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FM","link":"/"}},"stateofhealth_50811":{"type":"posts","id":"stateofhealth_50811","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"50811","score":null,"sort":[1437696032000]},"guestAuthors":[],"slug":"pricecheck-how-much-does-it-cost-to-have-a-baby-in-northern-california","title":"PriceCheck: How Much Does It Cost to Have a Baby in Northern California?","publishDate":1437696032,"format":"standard","headTitle":"Price Check | State of Health | KQED News","labelTerm":{"term":2492,"site":"stateofhealth"},"content":"\u003cp>Childbirth is the most common reason for hospitalization in the U.S. In California, about\u003ca href=\"http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_01.pdf\" target=\"_blank\"> half a million babies \u003c/a>are born every year. Given how common it is -- and that most births are fairly uncomplicated, medically -- you'd think there would be some predictability in prices.\u003c/p>\n\u003cp>But there isn't. The price of delivery varies dramatically, both nationwide and across California. A\u003ca href=\"http://bmjopen.bmj.com/content/4/1/e004017.abstract?sid=a32193cf-85b1-4f07-b2d1-cba35214aa0a\" target=\"_blank\"> study last year\u003c/a> of more than 109,000 births at 198 hospitals statewide found a stunning 11-fold variation in prices charged for vaginal delivery -- from $3,296 to $37,227 -- and more than 8-fold for cesarean section -- from $8,312 to $70,908.\u003c/p>\n\u003caside class=\"pullquote alignright\">Share what you paid to deliver your baby. \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">Help us make health costs transparent. Visit PriceCheck!\u003c/a>\u003c/aside>\n\u003cp>\"This type of variation is not unique to obstetrics,\" said the study's lead author, Renee Hsia, a physician and professor of health policy at UC San Francisco. \"This is unfortunately the state of our health care in the United States.\"\u003c/p>\n\u003cp>That's why we're turning next to childbirth in our PriceCheck project. On \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">PriceCheck\u003c/a>, we're crowdsourcing the price of common medical tests and procedures. We're asking people to share what they paid -- in this case -- for childbirth. More on how you can share further below, but first, some things you should know if you're pregnant now to make sure you can minimize your bills.\u003c/p>\n\u003cp>\u003cstrong>No Co-pay for Prenatal Care ...\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Under the Affordable Care Act, many preventive services -- including routine prenatal care -- \u003ca href=\"http://www.hhs.gov/healthcare/facts/factsheets/2010/07/preventive-services-list.html#CoveredPreventiveServicesforWomenIncludingPregnantWomen\" target=\"_blank\">must be covered at no cost to the patient\u003c/a>: no deductible, no co-insurance, no co-payment.\u003c/p>\n\u003cp>\"So the first thing they should be looking for and demanding is no cost-sharing for prenatal care,\" said Susan Berke Fogel, with the National Health Law Program. Common screenings like gestational diabetes and Rh incompatibility are just two of the \u003ca href=\"http://www.hhs.gov/healthcare/facts/factsheets/2010/07/preventive-services-list.html#CoveredPreventiveServicesforWomenIncludingPregnantWomen\" target=\"_blank\">tests included\u003c/a> at no cost to the patient.\u003c/p>\n\u003cp>The only exception is if you have a \"grandfathered\" plan. This is a plan that predated the Affordable Care Act and has not been changed much since. These grandfathered plans are not subject to many of the Affordable Care Act mandates and may not include the same benefits.\u003c/p>\n\u003cp>\u003cstrong>... But There Is for Labor and Delivery\u003c/strong>\u003c/p>\n\u003cp>While your costs will depend on your plan, you will almost certainly pay something for labor and delivery. Consumers should contact their plan to try to estimate their costs and check other requirements.\u003c/p>\n\u003cp>\"Understand specifics,\" says Lisa Zamosky, author of \"\u003ca href=\"http://lisazamosky.com/about/\" target=\"_blank\">Healthcare, Insurance and You: The Savvy Consumer's Guide\u003c/a>.\" She also worked for a large managed-care organization before becoming a writer. \"Are pre-authorizations required? Do you need to call the insurance company when you are admitted to the hospital?\"\u003c/p>\n\u003cp>[contextly_sidebar id=\"dSK0x9dmZALaarFtZERECULWv88aushi\"]The good news is that you have time to sort this all out. Both Zamosky and Fogel stressed to make sure both your doctor and the hospital are in network. Some women prefer to deliver at a birth center, but you need to make sure the center is in network, too. If not, do the math to see how an out-of-network birth center pencils out compared with an in-network hospital. (My PriceCheck colleague Rebecca Plevin at KPCC \u003ca href=\"http://www.scpr.org/blogs/health/2015/07/22/18049/pricecheck-how-much-does-it-cost-to-have-a-baby-at/\" target=\"_blank\">looked closely at this issue\u003c/a>.)\u003c/p>\n\u003cp>Even if you are at an in-network facility, it doesn't mean all the providers are also in network. I know this from my own experience. When I delivered my daughter in 2001 at an in-network hospital, I got a $1,200 bill months later for the anesthesiologist. (It was ultimately paid by my insurer.)\u003c/p>\n\u003cp>These \"surprise bills\" are not uncommon. A\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/05/07/nearly-1-in-4-californians-hit-by-surprise-medical-bills/\" target=\"_blank\"> Consumers Union survey \u003c/a>earlier this year found almost one in four Californians who had gone to a hospital or ER got an out-of-network bill from a doctor they had thought was in network.\u003c/p>\n\u003cp>There are steps you can take before you get to the hospital to try to avoid this, Zamosky says, \"but you should know there is a risk.\"\u003c/p>\n\u003cp>She recommends having a pointed conversation with your obstetrician. \"I would be forceful about it and be clear,\" Zamosky says. Tell the doctor: \"'Don't bring anyone in the room who is not participating [in the network]' so that you're not surprised by bills.\"\u003c/p>\n\u003cp>But she also adds that \"you don't have total control.\"\u003c/p>\n\u003cp>It's easy to imagine that you might need an anesthesiologist, but the only one available is out of network. A bill making its way through the California legislature, \u003ca href=\"https://legiscan.com/CA/bill/AB533/2015\" target=\"_blank\">AB533\u003c/a>, would end surprise bills by prohibiting consumers from paying out-of-network rates to doctors (or other providers) as long as they receive care at an in-network facility. If approved, the law would take effect in January.\u003c/p>\n\u003cp>\u003cstrong>What if You're Uninsured?\u003c/strong>\u003c/p>\n\u003cp>If you're pregnant, uninsured and outside the annual sign-up period for health insurance, you are out of luck for signing up for private insurance, including on Covered California. But you \u003cem>may\u003c/em> be eligible for Medi-Cal, the state's version of Medicaid, which is open for sign up year-round.\u003c/p>\n\u003cp>Pregnant women can qualify for Medi-Cal at \u003ca href=\"https://dpss.lacounty.gov/dpss/health/pregnant/medical.cfm?persona=pregnant\" target=\"_blank\">higher incomes\u003c/a> than if they were not pregnant. \"They shouldn't assume they're over income without filing an application,\" says Fogel. Medi-Cal providers may also be able to see a pregnant woman while she is waiting for her application to be processed under a program called \u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/PE_Info_women.aspx\" target=\"_blank\">Presumptive Eligibility\u003c/a>.\u003c/p>\n\u003cp>Once your baby is born, there's still more to think about, insurance-wise:\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>Contraception:\u003c/strong> Many women choose to have an IUD inserted after they have delivered their baby, but are still in the hospital. Under the Affordable Care Act, contraception -- including the IUD, which can be expensive -- is covered at no cost-sharing for the patient.\u003c/li>\n\u003cli>\u003cstrong>Catholic Hospitals:\u003c/strong> If you are considering an IUD, be sure to talk to your doctor about it in advance. Fogle noted a big \"consumer beware\" by pointing out that Catholic hospitals may not provide them. If you are considering a Catholic hospital, she says, be sure to ask your doctor if that hospital will provide the full range of reproductive services.