Checking up on the cost of care

January 13, 2012 

— Every year the health care we need costs more, even for those with health insurance. Coinsurance, deductibles and cost sharing keep going up under employer health plans, and those without insurance face bills even more astronomical than just a few years ago.

The new national health reform law will certainly help. Families with health insurance and without health insurance will both benefit from lower deductibles and premiums, substantial new tax credits worth thousands of dollars and a safety net of Medicaid coverage for families of four earning less than $30,000 a year. Families in all income brackets below $100,000 a year will see major savings, which means increased income for other needs and the security of knowing affordable health insurance is always available.

Reform can't do everything, however, and, although health plans will be more affordable, the design of our health care system makes it difficult to understand how protecting your health affects your bank account.

Most of us find out how much a medical test or procedure will cost us only after we've received it. This means we are missing an important part of the equation as we decide when - or even whether - to seek such tests and procedures.

When consumers understand the out-of-pocket costs they will have to pay for medical and dental procedures - whether as simple as an allergy shot or teeth cleaning, or as complicated as invasive surgery - they are empowered to make choices that will positively affect both their health and their budgets.

That's where the new independent, nonprofit organization FAIR Health comes in. FAIR Health ( fairhealthconsumer.org/)was created to cast light on the black box that has historically surrounded health costs and insurance reimbursement. The organization does something we take for granted in almost any other industry - it provides consumers reliable cost information for specific procedures in a given geographic area.

Insurance companies in North Carolina and across the country have submitted to FAIR Health cost data from private health care claims that have been stripped of all identifying information. FAIR Health has taken this national data on exactly how much insurers are paying for medical care and made it searchable and easy to access.

Consumers can now use the FAIR Health website to search for information about how much specific medical and dental services are likely to cost in their area. So, an individual in Raleigh wanting to know the average local cost of a CT scan or a root canal can look it up online and be able to make a more informed decision about his or her care in minutes.

In addition, some 70 percent of insured Americans have health plans that allow for reimbursement of out-of-network expenses. Getting a second opinion on a medical procedure or seeing a particular doctor for a very complicated problem sometimes can mean seeing a physician not in your health plan's network of providers. Consumers looking to go out of network can use FAIR Health data beforehand to find out how much they can expect to be reimbursed if they receive care from a provider who is not a part of their health plan - instead of waiting until the bill comes to learn what they owe.

FAIR Health online tools can help you find out how much it would cost in your area under your insurance plan to treat that ankle you may have sprained while decorating your house for the holidays, or to learn the cost for going out-of-network for a more serious procedure, like arthroscopic surgery.

Finally, for those currently uninsured, FAIR Health can give people an idea of the cost of specific procedures for the first time, although full implementation of the new national health reform law will be needed to actually make insurance affordable.

Health care is a major expense for millions of Americans. But armed with the right information and tools, consumers nationally and in North Carolina can take control and make informed health care decisions for themselves and their families.

Adam Searing is project director for the Health Access Coalition at the N.C. Justice Center. He is a member of a consumer advisory board for FAIR Health.

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