Zurik: 'Cracking the Code' of medical procedure pricing

Cracking the Code: Part 1
Published: Apr. 6, 2017 at 2:10 AM CDT|Updated: Apr. 6, 2017 at 8:51 AM CDT
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NEW ORLEANS (WVUE) - If you go to the doctor, the hospital or a medical facility, and those trips cost you money, this story matters. It's important to you. FOX 8 News and our partners at NOLA.com/The Times-Picayune launch a new investigative series. We're trying to crack the code of medical procedure pricing, as many of you deal with the rising cost of healthcare.

Consider: Stand-Up Open MRI Centers and Metairie Imaging are located just a mile and a half apart in Jefferson Parish. But when it comes to the price you pay for services, their prices are not even close.

Without using insurance but paying cash, a lower back MRI at Stand-Up costs $1,250. Down the road at Metairie Imaging, the same procedure costs $675 - about half the price.

"It doesn't make any sense at all," says Robert Field, a law professor at Drexel University and an expert on health management and policy.

We reached out to Stand-Up for comment on our findings, but we never heard back.

At Thibodaux Regional Medical Center, the cash price for an ultrasound on your abdomen is $971. In nearby Houma, at Leonard Chabert Medical Center, the same procedure costs $161.

"If you look at it from a system point of view, there's no reason at all," Field says. "And again, it's as though your Chevrolet cost $25,000 at one dealer and $50,000 at another dealer. Chest X-rays, artificial joints, heart surgery, you name it - the prices are literally all over the map."

Thibodaux Regional told us the price on the phone was an estimate, not a guarantee. We followed up and sent additional questions to the hospital; we haven't heard back yet.

In one Uptown New Orleans office building, a vasectomy costs $2,500 when patients pay Dr. Ronald Swartz cash. A block away, two doctors, Neil Baum and Thomas Ewing, charge much less - $850 - for the same procedure.

"Comparison shopping would do a lot to solve that because, if someone charged an outrageous price, you would know just not to use that," Field tells us. "But when there's no transparency it's invisible. So, you don't know if you're getting ripped off or if you're getting a good deal."

Right now, most prices are hidden; few hospitals or offices post them online. And, as we found out, getting answers on the phone can be difficult.

"It is chaos," says Dave deBronkart. "It's impossible for anyone to find out how much anything costs, and then people wonder why costs keep spiraling upwards."

DeBronkart had skin cancer and stage 4 kidney cancer; he almost died. Now he has his own website and advocates for price transparency and fairness.

"When someone's in a crisis, they don't have the luxury of going out and spending three months researching their options the way I did, when I had a simple skin cancer," he says. "So, they've got you, and you're having a heart attack and you're not going to go out shopping for alternatives. And this is where I feel that it verges on being immoral - because you've got somebody by the heart, perhaps literally, and you can just squeeze and get what you want out of them.

FOX 8 News and our partners at NOLA.com/The Times-Picayune have launched a new investigative project - Cracking the Code: The Real Cost of Healthcare. Our goal: bring transparency to prices in the metro area.

We've partnered with another company, ClearHealthCosts, which has spent the past two months gathering cash prices for 35 procedures. You can find those prices on our website.

This is where we need you - we want your help gathering prices.

We need the cost of any procedure you've had: MRI, colonoscopy, blood test, you name it. We want you to add all that information into our website to help create a larger data set and help us find stories - and help you get information.

Here's what we need you to do:

  • For each procedure, you should have received an Explanation of Benefits form, or an EOB (You can see an example here). Pull out that form.
  • Log on to FOX8live.com/Health. You'll find interactive online form - a widget, if you will - that allows you to enter your information. All of this is private.
  • At the top, enter the type of procedure you had, or what's called the CPT code - that's the number that goes with the procedure. If you had a vasectomy, for instance, that's CPT code 55250.
  • Next, enter the name of the hospital, medical office or doctor's office where you had the procedure.
  • You need to let us know if you have insurance and, if so, list your health insurer.
  • Put in the date of the procedure.
  • Enter the total price you were billed.
  • Then enter what insurance paid, and what it cost you.
  • You can give us your email and phone number if you like.
  • You can even upload your EOB form privately, directly to us.

"I think that if people know what's out there, they're more likely to demand something," Field says. "In a sense, knowledge is power. The less you know, the more you can get hit by a surprise bill."

You can also email us directly at health@fox8live.com, or call us at this number: 504-483-1558.

We want to help you discover findings like this: A FOX 8 employee recently went to the hospital for an MRI. The hospital charged $2,600; it cost our employee $1,500.

But when we called and asked for the cash price without insurance, we found out he could have saved money. It cost $1,500 through insurance; with cash, he would have paid just $900.

"To the extent you know, number one, there is a problem - which is what your series is doing - and number two, how to address it - maybe you don't have all the tools but you have some of the tools - I think that's a tremendous service that you're providing," Field says. "And if enough people do that, the hospitals might start paying attention."

When you buy a car, buy a TV, buy groceries, you know the price or at least have an idea of the cost before you check out. But in healthcare, many people go in blind.

We're asking you to join FOX 8 News and NOLA.com/The Times-Picayune over the next few months, and help us as we try cracking the code of healthcare costs.

"Imagine the auto ads in the newspaper or on TV if they just wouldn't tell you what the prices were," DeBronkart says. "It would be a very different thing, especially if you then get onto the lot and then they tell you, 'OK, yep, you just bought this car and we'll send you the bill later. And that's how absurd it is."

You can find the Times-Picayune's version of this report at NOLA.com/Health.

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