\u003c/li>\n\u003cli>\u003cb>Breastfeeding:\u003c/b> Counseling for breastfeeding and coverage of a breast pump must also be \u003ca href=\"https://www.healthcare.gov/coverage/breast-feeding-benefits/\" target=\"_blank\">covered at no cost\u003c/a> under the Affordable Care Act. But, especially with the pump, plans may vary in coverage. You may need a specific pump or you may need to purchase from a specific provider to get the no-cost benefit.\u003c/li>\n\u003c/ul>\n\u003cp>Of course, your baby will need health insurance, too, and you have a limited time to enroll the newborn. If you have employer-based coverage, you have \u003ca href=\"http://familiesusa.org/sites/default/files/product_documents/special-enrollment-opportunity.pdf\" target=\"_blank\">30 days to add the baby\u003c/a>. If the mother of the baby has a spouse, the spouse also has the opportunity to enroll in coverage within 30 days, says Cheryl Parcham at FamiliesUSA.\u003c/p>\n\u003cp>If you have a plan through Covered California (or any marketplace plan), \u003ca href=\"https://marketplace.cms.gov/technical-assistance-resources/helping-new-parents-enroll.pdf\" target=\"_blank\">you have 60 days to sign up the baby\u003c/a>. The additional bonus is that the whole family can pick a new Covered California plan, if you want to.\u003c/p>\n\u003cp>\u003cstrong>PriceCheck: Share What You Paid\u003c/strong>\u003c/p>\n\u003cp>Now that you have all these tips, we'd appreciate your help! While prices charged vary dramatically, it's impossible to know the variety of what insurers and consumers actually pay. That's because the \"insured prices\" are sealed by contract.\u003c/p>\n\u003cp>You can help shine a light on true costs by getting your \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/18/explaining-the-health-insurance-explanation-of-benefits/\" target=\"_blank\">explanation of benefits\u003c/a> and heading over to \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">PriceCheck\u003c/a>. There you can anonymously share the price charged, what your insurer paid and what you paid, in co-pay or deductible.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>We're primarily interested in vaginal birth, but if you had a cesarean section, we'll happily take those prices, too.\u003c/p>\n\n","blocks":[],"excerpt":"In California, prices charged for a vaginal delivery range 11-fold: $3,296 to $37,227. Share what you paid!","status":"publish","parent":0,"modified":1438035484,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":30,"wordCount":1300},"headData":{"title":"PriceCheck: How Much Does It Cost to Have a Baby in Northern California? | KQED","description":"In California, prices charged for a vaginal delivery range 11-fold: $3,296 to $37,227. Share what you paid!","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"PriceCheck: How Much Does It Cost to Have a Baby in Northern California?","datePublished":"2015-07-24T00:00:32.000Z","dateModified":"2015-07-27T22:18:04.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"50811 http://ww2.kqed.org/stateofhealth/?p=50811","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/07/23/pricecheck-how-much-does-it-cost-to-have-a-baby-in-northern-california/","disqusTitle":"PriceCheck: How Much Does It Cost to Have a Baby in Northern California?","path":"/stateofhealth/50811/pricecheck-how-much-does-it-cost-to-have-a-baby-in-northern-california","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Childbirth is the most common reason for hospitalization in the U.S. In California, about\u003ca href=\"http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_01.pdf\" target=\"_blank\"> half a million babies \u003c/a>are born every year. Given how common it is -- and that most births are fairly uncomplicated, medically -- you'd think there would be some predictability in prices.\u003c/p>\n\u003cp>But there isn't. The price of delivery varies dramatically, both nationwide and across California. A\u003ca href=\"http://bmjopen.bmj.com/content/4/1/e004017.abstract?sid=a32193cf-85b1-4f07-b2d1-cba35214aa0a\" target=\"_blank\"> study last year\u003c/a> of more than 109,000 births at 198 hospitals statewide found a stunning 11-fold variation in prices charged for vaginal delivery -- from $3,296 to $37,227 -- and more than 8-fold for cesarean section -- from $8,312 to $70,908.\u003c/p>\n\u003caside class=\"pullquote alignright\">Share what you paid to deliver your baby. \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">Help us make health costs transparent. Visit PriceCheck!\u003c/a>\u003c/aside>\n\u003cp>\"This type of variation is not unique to obstetrics,\" said the study's lead author, Renee Hsia, a physician and professor of health policy at UC San Francisco. \"This is unfortunately the state of our health care in the United States.\"\u003c/p>\n\u003cp>That's why we're turning next to childbirth in our PriceCheck project. On \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">PriceCheck\u003c/a>, we're crowdsourcing the price of common medical tests and procedures. We're asking people to share what they paid -- in this case -- for childbirth. More on how you can share further below, but first, some things you should know if you're pregnant now to make sure you can minimize your bills.\u003c/p>\n\u003cp>\u003cstrong>No Co-pay for Prenatal Care ...\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Under the Affordable Care Act, many preventive services -- including routine prenatal care -- \u003ca href=\"http://www.hhs.gov/healthcare/facts/factsheets/2010/07/preventive-services-list.html#CoveredPreventiveServicesforWomenIncludingPregnantWomen\" target=\"_blank\">must be covered at no cost to the patient\u003c/a>: no deductible, no co-insurance, no co-payment.\u003c/p>\n\u003cp>\"So the first thing they should be looking for and demanding is no cost-sharing for prenatal care,\" said Susan Berke Fogel, with the National Health Law Program. Common screenings like gestational diabetes and Rh incompatibility are just two of the \u003ca href=\"http://www.hhs.gov/healthcare/facts/factsheets/2010/07/preventive-services-list.html#CoveredPreventiveServicesforWomenIncludingPregnantWomen\" target=\"_blank\">tests included\u003c/a> at no cost to the patient.\u003c/p>\n\u003cp>The only exception is if you have a \"grandfathered\" plan. This is a plan that predated the Affordable Care Act and has not been changed much since. These grandfathered plans are not subject to many of the Affordable Care Act mandates and may not include the same benefits.\u003c/p>\n\u003cp>\u003cstrong>... But There Is for Labor and Delivery\u003c/strong>\u003c/p>\n\u003cp>While your costs will depend on your plan, you will almost certainly pay something for labor and delivery. Consumers should contact their plan to try to estimate their costs and check other requirements.\u003c/p>\n\u003cp>\"Understand specifics,\" says Lisa Zamosky, author of \"\u003ca href=\"http://lisazamosky.com/about/\" target=\"_blank\">Healthcare, Insurance and You: The Savvy Consumer's Guide\u003c/a>.\" She also worked for a large managed-care organization before becoming a writer. \"Are pre-authorizations required? Do you need to call the insurance company when you are admitted to the hospital?\"\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>The good news is that you have time to sort this all out. Both Zamosky and Fogel stressed to make sure both your doctor and the hospital are in network. Some women prefer to deliver at a birth center, but you need to make sure the center is in network, too. If not, do the math to see how an out-of-network birth center pencils out compared with an in-network hospital. (My PriceCheck colleague Rebecca Plevin at KPCC \u003ca href=\"http://www.scpr.org/blogs/health/2015/07/22/18049/pricecheck-how-much-does-it-cost-to-have-a-baby-at/\" target=\"_blank\">looked closely at this issue\u003c/a>.)\u003c/p>\n\u003cp>Even if you are at an in-network facility, it doesn't mean all the providers are also in network. I know this from my own experience. When I delivered my daughter in 2001 at an in-network hospital, I got a $1,200 bill months later for the anesthesiologist. (It was ultimately paid by my insurer.)