The patient as customer

kgarloch@charlotteobserver.comApril 24, 2012 

  • •  Aetna: Members-only cost comparison tool, gives estimated prices based on Aetna claims paid for hospital care by ZIP code.

    •  Blue Cross and Blue Shield of North Carolina: Members-only cost comparison tool, gives estimated prices based on Blue Cross claims paid for hospital care by ZIP code.

    • The following sites all use a variety of sources to provide estimates on what patients might pay for various medical procedures:,,,

    • A government website that lists a range of data about hospitals, including what Medicare pays for a number of procedures. Non-Medicare patients would pay more but could use those prices as a starting point for negotiation.

    Where to go for advice

    •  Medical Billing Advocates of America:; 540-387-5870;

    Karen Garloch

When buying a new car or TV, most consumers shop around and compare prices.

But when it comes to medical care, cost is often an afterthought.

“People have a tendency to put more thought into buying a pair of jeans than they do about getting the right knee replacement,” said Jarvis Leigh, a vice president with Aetna insurance company.

Part of the reason is that most people have health insurance, provided by an employer or the federal government, that covers most of their medical bills.

As more people are uninsured and as patients with insurance face higher deductibles and co-pays, there is a greater incentive to find out the cost in advance of treatment.

Trying to determine the cost for medical care is nearly impossible.

Despite that, government agencies, advocacy groups and insurance companies have begun to offer tips to help patients become better consumers.

The federal government’s website – – provides both cost and quality information about hospitals, including how much Medicare pays for various common procedures.

Fourteen states – but not the Carolinas – require collection of health care cost data for use by consumers. New Hampshire and Maine have published cost estimates online.

Aetna insurance and Blue Cross and Blue Shield of North Carolina voluntarily provide cost comparisons for procedures at specific hospitals in their ZIP codes. Their websites can calculate members’ potential out-of-pocket costs. Another agency that helps patients with hospital bills is Medical Billing Advocates of America. Pat Palmer, of Roanoke, Va., founded the organization 15 years ago after disputing erroneous items on her daughters’ medical bills.

“I realized I was being totally overcharged,” Palmer said. “Most people just pay what they’re asked, assuming everybody’s doing everything in good faith.”

Palmer has trained more than 80 advocates across the country and advises patients on how to dispute their bills.

Garloch: 704-358-5078

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