Medical cost data put online

Blue Cross aims to spur discussion

Hoping to trigger discussions between patients and doctors about the cost of health care, Blue Cross and Blue Shield of North Carolina posted prices online Thursday for hundreds of services from a routine physical to a coronary bypass.

While the service is immediately useful for Blue Cross members who want to track and possibly save for future health-care expenses, it is more important for what it represents as the industry pushes consumers to play a larger role in holding down health-care costs.

"Coverage is headed toward offering employees a variety of high-deductible plans," said John McDonnell, a partner in Progressive Benefit Solutions of Raleigh. "To make good decisions about those plans, consumers need good information about the costs of health care. This is a step in that direction."

The future of high-deductible plans is uncertain, but the idea behind them is to hold down annual premiums by requiring patients to meet deductibles that are much higher than traditional health insurance -- anywhere from $2,000 to $10,000 a year.

But deciding how much money to set aside is virtually impossible when consumers have no idea how much health care actually costs.

The Blue Cross and Blue Shield program allows members to calculate those costs for medical procedures, prescription drugs, office visits and dozens of services offered on an outpatient basis or after being admitted to a hospital.

It's possible that people might look at the costs and simply delay care, said Steve Graybill, a senior benefits consultant for Mercer Human Resource Consulting in Charlotte.

"But I may also say, 'This is really bothering me,' and go back to my physician and ask if there are other alternatives at a lower cost," Graybill said. "It gets that conversation going."

Blue Cross is not the first insurance company to offer such information, but as the largest insurer in North Carolina, it will likely nudge other insurers or health-care providers to provide more information than currently available.

"We hope by leading by example, others will follow," said Don Bradley, chief medical officer for Blue Cross and Blue Shield of North Carolina. "We see as part of our mission to improve the health of all North Carolinians, and part of that is having better information."

The transparency ends, however, when it comes to providing charges levied by specific doctors. Some insurance companies make such details available in a few metro areas of the country so consumers can comparison shop among doctors.

But Bradley said in North Carolina, Blue Cross decided it was more important to simply get the conversation started between patients and doctors.

Insurance companies are also walking a fine line when it comes to how much information they want to share, McDonnell said.

While customers need to be informed if they are going to help hold down costs, insurance companies aren't eager to let competitors know the specific reimbursement rates they have negotiated with every provider. In some cases, contracts with providers might even prevent it.

Critics of high-deductible insurance say that type of conflict underscores its basic problem.

"I really think it's about trying to deflect blame and say it's all the patient's responsibility," said Adam Searing, project director at the N.C. Justice Center's Health Access Coalition in Raleigh. "Sure, consumers have some responsibility, but you don't want to be sitting there with a calculator and some Web site trying to decide if you can afford an MRI. What kind of health-care system is that?"