\u003c/p>\n\u003cp>These \"surprise bills\" are not uncommon. A\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/05/07/nearly-1-in-4-californians-hit-by-surprise-medical-bills/\" target=\"_blank\"> Consumers Union survey \u003c/a>earlier this year found almost one in four Californians who had gone to a hospital or ER got an out-of-network bill from a doctor they had thought was in network.\u003c/p>\n\u003cp>There are steps you can take before you get to the hospital to try to avoid this, Zamosky says, \"but you should know there is a risk.\"\u003c/p>\n\u003cp>She recommends having a pointed conversation with your obstetrician. \"I would be forceful about it and be clear,\" Zamosky says. Tell the doctor: \"'Don't bring anyone in the room who is not participating [in the network]' so that you're not surprised by bills.\"\u003c/p>\n\u003cp>But she also adds that \"you don't have total control.\"\u003c/p>\n\u003cp>It's easy to imagine that you might need an anesthesiologist, but the only one available is out of network. A bill making its way through the California legislature, \u003ca href=\"https://legiscan.com/CA/bill/AB533/2015\" target=\"_blank\">AB533\u003c/a>, would end surprise bills by prohibiting consumers from paying out-of-network rates to doctors (or other providers) as long as they receive care at an in-network facility. If approved, the law would take effect in January.\u003c/p>\n\u003cp>\u003cstrong>What if You're Uninsured?\u003c/strong>\u003c/p>\n\u003cp>If you're pregnant, uninsured and outside the annual sign-up period for health insurance, you are out of luck for signing up for private insurance, including on Covered California. But you \u003cem>may\u003c/em> be eligible for Medi-Cal, the state's version of Medicaid, which is open for sign up year-round.\u003c/p>\n\u003cp>Pregnant women can qualify for Medi-Cal at \u003ca href=\"https://dpss.lacounty.gov/dpss/health/pregnant/medical.cfm?persona=pregnant\" target=\"_blank\">higher incomes\u003c/a> than if they were not pregnant. \"They shouldn't assume they're over income without filing an application,\" says Fogel. Medi-Cal providers may also be able to see a pregnant woman while she is waiting for her application to be processed under a program called \u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/PE_Info_women.aspx\" target=\"_blank\">Presumptive Eligibility\u003c/a>.\u003c/p>\n\u003cp>Once your baby is born, there's still more to think about, insurance-wise:\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>Contraception:\u003c/strong> Many women choose to have an IUD inserted after they have delivered their baby, but are still in the hospital. Under the Affordable Care Act, contraception -- including the IUD, which can be expensive -- is covered at no cost-sharing for the patient.\u003c/li>\n\u003cli>\u003cstrong>Catholic Hospitals:\u003c/strong> If you are considering an IUD, be sure to talk to your doctor about it in advance. Fogle noted a big \"consumer beware\" by pointing out that Catholic hospitals may not provide them. If you are considering a Catholic hospital, she says, be sure to ask your doctor if that hospital will provide the full range of reproductive services.\u003c/li>\n\u003cli>\u003cb>Breastfeeding:\u003c/b> Counseling for breastfeeding and coverage of a breast pump must also be \u003ca href=\"https://www.healthcare.gov/coverage/breast-feeding-benefits/\" target=\"_blank\">covered at no cost\u003c/a> under the Affordable Care Act. But, especially with the pump, plans may vary in coverage. You may need a specific pump or you may need to purchase from a specific provider to get the no-cost benefit.\u003c/li>\n\u003c/ul>\n\u003cp>Of course, your baby will need health insurance, too, and you have a limited time to enroll the newborn. If you have employer-based coverage, you have \u003ca href=\"http://familiesusa.org/sites/default/files/product_documents/special-enrollment-opportunity.pdf\" target=\"_blank\">30 days to add the baby\u003c/a>. If the mother of the baby has a spouse, the spouse also has the opportunity to enroll in coverage within 30 days, says Cheryl Parcham at FamiliesUSA.\u003c/p>\n\u003cp>If you have a plan through Covered California (or any marketplace plan), \u003ca href=\"https://marketplace.cms.gov/technical-assistance-resources/helping-new-parents-enroll.pdf\" target=\"_blank\">you have 60 days to sign up the baby\u003c/a>. The additional bonus is that the whole family can pick a new Covered California plan, if you want to.\u003c/p>\n\u003cp>\u003cstrong>PriceCheck: Share What You Paid\u003c/strong>\u003c/p>\n\u003cp>Now that you have all these tips, we'd appreciate your help! While prices charged vary dramatically, it's impossible to know the variety of what insurers and consumers actually pay. That's because the \"insured prices\" are sealed by contract.\u003c/p>\n\u003cp>You can help shine a light on true costs by getting your \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/18/explaining-the-health-insurance-explanation-of-benefits/\" target=\"_blank\">explanation of benefits\u003c/a> and heading over to \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">PriceCheck\u003c/a>. There you can anonymously share the price charged, what your insurer paid and what you paid, in co-pay or deductible.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>We're primarily interested in vaginal birth, but if you had a cesarean section, we'll happily take those prices, too.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/50811/pricecheck-how-much-does-it-cost-to-have-a-baby-in-northern-california","authors":["240"],"series":["stateofhealth_2492"],"categories":["stateofhealth_14","stateofhealth_13"],"tags":["stateofhealth_482","stateofhealth_28","stateofhealth_841"],"featImg":"stateofhealth_51237","label":"stateofhealth_2492"},"stateofhealth_30459":{"type":"posts","id":"stateofhealth_30459","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"30459","score":null,"sort":[1432755370000]},"guestAuthors":[],"slug":"pricecheck-how-much-does-a-colonoscopy-cost","title":"PriceCheck: How Much Does A Colonoscopy Cost?","publishDate":1432755370,"format":"image","headTitle":"Price Check | State of Health | KQED News","labelTerm":{"term":2492,"site":"stateofhealth"},"content":"\u003cp>The colonoscopy: it may be the most dreaded screening test out there, and it's the next procedure we're covering as part of \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">PriceCheck\u003c/a>.\u003c/p>\n\u003cp>On PriceCheck, we're crowdsourcing prices of common health tests and procedures. KQED, along with our colleagues at \u003ca href=\"http://www.scpr.org/price-check\" target=\"_blank\">KPCC in LA\u003c/a>, and \u003ca href=\"http://clearhealthcosts.com\" target=\"_blank\">ClearHealthCosts.com,\u003c/a> a health cost transparency start up in New York, are shining a light on health care costs by asking you --members of our community -- to share what you've paid for various health care procedures.\u003c/p>\n\u003cp>We turned to crowdsourcing because health care prices are wildly variable and opaque. It sometimes stuns people to find out there is no central database of prices. Gag clauses in contracts between doctors and insurers forbid both parties to disclose prices.\u003c/p>\n\u003cp>But you can use \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">our form\u003c/a> to help bring prices into the open. Just get the \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/18/explaining-the-health-insurance-explanation-of-benefits/\" target=\"_blank\">explanation of benefits\u003c/a> your insurance company sent for the colonoscopy, and enter price charged, price the insurance company paid and your co-pay (which should be zero for a screening colonoscopy -- more on that below.)\u003c/p>\n\u003cp>[contextly_sidebar id=\"puvCWmnJOc4fK0T9WeE3LJOSU6tZE7it\"]Our PriceCheck database already contains entries for colonoscopy prices -- they range from $1,000-$5000 in the Bay Area. Surprised by that range? It's in line with the price variation reported both by policy experts and our community on PriceCheck for other procedures.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>After we get more shared prices (usually in a few weeks), we'll report them back to you on State of Health.\u003c/p>\n\u003cp>Under the Affordable Care Act (ACA), certain screening tests --including the colonoscopy -- are mandated to be covered at no cost to the patient. But we should all care about the wild variation in prices because as health care costs rise, health insurance premiums go up. If you have employer-sponsored health insurance, that can mean \u003ca href=\"http://www.nber.org/digest/aug05/w11063.html\" target=\"_blank\">your own part of the premium\u003c/a> will go up. Public insurance programs like Medicare and Medicaid get more expensive, too, and those are paid for through taxes.