A patient insured through an employer in Dallas might pay as little as $15 or as much as $343 for a cholesterol test, and a patient in Philadelphia could pay anywhere between $264 and $3,271 for a head CT scan, according to a new cost-comparison map from Castlight Health.
The company, which sells price transparency products and services to large employers, compared prices of four common outpatient services in more than 62 metropolitan areas of the U.S. and found tremendous variation in what patients pay, even when they are insured through their job.
Consumers often assume that by choosing an in-network plan, they are getting a better price or value, said Dr. Jennifer Schneider, president of strategic analytics for Castlight, who notes that 48% of Americans are covered by employer-sponsored insurance. The new findings highlight that more transparency on costs is needed to prevent employees, especially those in high-deductible plans, from feeling sticker shock.
“There’s no way today for someone to know what things will cost if they simply follow the rules and go in-network,” Schneider said. “It’s like letting someone shop on your credit card without any sort of limit.”
Castlight gathered medical claims data from self-insured employers, as well as rate sheets from providers, to create the city-by-city tool showing prices for four common procedures: a cholesterol test, head CT scan, an MRI of the lower back, and a visit to a primary-care doctor.
Among the most notable variations revealed were in Dallas, where the top price paid to providers of a cholesterol test was about 23 times as much as the lowest price, and in Philadelphia, where the highest cost for CT scans was more than 12 times as much as the lowest. In New York City, the lowest price for an MRI of the lower back was $416, while the highest (nearly 11 times as much higher) was $4,527. In Charlotte, N.C., a patient might pay as little as $60 or up to $241, a 300% increase, to visit a primary-care physician.
“Healthcare is a line item that just keeps increasing,” noted Schneider, who says employers need to negotiate better to help drive down the costs. Just as chief financial officers often know how much they spend on travel or marketing and can set spending parameters, she said, the same needs to happen for healthcare. The tool, she said, is meant to help drive those negotiations.
“Understanding healthcare costs is a first step in enabling employers to fix what is broken in enterprise healthcare,” Schneider said.
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Jeffrey R. Ungvary