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.

Moral Movement targets Medicaid expansion

The Rev. William Barber,  president of North Carolina's NAACP branch, is turning to the Bible in his call for state lawmakers to expand Medicaid coverage to impoverished adults.

"Gov. Pat McCrory and his allies in the North Carolina Senate and House are returning to Raleigh to continue their unrelenting War on the Poor,"  Barber says in a statement released Friday.  "The Governor and legislators of North Carolina need to be reminded of the requirements of the Constitutions they swore to uphold, drawn from Judeo-Christian values expressed in the Bible they hold when they are sworn into office. One particular scripture makes it clear that although they profess to believe in God and His sacred scriptures, their hearts and actions are far from Him: 'Doom to you who legislate evil, Who make laws that make victims; Laws that make misery for the poor, That rob my destitute people of dignity'  (Isaiah 10, 1-4)."

Barber (center)

Barber sent the statement in response to news of this week's meeting between McCrory and President Obama to discuss options that would let the state craft its own version of coverage for thousands of low-income people who fall into the Medicaid gap.  McCrory,  unlike some legislative leaders,  wants to find a way to take the money and expand Medicaid,  but with conditions,  such as tying eligibility to having a job or being in job training.  It's unclear whether the federal government would accept such a plan,  even if he could get the General Assembly to sign on.

Barber says McCrory's plan  "deviates in substantial ways"  from the intent of the program.  He also cited a recent Families USA study showing that many of the people who are now shut out of affordable coverage are working people in jobs such as construction,  food service and transportation, working for low wages without workplace insurance.  If their income falls below the federal poverty level  ($23,850 for a family of four),  they can't get subsidies to buy insurance on the Affordable Care Act marketplace,  either.

The statement was issued on behalf of the NAACP and the Forward Together Moral Movement,  which grew out of Moral Monday protests when the state legislature was in session in 2013 and 2014.  They'll convene for 2015 on Wednesday,  and it's a safe bet that protesters won't be far behind.