\u003c/p>\n\u003cp>Colonoscopy is \"a messy one\" for other reasons, too, says Maribeth Shannon with some irony. She specializes in market transparency and accountability at the California HealthCare Foundation.\u003c/p>\n\u003cp>She's not just referring to the procedure itself. Colonoscopy is messy because of the way it's billed. Here are some things to ask about before you go in for the procedure:\u003c/p>\n\u003cp>\u003cstrong>Screening or diagnostic\u003c/strong>: In a screening colonoscopy, a doctor threads a flexible tube with an attached camera into the colon to look for abnormalities, like a polyp. If a polyp is found, it can be removed during the procedure. After the ACA first took effect, patients who had polyps removed discovered that this action changed the colonoscopy from a \"free\" screening test to a diagnostic test, and they were \u003ca href=\"http://khn.org/news/michelle-andrews-q-and-a-on-insurance-coverage-costs/\" target=\"_blank\">on the hook for a big bill\u003c/a>.\u003c/p>\n\u003cp>\u003ca href=\"http://www.dol.gov/ebsa/faqs/faq-aca12.html\" target=\"_blank\">Federal rules\u003c/a> about the free screening colonoscopy have since been updated. \"(P)olyp removal is an integral part of a colonoscopy,\" says the federal government, and must be included at no cost to the patient. Still, Maribeth Shannon says that \"consumers should check with their health plan and ask 'what happens if a polyp is found -- you're going to treat that as preventive, right?'\"\u003c/p>\n\u003cp>\u003cstrong>[contextly_sidebar id=\"Rb89uD7TSagofaKysPbEsJRMKO4UX3rU\"]Anesthesia: \u003c/strong>You might think that anesthesia would be included with the price of a colonoscopy. After all, it's not surprising that many patients would want to be anesthetized when they are having a colonoscopy. But for quite awhile, patients were being billed for anesthesia, which by itself can run be $1,000 or more.\u003c/p>\n\u003cp>That's what happened to Gareth Tyrnauer of Sebastopol. He was delighted when his insurer sent him a letter that said a colonoscopy would be covered 100 percent. \"I'd be a fool not to do this,\" he recalls thinking. But, after the procedure, he got a $1,200 bill -- just for the anesthesia. He called his insurer's customer service to fight the bill, saying he told the representative, \"I've got a piece of paper right here and it says 'it's 100 percent covered. What part of 100 percent don't I understand?'\" He ultimately won.\u003c/p>\n\u003cp>\u003ca href=\"http://www.npr.org/sections/health-shots/2015/05/15/406969802/feds-tell-insurers-to-pay-for-anesthesia-during-screening-colonoscopies\" target=\"_blank\">Earlier this month\u003c/a>, the federal government stepped in again and \u003ca href=\"http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/aca_implementation_faqs26.pdf\" target=\"_blank\">issued a clarification \u003c/a>that insurers may not charge for anesthesia used in connection with a preventive colonoscopy.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/207652658\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>\u003cstrong>In-network is key: \u003c/strong>Make sure you know in advance who is involved in the procedure, warns Dena Mendelsohn, a health policy analyst with Consumers Union in San Francisco. \"Consumers should be sure to confirm that the facility where they're going is in-network and the provider they will have is in-network.\"\u003c/p>\n\u003cp>\u003cstrong>Quality:\u003c/strong> In health care, determining quality of a procedure can be as difficult as determining how much it might cost. A strong predictor of quality is volume of procedures. A doctor or facility that has high volume is likely to be doing a higher quality job. Mendelsohn says many health insurance plans have tools for their customers on their websites and sometimes that includes volume. How much is the right amount? Hard to know, she says, but consumers could compare \"hundreds or thousands versus dozens.\"\u003c/p>\n\u003cp>Mendelsohn also recommends avoiding a large university medical center for a colonoscopy. \"Large universities are tailored toward more complicated procedures,\" she says. \"Since a screening colonoscopy is more routine, it's not necessarily the case that going to a large university will get you a better colonoscopy.\"\u003c/p>\n\u003cp>\u003cstrong>Other options: \u003c/strong>If you've been dreading have a colonoscopy, you're not alone. But there are other \u003ca href=\"http://healthfinder.gov/HealthTopics/Category/doctor-visits/screening-tests/get-tested-for-colorectal-cancer\" target=\"_blank\">non-invasive options\u003c/a> for colon cancer screening, including the fecal-occult blood test. If you've been \u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/02/23/avoiding-a-colonoscopy-youre-not-alone/\" target=\"_blank\">avoiding a colonoscopy\u003c/a>, you may want to learn more about this option.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>An earlier version of this story misstated how screening and diagnostic colonoscopies were billed after some aspects of the Affordable Care Act went into effect. We regret the error.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Health care prices are wildly variable. KQED is crowdsourcing prices to show exactly what procedures cost.","status":"publish","parent":0,"modified":1434054977,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":22,"wordCount":1022},"headData":{"title":"PriceCheck: How Much Does A Colonoscopy Cost? | KQED","description":"Health care prices are wildly variable. KQED is crowdsourcing prices to show exactly what procedures cost.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"PriceCheck: How Much Does A Colonoscopy Cost?","datePublished":"2015-05-27T19:36:10.000Z","dateModified":"2015-06-11T20:36:17.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"30459 http://ww2.kqed.org/stateofhealth/?p=30459","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/05/27/pricecheck-how-much-does-a-colonoscopy-cost/","disqusTitle":"PriceCheck: How Much Does A Colonoscopy Cost?","path":"/stateofhealth/30459/pricecheck-how-much-does-a-colonoscopy-cost","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>The colonoscopy: it may be the most dreaded screening test out there, and it's the next procedure we're covering as part of \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">PriceCheck\u003c/a>.\u003c/p>\n\u003cp>On PriceCheck, we're crowdsourcing prices of common health tests and procedures. KQED, along with our colleagues at \u003ca href=\"http://www.scpr.org/price-check\" target=\"_blank\">KPCC in LA\u003c/a>, and \u003ca href=\"http://clearhealthcosts.com\" target=\"_blank\">ClearHealthCosts.com,\u003c/a> a health cost transparency start up in New York, are shining a light on health care costs by asking you --members of our community -- to share what you've paid for various health care procedures.\u003c/p>\n\u003cp>We turned to crowdsourcing because health care prices are wildly variable and opaque. It sometimes stuns people to find out there is no central database of prices. Gag clauses in contracts between doctors and insurers forbid both parties to disclose prices.\u003c/p>\n\u003cp>But you can use \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">our form\u003c/a> to help bring prices into the open. Just get the \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/18/explaining-the-health-insurance-explanation-of-benefits/\" target=\"_blank\">explanation of benefits\u003c/a> your insurance company sent for the colonoscopy, and enter price charged, price the insurance company paid and your co-pay (which should be zero for a screening colonoscopy -- more on that below.)\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Our PriceCheck database already contains entries for colonoscopy prices -- they range from $1,000-$5000 in the Bay Area. Surprised by that range? It's in line with the price variation reported both by policy experts and our community on PriceCheck for other procedures.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>After we get more shared prices (usually in a few weeks), we'll report them back to you on State of Health.