcare service, such as an MRI or CT scan, what process should be followed to purchase healthcare services?
It starts with your prescribing physician. Say you have pain and difficulty moving your shoulder and you go see an orthopedist who will diagnose and treat your condition. The orthopedist, upon an initial in person examination will prescribe an MRI of the affected shoulder to effectively diagnose the ailment. The orthopedist will subsequently provide you, in the form of a physician order, with a five-digit number known as a procedure code.
This code indicates the exact procedure you need to receive. In the case of an orthopedist who needs to diagnose a shoulder issuer, 73221 is the procedure code for a shoulder MRI.
With hospitals now required to publicly post their insurance specific prices, a consumer can use this code to determine the price they would need to pay. This can be done by going to the website of a hospital, opening up the file containing this list of prices then cross referencing the procedure code with your insurance plan.
Of course, price may not be the highest priority of a consumer. Quality and distance to provider, can and should be included in determining where to get a procedure. Despite pleadings to the contrary, shopping for healthcare really is this simple.
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