A new story from Consumer Reports highlights how extreme price variation and sketchy transparency can mean that even insured patients often end up on the hook for huge, unanticipated bills.
The report homes in on two big themes: The broad range of prices that various providers charge for the same procedures, even if they are all considered in the network of a particular insurer; and changes in how plans calculate “usual and customary charges” mean that out-of-network reimbursements frequently cover a much smaller percentage of costs than patients typically realize.
"The amount you pay can vary dramatically based on the type of provider you go to," said Nancy Metcalf, who wrote the story.
Data in the report illustrate some of the price spreads: In one Midwestern city, the cost of a simple colonoscopy can range from $840 to $4,481.
The price tags are beginning to matter more, and an increasing number of health insurance products include high deductibles. Patients who aren't savvy, the piece says, can get stuck with big surprise bills.
The story also notes that even some informed patients face difficulties in simply obtaining the cost of procedures in advance, because much of that information is not public.