A $10,000 Blood Test

24 Jun A $10,000 Blood Test

Discussing Price Volatility & Transparency in the Healthcare System seems to finally be picking up steam.  Over the last few months, I have seen more and more articles outlining the need for pricing transparency in the healthcare system.  For a long time, the price that was received by the facilities was shrouded in mystery and protected as “trade secrets” by the insurance companies.  In the past few years, with the popularity of HSA High Deductible plans, pricing is starting to creep out into the sun.

The article below from VOX illustrates the madness of price volatility as it exists today in the healthcare market. Please read the article.

http://www.vox.com/2014/8/15/6005953/a-10169-blood-test-is-everything-wrong-with-american-health-care

It is truly astounding the difference in pricing between outlets for the same service.  I know that sometimes this type of article uses absurd examples, or overstate their argument.  I can tell you, from someone who looks at claims on a near daily basis, I am always shocked at the amount certain providers reap compared to others.

The other thing to keep in mind is that in study after study, the correlation between cost and quality is EXTREMELY LOW.  That means that just because the facility is charging more does not mean that the quality of the outcome is any better than the less expensive facility.

I have a self-insured client that has an employee who is undergoing treatment for cancer.  We have been watching the bills very closely.  The costs for the treatment has exceed $80,000.  Last year another client had a member on their plan go through the same treatment regimen at another comparable facility.  Total cost for their treatment- $28,000…..

Needless to say, my client is NOT happy.  We are investigating ways to either exclude the provider, or offer lower reimbursements to them.

Contact us if you have seen similar pricing volatility in your claims experience to discuss some cutting edge techniques to level the playing field and take back some of the pricing power.

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