STEVE INSKEEP, HOST:
Today in Your Health, we will report on people who try to find out the cost of medical procedures before having them done. We emphasize they try to find out the costs. Many insurance companies offer tools to get estimates. But as Elana Gordon from member station WHYY reports, the tools often fall short.
ELANA GORDON, BYLINE: This story begins with a couple who was recently thrown into the thick of health care costs. They live about an hour north of Philadelphia.
SCOTT SAVETT: I'm Scott.
KATE SAVETT: Kate Savett.
S. SAVETT: We met in 2005 on eHarmony.
GORDON: They got married in 2007. Scott's 43, Kate 37. They hadn't used their insurance much until this year.
S. SAVETT: For me, it's been relatively minor stuff, but for Kate it's been a little bit more - what? - (laughter).
K. SAVETT: I was diagnosed with multiple sclerosis this year.
GORDON: It happened in January. Kate recalls certain parts of her body went completely numb. Doctors had to do a lot of tests. And separately, Scott not needed an MRI for a spinal issue. Under their insurance plan, they're on the hook for about $8,000 of their care. So they wanted to find the best place for the best deal. But how?
S. SAVETT: You first have to log in to the main UnitedHealthcare site...
GORDON: They investigated with the help of a nifty online tool, touted by their insurance, UnitedHealthcare.
S. SAVETT: ...On the right side here an icon that says estimate health care costs...
GORDON: He types in the procedure - an MRI scan.
S. SAVETT: ...Without dying...
GORDON: And voila.
S. SAVETT: So it tells us that in our area, the average cost is $1,270. The lowest would be 512.
GORDON: The tool also gives him a list of providers in his area and shows a specific estimated cost of the procedure at each of those places. This seemed great. But for Scott and Kate, the tool quickly became a headache.
S. SAVETT: Two days before Kate was scheduled to have her first MRI, we got a call from the provider, saying oh, by the way, the MRI is $2,400. The cost estimator told me it would be 500 and change. So what's the disconnect?
GORDON: They learned that a hospital had bought the facility, and so the prices had all gone up. The tool misquoted them for other procedures, too, often by more than a thousand dollars.
S. SAVETT: I was frustrated, mad. I mean, I went through the range of emotions.
GORDON: Financial planning went out the window. They pushed back buying a new water heater for their house.
K. SAVETT: It's just really hard for us to pull the trigger on something like that knowing that another bill could be coming around the corner.
GORDON: It's unclear how common these inaccuracies with estimator tools are. But such products are becoming more popular, especially as more people shoulder more of the cost of their care. Companies small and large are developing them, as are insurers.
FRANCOIS DE BRANTES: Each one of them, you know, whether it's Aetna, United, Cigna, they all have something.
GORDON: Francois de Brantes is director of the nonprofit Health Care Incentives Improvement Institute in Connecticut.
DE BRANTES: There's lots and lots of variability in the information that's provided to consumers.
GORDON: Some reflect a range of possible costs. Some use old data or don't have complete information. As for the estimator Scott and Kate used, Craig Hankins oversees United Health's digital side.
CRAIG HANKINS: Our tool relative to others that are offered, I would say ours is average, if not above average in terms of both the breadth of services as well as the accuracy.
GORDON: Hankins says the tool is based on current information. But it can be hard to predict what doctors will actually do and how they'll bill for it. For David Newman, director of the Health Care Cost Institute in Washington, D.C., that gets at a deeper challenge with these tools. Billing and healthcare is complicated.
DAVID NEWMAN: There are 8,000 procedure codes, a million providers and suppliers in this country and there's hundreds of insurance companies. In real time, this is going to be probably as good as it gets.
GORDON: But Francois de Brantes says the bigger problem is the health care industry has grown up around keeping prices secret.
DE BRANTES: It should be 100 percent accurate. You've got to schedule with very specific dollar values that have been negotiated between the plan and the provider.
GORDON: The needle is starting to move. Employers are demanding better estimates for employees. Several states now mandate reporting price information. As for Scott Savett, he knows he and his wife are now nearing their $8,000 out-of-pocket cap. Insurance will soon cover the entire cost of their care. But still, he says...
S. SAVETT: I would rather crawl to that cap than sprint to it. I know we're going to get there this year, unfortunately. But to blow it all in an MRI that's just excessively priced rubs me the wrong way.
GORDON: A few weeks after we spoke, Scott got a bill for another MRI. It was actually pretty close to what the estimator had predicted - $1,100. He says he'll keep using the tool, but he sees it as an imperfect clue rather than a price tag. For NPR News, I'm Elana Gordon in Philadelphia.
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