Pain in the Pocketbook - WCAX.COM Local Vermont News, Weather and Sports-

Pain in the Pocketbook

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No matter how you pay for it, health care is expensive and costs are opaque. But experts say you can save yourself some cash by asking tough questions before you are treated.

"Just about the time I was full apex turning, my knee popped and I fell to the ground," said Adam Royer, patient.

Doctors told Royer he needed an MRI after a nasty spill on the softball field. Like most patients, the 31-year-old followed medical advice without first questioning costs. 

"I didn't realize it was going to cost me $3,300 for 20 minutes in a box," said Royer.
Turns out, Royer tore his ACL. That meant surgery and lots of medical bills. 

"They're coming in 2, 3, 4 every other day," said Royer.

Royer has medical insurance but says keeping track of all the charges is overwhelming.

"I'm just very confused on how this all works," said Royer.

"We think the payment system is broken," said Bea Grause, CEO of the Vermont Association of Hospitals.

Grause lobbies for health care and payment reform. She says consumers are becoming savvier, but can always do more to protect their pocketbooks. 
So what's the best prescription for managing your medical decisions?

Experts say:

  • Find out exactly what procedure you need
  • Identify your out-of-pocket expenses like deductibles and co-pays
  • Call the hospital's business office before your procedure to discuss discounts based on your insurance coverage

"You're not going to get an exact price, like you would if you were getting your oil changed, but you are certainly going to get a range," said Grause.

Grause says don't be afraid to shop around and inquire about hospital and physician charges. Facilities must disclose their charge master or list price for services.
We discovered price tags for the same procedures can be wildly different at Vermont's 14 hospitals. 

According to the latest Hospital Report Card an emergency room visit will cost between $156 at Grace Cottage Hospital to $408 at Mt. Ascutney Hospital & Health Center.

For pregnant women ultrasounds range from $211 at Northeastern Vermont Regional Hospital to $1,251 at North Country Hospital.

But North Country charges the least for MRIs of upper extremity joints at $1,210. Mt. Ascutney tops the chart at $4,089.

A cat scan can cost as little as $485 at Northeastern Vermont Regional Hospital or 5 times that $2,306 at UVM Medical Center.

Bringing a baby into the world is an exciting step, but it's also expensive. Vaginal births range from $5,103 at Northwestern Medical Center to $13,382 at Gifford Medical Center.

If you deliver by cesarean charges nearly double. Again, Northwestern Medical Center is the cheapest at $10,977 and Gifford the priciest at $23,949.

Hospitals negotiate discounts with private insurance companies. But cost variation is largely linked to location. Hospitals in communities with high concentrations of Medicaid, Medicare and uninsured patients will have higher prices to offset revenue losses generated by that population.  
The size of the hospital also matters.

"Smaller hospitals have higher fixed costs and they have to cover those fixed costs and they have lower volumes," said Grause.

"It makes me stressed out, but I'm trying not to stress out because there's nothing I can do about it," said Royer.

Royer chose the state's largest hospital not based on price, but convenience and the surgeon's reputation. Although he's been happy with his care, Royer wonders how much he could have saved had he shopped around before going under the knife. 

Again, the numbers listed in our story are sticker prices for procedures. What patients actually pay out-of-pocket will vary greatly by individual medical insurance plans.

Click here to learn how your local hospital stacks up.

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