\u003c/p>\n\u003cp>Under the Affordable Care Act (ACA), certain screening tests --including the colonoscopy -- are mandated to be covered at no cost to the patient. But we should all care about the wild variation in prices because as health care costs rise, health insurance premiums go up. If you have employer-sponsored health insurance, that can mean \u003ca href=\"http://www.nber.org/digest/aug05/w11063.html\" target=\"_blank\">your own part of the premium\u003c/a> will go up. Public insurance programs like Medicare and Medicaid get more expensive, too, and those are paid for through taxes.\u003c/p>\n\u003cp>Colonoscopy is \"a messy one\" for other reasons, too, says Maribeth Shannon with some irony. She specializes in market transparency and accountability at the California HealthCare Foundation.\u003c/p>\n\u003cp>She's not just referring to the procedure itself. Colonoscopy is messy because of the way it's billed. Here are some things to ask about before you go in for the procedure:\u003c/p>\n\u003cp>\u003cstrong>Screening or diagnostic\u003c/strong>: In a screening colonoscopy, a doctor threads a flexible tube with an attached camera into the colon to look for abnormalities, like a polyp. If a polyp is found, it can be removed during the procedure. After the ACA first took effect, patients who had polyps removed discovered that this action changed the colonoscopy from a \"free\" screening test to a diagnostic test, and they were \u003ca href=\"http://khn.org/news/michelle-andrews-q-and-a-on-insurance-coverage-costs/\" target=\"_blank\">on the hook for a big bill\u003c/a>.\u003c/p>\n\u003cp>\u003ca href=\"http://www.dol.gov/ebsa/faqs/faq-aca12.html\" target=\"_blank\">Federal rules\u003c/a> about the free screening colonoscopy have since been updated. \"(P)olyp removal is an integral part of a colonoscopy,\" says the federal government, and must be included at no cost to the patient. Still, Maribeth Shannon says that \"consumers should check with their health plan and ask 'what happens if a polyp is found -- you're going to treat that as preventive, right?'\"\u003c/p>\n\u003cp>\u003cstrong>\u003c/p>\u003cp>\u003c/p>\u003cp>Anesthesia: \u003c/strong>You might think that anesthesia would be included with the price of a colonoscopy. After all, it's not surprising that many patients would want to be anesthetized when they are having a colonoscopy. But for quite awhile, patients were being billed for anesthesia, which by itself can run be $1,000 or more.\u003c/p>\n\u003cp>That's what happened to Gareth Tyrnauer of Sebastopol. He was delighted when his insurer sent him a letter that said a colonoscopy would be covered 100 percent. \"I'd be a fool not to do this,\" he recalls thinking. But, after the procedure, he got a $1,200 bill -- just for the anesthesia. He called his insurer's customer service to fight the bill, saying he told the representative, \"I've got a piece of paper right here and it says 'it's 100 percent covered. What part of 100 percent don't I understand?'\" He ultimately won.\u003c/p>\n\u003cp>\u003ca href=\"http://www.npr.org/sections/health-shots/2015/05/15/406969802/feds-tell-insurers-to-pay-for-anesthesia-during-screening-colonoscopies\" target=\"_blank\">Earlier this month\u003c/a>, the federal government stepped in again and \u003ca href=\"http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/aca_implementation_faqs26.pdf\" target=\"_blank\">issued a clarification \u003c/a>that insurers may not charge for anesthesia used in connection with a preventive colonoscopy.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/207652658&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/207652658'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003cstrong>In-network is key: \u003c/strong>Make sure you know in advance who is involved in the procedure, warns Dena Mendelsohn, a health policy analyst with Consumers Union in San Francisco. \"Consumers should be sure to confirm that the facility where they're going is in-network and the provider they will have is in-network.\"\u003c/p>\n\u003cp>\u003cstrong>Quality:\u003c/strong> In health care, determining quality of a procedure can be as difficult as determining how much it might cost. A strong predictor of quality is volume of procedures. A doctor or facility that has high volume is likely to be doing a higher quality job. Mendelsohn says many health insurance plans have tools for their customers on their websites and sometimes that includes volume. How much is the right amount? Hard to know, she says, but consumers could compare \"hundreds or thousands versus dozens.\"\u003c/p>\n\u003cp>Mendelsohn also recommends avoiding a large university medical center for a colonoscopy. \"Large universities are tailored toward more complicated procedures,\" she says. \"Since a screening colonoscopy is more routine, it's not necessarily the case that going to a large university will get you a better colonoscopy.\"\u003c/p>\n\u003cp>\u003cstrong>Other options: \u003c/strong>If you've been dreading have a colonoscopy, you're not alone. But there are other \u003ca href=\"http://healthfinder.gov/HealthTopics/Category/doctor-visits/screening-tests/get-tested-for-colorectal-cancer\" target=\"_blank\">non-invasive options\u003c/a> for colon cancer screening, including the fecal-occult blood test. If you've been \u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/02/23/avoiding-a-colonoscopy-youre-not-alone/\" target=\"_blank\">avoiding a colonoscopy\u003c/a>, you may want to learn more about this option.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>An earlier version of this story misstated how screening and diagnostic colonoscopies were billed after some aspects of the Affordable Care Act went into effect. We regret the error.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/30459/pricecheck-how-much-does-a-colonoscopy-cost","authors":["240"],"series":["stateofhealth_2492"],"categories":["stateofhealth_13"],"tags":["stateofhealth_482","stateofhealth_841"],"featImg":"stateofhealth_30722","label":"stateofhealth_2492"},"stateofhealth_22488":{"type":"posts","id":"stateofhealth_22488","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"22488","score":null,"sort":[1415814063000]},"guestAuthors":[],"slug":"pricecheck-insurer-payments-for-iuds-vary-by-500-in-california","title":"PriceCheck: Insurer Payments for IUDs Vary by $800 in California","publishDate":1415814063,"format":"aside","headTitle":"Price Check | State of Health | KQED News","labelTerm":{"term":2492,"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_22493\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/iStock_000037081776_Large.jpg\">\u003cimg class=\"size-large wp-image-22493\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/iStock_000037081776_Large-640x424.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"424\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Earlier this year, KQED launched \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">PriceCheck,\u003c/a> our crowdsourcing project on health costs. We’re working in collaboration with \u003ca style=\"font-weight: bold;color: #114999\" href=\"http://www.scpr.org/blogs/health/2014/07/21/17024/next-up-for-pricecheck-back-mri-s/\" target=\"_blank\">KPCC\u003c/a> public media in Los Angeles and \u003ca style=\"font-weight: bold;color: #114999\" href=\"http://clearhealthcosts.com/\" target=\"_blank\">ClearHealthCosts.com\u003c/a>, a New York City startup looking at health costs.\u003c/p>\n\u003cp>On PriceCheck we're shining a light on the opaque world of health care costs. We've asked what you, the members of our audience, have been charged for common medical tests and services, including \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/07/11/pricecheck-what-insurance-companies-are-paying-for-mammograms/\" href=\"http://ww2.kqed.org/stateofhealth/2014/07/11/pricecheck-what-insurance-companies-are-paying-for-mammograms/\" target=\"_blank\">mammograms\u003c/a> and \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/08/01/pricecheck-how-much-for-a-back-mri-in-the-bay-area-255-or-3700/\" href=\"http://ww2.kqed.org/stateofhealth/2014/08/01/pricecheck-how-much-for-a-back-mri-in-the-bay-area-255-or-3700/\" target=\"_blank\">lower-back MRIs\u003c/a>.\u003c/p>\n\u003cp>Now a PriceCheck update on IUDs, the long-acting contraceptive. (And \u003ca title=\"http://bedsider.org/features/243\" href=\"//bedsider.org/features/243\" target=\"_blank\">it's really long-acting\u003c/a> -- up to seven years for the hormonal type; up to 12 years for the copper IUD). You told us what you were charged and what your insurers paid for an IUD.