Monday, January 12, 2015

Blue Cross clarifies NC cost tool

When Blue Cross and Blue Shield of North Carolina unveiled a new online cost tool last week, the immediate concern raised by national experts and Charlotte health executives was that it wasn't clear what the numbers mean.

Blue Cross spokeswoman Michelle Douglas said Monday the company has added an explanation:  Cost estimates are averages based on historical BCBSNC claims data. Amounts listed typically include physician fees, facility fees and costs for things like anesthesia, drugs, medical supplies – as well as customer responsibility (deductible, co-pay and co-insurance). Your actual costs may be different based on variations in these factors as well as your health plan design, deductibles/co-insurance and out-of-pocket limits.

"The fact that hospitals say the numbers are Greek to them is indicative of why the tool was necessary,"  Douglas said in an email.  "Before, customers had no place to go and ask how much the total cost (physician fee, hospital fee, labs, anesthesia, etc.) of a health care procedure might be."

Meanwhile,  John Murawski with the News & Observer forwarded a message noting that UnitedHealthcare offers cost estimates to the public on its Health4Me mobile app  (it's free on for Apple or Android devices,  or see an online demonstration).

The UnitedHealthcare guest function lists estimates  "based on local market average costs,"  rather than breakdowns by provider,  as the Blue Cross tool does.  (UnitedHealthcare, Blue Cross and many other insurance companies offer more detailed members-only data,  including what patients can expect to payout of pocket based on their plan.)   I looked up knee replacement,  which the Blue Cross tool listed as ranging from $20,154 to $40,148 in the Charlotte area.  On Health4Me I got a Charlotte average of $60,185  ($59,125 for the procedure itself,  with the rest for pre- and post-surgical office visits and physical therapy).

So we're all starting to get a peek behind the curtain of health care costs.  But making sense of it is going to take a lot more work.


Anonymous said...

So, the numbers are an average of the claims, by procedure, by provider, and NOT the amount reimbursed to providers, correct? I can understand why some reporters might find that confusing. I can't understand why hospital administrators would find it confusing. Though, I suppose I could see why they'd feign confusion, given some of the disparities in pricing.

Ann Doss Helms said...

12:47, I don't blame you for being confused, but after another round of emails with Blue Cross to make sure I'm understanding this right: They aren't reporting what the hospital charges. They're reporting what's paid under the BCBS arrangement (BCBS + patient out of pocket). So if you get that bill that says Dr. X charges $1,000 and BCBS allows $750, they're using the $750 (plus the reimbursed expenses for everything else involved in that "episode").

Anonymous said...

That doesn't make sense. How is it of any benefit to the consumer to know what BCBS's reimbursement is; particularly when you consider that reimbursement is negotiated individually, with each provider? Further, cost share and copays would vary, based on the subscriber's particular policy, making this tool fairly worthless.

Ann Doss Helms said...

Right. It doesn't tell you what your out-of-pocket will be (though BCBS and many other companies do that for their customers), or what uninsured patients pay, or what other insurance companies pay. The BCBS position is it's one data point to help people ask better questions.

Anonymous said...

How can this "information" be of any help to anyone except the Medical-Insurance Mafia.

The doctors will not tell you what they charge. The hospital will not tell you what they charge. They just say, " We will let you know after the operation, and then you can send in all your net worth." And if you don't they will sue you and your spouse and your children and your grandchildren.

It is a criminal enterprise and you are not allowed to look behind the curtain

Anonymous said...

I believe I would investigate and try to gain some knowledge before making such negative statements about the hospitals. Both CHS and Novant have price lines that patient's can call and get information on the cost of a procedure before having it done. I can't understand all the negativity toward the large hospital systems in Charlotte that employ so many and give back to the community. I am glad we have such great organizations in Charlotte. A new NC law now requires more price transparency. Let's be positive!

Anonymous said...

if you have insurance the amounts reduced by heath care billing is around 35-50% of the total gross bills or whatever the contract between your insurance and the health care provider is.

if your bill is a million then your insurance company will pay 650,000 to 500,000 and you end up paying your deductible and co pay or co insurance of the rest.

you can negotiate with the billing dept in some cases on your share. good luck with that.

if you dont pay your monthly bill your wages will be garnished or they take your tax refunds in court and a collection agency will be calling daily for any remainder.

of course if are poor or an illegal you dont have to worry about a thing as it is all taken care of for you and you pay nothing via the govt.

also if you go to the ER initially at say CMC it will always be full of about 90% illegals 24/7 who bring all their kids in and take up all the space and chairs.
your wait could be 12 hrs or longer and you could even die in the ER.

if you die in the ER then you are in luck and dont have to worry about a thing.

it america these days it is an advantage to be poor so you may want to consider this before you study make good grades and go to college to get out and find a high paying position making a couple hundred thousand a yr such as write for a big newspaper but end up with 500,000 in out of pocket expenses that would kill you anyway.

and make no mistake that med costs are rising up up up with no relief and up about 2500% i the past 25 yrs.

you may want to consider getting into the medical profession where you get equal benefits as the poor or illegal alien who you will be treating 90% of the time.

this is your only hope plus if you get sick you can slip in and get treatment before you die in the ER.

also if you work for say CMC you get everything paid for usually with no out of pocket costs like the poor and illegals ...

Kristine said...

Dear Anonymous - would you be so bold in your statements is you weren't hiding behind the proverbial curtain of "anonymous" while bashing insurance companies and hospitals by name??