Insurance Companies Offer Cost Estimates to Assist Clients Evaluate Health-care Prices

The norm was that when one was sick- they saw a doctor, received treatment and paid the bill. Not so now. The bill can be negotiated, though not many are aware of this. Dr. Andrew Agwunobi, director of hospital performance improvement at Berkeley Research Group in Washington, D.C. negotiated the amount on his bill.

He saw a dermatologist who could not diagnose the problem; still Agwunobi received a big bill. "I called up the office and said that I felt like the bill greatly exceeded the value of the office visit because I didn't get a diagnosis and I didn't get any medication. And then that doctor's office actually cut the bill in half," he said.

Apollo Munich Health Insurance Company Limited

Apollo Munich Health Insurance Co. Ltd is a joint venture of Apollo Hospitals Group, Munich Health. Apollo Munich offers a wide array of health insurance plans.

As a hospital administrator, Agwunobi also has been involved in price negotiations with patients who can't afford their bills. "Many patients don't realize that they can negotiate not just with doctors, but you can negotiate with your hospital," he said.

"Patients are not empowered health-care consumers. It's very, very difficult for patients to challenge doctors," said Vicki Rackner, a surgeon and expert in the doctor-patient relations. "There's just a way that doctors and patients interact. It's really hard to change that behavior."

United Health care, one of the nation's largest insurers, has a product that allows clients to learn and compare prices of different providers through its website or a mobile application before walking into a doctor's office.

Tori Bogatyrenko, an executive overseeing the company's price transparency efforts, said that the prices were estimates based on current contracts.

"We're not just giving you a price for your office visit with the doctor but will include what you pay the lab and what you might have with a radiologist or other preventive screenings that are all part of what you experience in that one visit but, in fact, you are paying a different bunch of people," Bogatyrenko said.

Health Care Service Corp., which operates Blue Cross and Blue Shield plans in Illinois, has developed the Benefits Value Advisor program. The system compares cost estimates from in-network providers and facilities and also provides patients' reviews on quality. Company executives say they analyzed data from approximately 2,000 members in Illinois and Texas, those who chose different doctors from the program saved almost $2000 per claim.

In New Jersey, a 5 year old website named Vitals.com allows people to search, read and write reviews about 830,000 doctors nationwide. The website draws approximately 100 million patients every year.

For patients to get price information from doctors is very tough, many calls messages and emails result in a very varied pricing.

Rackner feels the reason is also that doctors don't know the cost of drugs. "I was just prescribing an antibiotic for a patient who had a really bad side effect profile. I just had a drug rep come to my office and he told me about this new antibiotic that avoided it, but it was 10 times as expensive. I had no idea," Rackner said.

Customer Care in Health Insurance Industry

Health Insurance Industry is a service-oriented industry with customer satisfaction and customer grievances being important components of its business operations. Both the issues - Customer satisfaction and Customer Grievances have been described in the article in co-relation with the health insurance sector.

Rackner was glad that insurance companies were giving price estimates because they knew best about health care.

"It will take some work, but hospitals can do better, and simply submitting historical averages of what they have charged," Agwunobi said.

"Hospitals should come together to figure out how to quote prices, actual prices and hold themselves to it, either prices or a price range," Agwunobi said. Providers should stick to their range even in the case of complications, he added.

Though doctors and experts feel there is a marked transparency in the pricing, it will be some time before patients can actually do comparative cost analysis.

References :

Hannah Punitha (IRDA Licence Number: 2710062)

Zongwei Li, March 2013

Source: Medindia