\u003c/p>\n\u003cp>Like all FDA-approved methods of birth control, IUDs are supposed to be available at no co-pay to consumers under a\u003ca title=\"http://www.hrsa.gov/womensguidelines/\" href=\"http://www.hrsa.gov/womensguidelines/\" target=\"_blank\"> requirement of the Affordable Care Act\u003c/a>. Were they? The device alone generally costs several hundred dollars; a doctor's charge to insert the device can be hundreds more.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>That's why the \"no co-pay\" mandate of the health law is so important. A\u003ca title=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1400506?query=featured_home\" href=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1400506?query=featured_home\" target=\"_blank\"> recent study\u003c/a> published in the New England Journal of Medicine found that teenagers who received counseling about long-acting birth control, and then were offered to choose an option at no cost, chose a long-acting method, like an IUD. Researchers then found they were much less likely to get pregnant, give birth or have an abortion.\u003c/p>\n\u003cp>\u003cstrong>What We Found: Prices Paid Ranged from $440 to $1,230\u003c/strong>\u003c/p>\n\u003cp>On PriceCheck, some women who shared their prices had gotten their IUD before the health law went into effect. Some of these women reported paying as much as $600 for their IUD. But none of the women in our group who got an IUD since the health law took effect reported paying a co-pay.\u003c/p>\n\u003caside class=\"pullquote alignright\">Learn more: \u003ca href=\"http://ww2.kqed.org/stateofhealth/series/price-check/\" target=\"_blank\">read all our PriceCheck coverage\u003c/a>. \u003c/aside>\n\u003cp>Of the submissions we received from women who got an IUD, overall prices charged ranged from about $650 to about $1,600.\u003c/p>\n\u003cp>But \"prices charged\" are considered \"retail\" prices. Insurance companies negotiate contracts with doctors, and the amount they pay is sometimes significantly less than what is charged. It's impossible for consumers to see this price range because those contracts are sealed.\u003c/p>\n\u003cp>We found that what insurers actually paid ranged from a low of $440, by Kaiser Sunset in Los Angeles, to $1,230 by Premera Blue Cross (an insurance company based in the state of Washington) to the Palo Alto Medical Foundation.\u003c/p>\n\u003cp>\u003cstrong>What Women Told Us\u003c/strong>\u003c/p>\n\u003cp>All the women in our database who got their IUD after the health law's requirement of no co-pay went into effect reported that they did not pay anything:\u003c/p>\n\u003cul>\n\u003cli>\"My insurance covered for me to get this free of charge.\"\u003c/li>\n\u003cli>\"I only paid my co pay for my first visit which was a pap and pregnancy test and consultation for the IUD. (After the appointment for the procedure and two follow ups) I didn't pay anything.\u003c/li>\n\u003c/ul>\n\u003cp>Another woman reported that she \u003cem>did\u003c/em> have to pay for a follow-up appointment. Anthem Blue Cross had covered the $1,149 cost of her IUD and doctors' fees, even though she had \"a few thousand dollar deductible … because it was considered preventative.\" Still, she had a six-week follow-up appointment and had to pay the full $197 cost.\u003c/p>\n\u003cp>Another woman said she was initially charged the full $1,200 cost, but called her insurer to challenge the charge. The insurer discovered the procedure had not been coded correctly. The error was fixed and her costs were \"completely covered … three months later.\"\u003c/p>\n\u003cp>In other words, it pays to review your bills and call to ask.\u003c/p>\n\u003cp>\u003cstrong>Are You Paying a Co-Pay for Your Birth Control?\u003c/strong>\u003c/p>\n\u003cp>Recent studies show that our survey sample is not representative of what's happening across the country. The Guttmacher Institute \u003ca title=\"http://www.contraceptionjournal.org/article/S0010-7824(14)00687-8/pdf\" href=\"http://www.contraceptionjournal.org/article/S0010-7824(14)00687-8/pdf\" target=\"_blank\">surveyed \u003c/a>privately insured women across the country. While the proportion of women obtaining IUDs at no cost rose from about 45 percent to just over 60 percent, you have to wonder why 40 percent of women are still having to pay.\u003c/p>\n\u003cp>“The biggest reason is probably the issue of \u003ca style=\"color: #003b79\" href=\"https://www.healthcare.gov/health-care-law-protections/grandfathered-plans/\" target=\"_blank\">grandfathered plans\u003c/a>,” Adam Sonfield, a senior public policy associate at the Guttmacher Institute and the study’s lead author, told \u003ca title=\"http://kaiserhealthnews.org/news/michelle-andrews-on-contraception-coverage/\" href=\"http://kaiserhealthnews.org/news/michelle-andrews-on-contraception-coverage/\" target=\"_blank\">Kaiser Health News\u003c/a>. Sonfield was referring to plans that were in effect when the Affordable Care Act was passed in March 2010 and haven’t changed substantially since. These grandfathered plans are not required to provide free contraceptive coverage.\u003c/p>\n\u003cp>Churches and other religious employers are also exempt from the requirement.\u003c/p>\n\u003cp>\u003cstrong>Share What You Paid!\u003c/strong>\u003c/p>\n\u003cp>We invite you, the members of our audience, \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/06/23/kqed-launches-project-to-help-make-health-costs-transparent/\" href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/kqed-launches-project-to-help-make-health-costs-transparent/\" target=\"_blank\">to share what you paid\u003c/a>. We're especially interested in IUDs, mammograms and lower-back MRIs, but our form is designed to accept virtually all health care tests, services and procedures. All you need is your insurance \"\u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/07/18/explaining-the-health-insurance-explanation-of-benefits/\" href=\"http://ww2.kqed.org/stateofhealth/2014/07/18/explaining-the-health-insurance-explanation-of-benefits/\" target=\"_blank\">explanation of benefits\u003c/a>\" and a visit to\u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/06/23/kqed-launches-project-to-help-make-health-costs-transparent/\" href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/kqed-launches-project-to-help-make-health-costs-transparent/\" target=\"_blank\"> KQED's PriceCheck\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This post has been updated to reflect a new lowest-cost IUD. \u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"On PriceCheck, we're crowdsourcing health care costs. ","status":"publish","parent":0,"modified":1416272620,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":25,"wordCount":867},"headData":{"title":"PriceCheck: Insurer Payments for IUDs Vary by $800 in California | KQED","description":"On PriceCheck, we're crowdsourcing health care costs. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"PriceCheck: Insurer Payments for IUDs Vary by $800 in California","datePublished":"2014-11-12T17:41:03.000Z","dateModified":"2014-11-18T01:03:40.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"22488 http://blogs.kqed.org/stateofhealth/?p=22488","disqusUrl":"https://ww2.kqed.org/stateofhealth/2014/11/12/pricecheck-insurer-payments-for-iuds-vary-by-500-in-california/","disqusTitle":"PriceCheck: Insurer Payments for IUDs Vary by $800 in California","path":"/stateofhealth/22488/pricecheck-insurer-payments-for-iuds-vary-by-500-in-california","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_22493\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/iStock_000037081776_Large.jpg\">\u003cimg class=\"size-large wp-image-22493\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/iStock_000037081776_Large-640x424.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"424\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Earlier this year, KQED launched \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">PriceCheck,\u003c/a> our crowdsourcing project on health costs. We’re working in collaboration with \u003ca style=\"font-weight: bold;color: #114999\" href=\"http://www.scpr.org/blogs/health/2014/07/21/17024/next-up-for-pricecheck-back-mri-s/\" target=\"_blank\">KPCC\u003c/a> public media in Los Angeles and \u003ca style=\"font-weight: bold;color: #114999\" href=\"http://clearhealthcosts.com/\" target=\"_blank\">ClearHealthCosts.com\u003c/a>, a New York City startup looking at health costs.\u003c/p>\n\u003cp>On PriceCheck we're shining a light on the opaque world of health care costs. We've asked what you, the members of our audience, have been charged for common medical tests and services, including \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/07/11/pricecheck-what-insurance-companies-are-paying-for-mammograms/\" href=\"http://ww2.kqed.org/stateofhealth/2014/07/11/pricecheck-what-insurance-companies-are-paying-for-mammograms/\" target=\"_blank\">mammograms\u003c/a> and \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/08/01/pricecheck-how-much-for-a-back-mri-in-the-bay-area-255-or-3700/\" href=\"http://ww2.kqed.org/stateofhealth/2014/08/01/pricecheck-how-much-for-a-back-mri-in-the-bay-area-255-or-3700/\" target=\"_blank\">lower-back MRIs\u003c/a>.\u003c/p>\n\u003cp>Now a PriceCheck update on IUDs, the long-acting contraceptive. (And \u003ca title=\"http://bedsider.org/features/243\" href=\"//bedsider.org/features/243\" target=\"_blank\">it's really long-acting\u003c/a> -- up to seven years for the hormonal type; up to 12 years for the copper IUD). You told us what you were charged and what your insurers paid for an IUD.\u003c/p>\n\u003cp>Like all FDA-approved methods of birth control, IUDs are supposed to be available at no co-pay to consumers under a\u003ca title=\"http://www.hrsa.gov/womensguidelines/\" href=\"http://www.hrsa.gov/womensguidelines/\" target=\"_blank\"> requirement of the Affordable Care Act\u003c/a>. Were they? The device alone generally costs several hundred dollars; a doctor's charge to insert the device can be hundreds more.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>That's why the \"no co-pay\" mandate of the health law is so important. A\u003ca title=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1400506?query=featured_home\" href=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1400506?query=featured_home\" target=\"_blank\"> recent study\u003c/a> published in the New England Journal of Medicine found that teenagers who received counseling about long-acting birth control, and then were offered to choose an option at no cost, chose a long-acting method, like an IUD. Researchers then found they were much less likely to get pregnant, give birth or have an abortion.\u003c/p>\n\u003cp>\u003cstrong>What We Found: Prices Paid Ranged from $440 to $1,230\u003c/strong>\u003c/p>\n\u003cp>On PriceCheck, some women who shared their prices had gotten their IUD before the health law went into effect. Some of these women reported paying as much as $600 for their IUD. But none of the women in our group who got an IUD since the health law took effect reported paying a co-pay.\u003c/p>\n\u003caside class=\"pullquote alignright\">Learn more: \u003ca href=\"http://ww2.kqed.org/stateofhealth/series/price-check/\" target=\"_blank\">read all our PriceCheck coverage\u003c/a>. \u003c/aside>\n\u003cp>Of the submissions we received from women who got an IUD, overall prices charged ranged from about $650 to about $1,600.\u003c/p>\n\u003cp>But \"prices charged\" are considered \"retail\" prices. Insurance companies negotiate contracts with doctors, and the amount they pay is sometimes significantly less than what is charged. It's impossible for consumers to see this price range because those contracts are sealed.\u003c/p>\n\u003cp>We found that what insurers actually paid ranged from a low of $440, by Kaiser Sunset in Los Angeles, to $1,230 by Premera Blue Cross (an insurance company based in the state of Washington) to the Palo Alto Medical Foundation.\u003c/p>\n\u003cp>\u003cstrong>What Women Told Us\u003c/strong>\u003c/p>\n\u003cp>All the women in our database who got their IUD after the health law's requirement of no co-pay went into effect reported that they did not pay anything:\u003c/p>\n\u003cul>\n\u003cli>\"My insurance covered for me to get this free of charge.\"\u003c/li>\n\u003cli>\"I only paid my co pay for my first visit which was a pap and pregnancy test and consultation for the IUD. (After the appointment for the procedure and two follow ups) I didn't pay anything.\u003c/li>\n\u003c/ul>\n\u003cp>Another woman reported that she \u003cem>did\u003c/em> have to pay for a follow-up appointment. Anthem Blue Cross had covered the $1,149 cost of her IUD and doctors' fees, even though she had \"a few thousand dollar deductible … because it was considered preventative.\" Still, she had a six-week follow-up appointment and had to pay the full $197 cost.\u003c/p>\n\u003cp>Another woman said she was initially charged the full $1,200 cost, but called her insurer to challenge the charge. The insurer discovered the procedure had not been coded correctly. The error was fixed and her costs were \"completely covered … three months later.\"\u003c/p>\n\u003cp>In other words, it pays to review your bills and call to ask.\u003c/p>\n\u003cp>\u003cstrong>Are You Paying a Co-Pay for Your Birth Control?\u003c/strong>\u003c/p>\n\u003cp>Recent studies show that our survey sample is not representative of what's happening across the country. The Guttmacher Institute \u003ca title=\"http://www.contraceptionjournal.org/article/S0010-7824(14)00687-8/pdf\" href=\"http://www.contraceptionjournal.org/article/S0010-7824(14)00687-8/pdf\" target=\"_blank\">surveyed \u003c/a>privately insured women across the country. While the proportion of women obtaining IUDs at no cost rose from about 45 percent to just over 60 percent, you have to wonder why 40 percent of women are still having to pay.\u003c/p>\n\u003cp>“The biggest reason is probably the issue of \u003ca style=\"color: #003b79\" href=\"https://www.healthcare.gov/health-care-law-protections/grandfathered-plans/\" target=\"_blank\">grandfathered plans\u003c/a>,” Adam Sonfield, a senior public policy associate at the Guttmacher Institute and the study’s lead author, told \u003ca title=\"http://kaiserhealthnews.org/news/michelle-andrews-on-contraception-coverage/\" href=\"http://kaiserhealthnews.org/news/michelle-andrews-on-contraception-coverage/\" target=\"_blank\">Kaiser Health News\u003c/a>. Sonfield was referring to plans that were in effect when the Affordable Care Act was passed in March 2010 and haven’t changed substantially since. These grandfathered plans are not required to provide free contraceptive coverage.\u003c/p>\n\u003cp>Churches and other religious employers are also exempt from the requirement.\u003c/p>\n\u003cp>\u003cstrong>Share What You Paid!\u003c/strong>\u003c/p>\n\u003cp>We invite you, the members of our audience, \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/06/23/kqed-launches-project-to-help-make-health-costs-transparent/\" href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/kqed-launches-project-to-help-make-health-costs-transparent/\" target=\"_blank\">to share what you paid\u003c/a>. We're especially interested in IUDs, mammograms and lower-back MRIs, but our form is designed to accept virtually all health care tests, services and procedures. All you need is your insurance \"\u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/07/18/explaining-the-health-insurance-explanation-of-benefits/\" href=\"http://ww2.kqed.org/stateofhealth/2014/07/18/explaining-the-health-insurance-explanation-of-benefits/\" target=\"_blank\">explanation of benefits\u003c/a>\" and a visit to\u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/06/23/kqed-launches-project-to-help-make-health-costs-transparent/\" href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/kqed-launches-project-to-help-make-health-costs-transparent/\" target=\"_blank\"> KQED's PriceCheck\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This post has been updated to reflect a new lowest-cost IUD. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/22488/pricecheck-insurer-payments-for-iuds-vary-by-500-in-california","authors":["240"],"series":["stateofhealth_2492"],"categories":["stateofhealth_13"],"tags":["stateofhealth_625","stateofhealth_799","stateofhealth_841"],"featImg":"stateofhealth_22493","label":"stateofhealth_2492"},"stateofhealth_21777":{"type":"posts","id":"stateofhealth_21777","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"21777","score":null,"sort":[1412009825000]},"guestAuthors":[],"slug":"shining-light-on-the-cost-of-diabetes-test-strips","title":"Shining Light on the Cost of Diabetes Test Strips","publishDate":1412009825,"format":"aside","headTitle":"Price Check | State of Health | KQED News","labelTerm":{"term":2492,"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_21794\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"https://www.flickr.com/photos/v1ctor/10871254373/in/photolist-7xnQUz-4VVzWz-duRtoY-dteyRf-dtenzF-6onXMj-51knzJ-Q7qvr-51knpN-51gbqX-cBgG4U-53ybQU-CDq9F-hyE2be-25tH2r-6oiMk6-6oiM3g-6onXGL-5zr3ZY-6onXW9-9kVf2j-6oiMcc-53yc11-dHqMtG-cBgFKq-9kSbEZ-a3Qrfu-cBgFCW-cBgFyS-b8pMUx-aBgDAQ-53yc8S-EjCFC-7Vh97k-7Vhboa-7VkmkG-7VkjAo-6onY61-6onXyd-f1H9qJ-6onXuN-6oiLNF-25tDrw-L6Gwo-4bu3uW-4z8pLs-3mkAZ1-6DyhnP-5UDiQq-PiQgG\">\u003cimg class=\"size-large wp-image-21794\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/09/10871254373_07e4989b3c_k-640x424.jpg\" alt=\"(Victor/via Flickr)\" width=\"640\" height=\"424\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Test strips -- the white strip in the photo above -- vary dramatically both in cash price and in insurance coverage. (Victor/via Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Since early this summer, KQED and our partners, KPCC and ClearHealthCosts.com, have been crowdsourcing the costs of common health care procedures.\u003c/p>\n\u003caside class=\"pullquote alignleft\">'Every time someone moves to a new insurer, the pricing will be very different on test strips. Nobody is going to send you a breakdown.' \u003c/aside>\n\u003cp>If you're one of the 29 million people in America who has diabetes, we're turning now to you. We know that many people with diabetes must check their blood sugar, also called glucose, level several times a day.\u003c/p>\n\u003cp>For those of you who don't have diabetes, the reason for frequent checking is because in diabetes, sugar can build up in the bloodstream because the body is not able to process it. That can be dangerous. Depending on the severity of the disease, many people with diabetes must check their glucose level several times a day to make sure it is neither dangerously high nor dangerously low.\u003c/p>\n\u003cp>To \u003ca title=\"http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/checking-your-blood-glucose.html\" href=\"http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/checking-your-blood-glucose.html\" target=\"_blank\">check their blood sugar\u003c/a>, people with diabetes have a glucose meter. Each time they test their blood, a test strip is inserted into the meter. Then they use a special needle to prick a finger and place a drop of blood on a test strip. The meter displays the result.\u003c!--more-->\u003c/p>\n\u003cp>A single strip is not so much money, but testing day in, day out, the money adds up. In addition, like everything else in health care, different insurers cover different brands at different quantities and different co-pays or co-insurance.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"If you rely on our [health care] system,\" said Amy Tenderich, \u003ca title=\"http://www.diabetesmine.com/about\" href=\"http://www.diabetesmine.com/about\" target=\"_blank\">founder and editor of DiabetesMine.com,\u003c/a> a diabetes news, advocacy and community website, \"it's a major thorn in your side, because you have no way of knowing what the real costs are or how anything is calculated.\"\u003c/p>\n\u003cp>Tenderich knows the issue of test strips well. She was diagnosed with Type 1 diabetes in 2003.\u003c/p>\n\u003cp>Early last year, it looked like there was a glimmer of hope in the expense around test strips. Medicare instituted a \u003ca title=\"http://www.medicare.gov/coverage/blood-sugar-test-strips.html\" href=\"http://www.medicare.gov/coverage/blood-sugar-test-strips.html\" target=\"_blank\">competitive bidding process\u003c/a>. That brought the price of test strips down some, but may have created a ripple effect where other private insurers are clamping down on both quantity and variety of strips they cover. (Many in the diabetes community have also sharply criticized the move because they say the lower-cost strips are \u003ca title=\"http://asweetlife.org/riva/blogs/diabetes-management-blogs/the-diabetes-test-strips-crisis-how-cutting-costs-is-robbing-your-health/33603/\" href=\"http://asweetlife.org/riva/blogs/diabetes-management-blogs/the-diabetes-test-strips-crisis-how-cutting-costs-is-robbing-your-health/33603/\" target=\"_blank\">often less accurate\u003c/a>.)\u003c/p>\n\u003cp>Yes, you can\u003ca title=\"https://www.google.com/search?client=safari&rls=en&q=cost+of+diabetes+test+strips&ie=UTF-8&oe=UTF-8&gws_rd=ssl#q=cost+of+diabetes+test+strips&rls=en&tbm=shop\" href=\"https://www.google.com/search?client=safari&rls=en&q=cost+of+diabetes+test+strips&ie=UTF-8&oe=UTF-8&gws_rd=ssl#q=cost+of+diabetes+test+strips&rls=en&tbm=shop\" target=\"_blank\"> search online\u003c/a> and find the cash price for test strips pretty easily. But the variety can be confounding! First in quantity: boxes of 100, boxes of 50, a\u003ca title=\"http://www.totaldiabetessupply.com/glucose-test-strips/accu-chek-compact-glucose-test-strips-51.html?gdftrk=gdfV21446_a_7c1042_a_7c8455_a_7c7553747419&gclid=Cj0KEQjwnZShBRDfxqzr55rcyMEBEiQA1iRNPw_sUeHZuZeniGl06tQlgAqH5E0Y2yN4XctiOKSKV9YaAsZP8P8HAQ\" href=\"http://www.totaldiabetessupply.com/glucose-test-strips/accu-chek-compact-glucose-test-strips-51.html?gdftrk=gdfV21446_a_7c1042_a_7c8455_a_7c7553747419&gclid=Cj0KEQjwnZShBRDfxqzr55rcyMEBEiQA1iRNPw_sUeHZuZeniGl06tQlgAqH5E0Y2yN4XctiOKSKV9YaAsZP8P8HAQ\" target=\"_blank\"> box of 5\u003c/a>1.\u003c/p>\n\u003cp>Then there's price -- two brands I found were $17.17 for 100 count; another box of 50 was $33.79.\u003c/p>\n\u003cp>But cash prices found online are of little help to the millions of Americans who are insured and are restricted to what their insurer covers, both in brand and in quantity. The quantity is strips-per-some-arbitrary-unit-of-time. Maybe it's strips per day or per month, or 60 days, or 90 days.\u003c/p>\n\u003cp>It all depends on what contracts the insurance company has made with test strip manufacturers. Remember that those contracts are sealed; You can't compare insurer to insurer.\u003c/p>\n\u003cp>\"Every time someone moves to a new insurer,\" Tenderich says, \"the pricing will be very different on the drugs I'm taking and the test strips as well. Nobody is going to send you a breakdown. You have no way of knowing how they're calculated.\"\u003c/p>\n\u003cp>That's where PriceCheck comes in.\u003c/p>\n\u003cp>If you have diabetes and you test your blood sugar regularly, \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">please visit PriceCheck\u003c/a> and submit what you paid and what your insurer paid. In addition, please share the specifics of your own insurance -- how many strips a day (or month) your insurer covers and exactly what your co-pay or co-insurance is on test strips. We want to know the limitations of your insurance. Since people with Type 2 diabetes may face strict restrictions on the number of strips they can use, we're also asking people to let us know if they have Type 1 or Type 2 diabetes.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Help us make health costs transparent in California -- \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">visit PriceCheck\u003c/a> and share your costs!\u003c/p>\n\n","blocks":[],"excerpt":"KQED's PriceCheck project asks readers to share the price they've paid for diabetes test strips.","status":"publish","parent":0,"modified":1413054755,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":18,"wordCount":726},"headData":{"title":"Shining Light on the Cost of Diabetes Test Strips | KQED","description":"KQED's PriceCheck project asks readers to share the price they've paid for diabetes test strips.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Shining Light on the Cost of Diabetes Test Strips","datePublished":"2014-09-29T16:57:05.000Z","dateModified":"2014-10-11T19:12:35.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"21777 http://blogs.kqed.org/stateofhealth/?p=21777","disqusUrl":"https://ww2.kqed.org/stateofhealth/2014/09/29/shining-light-on-the-cost-of-diabetes-test-strips/","disqusTitle":"Shining Light on the Cost of Diabetes Test Strips","path":"/stateofhealth/21777/shining-light-on-the-cost-of-diabetes-test-strips","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_21794\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"https://www.flickr.com/photos/v1ctor/10871254373/in/photolist-7xnQUz-4VVzWz-duRtoY-dteyRf-dtenzF-6onXMj-51knzJ-Q7qvr-51knpN-51gbqX-cBgG4U-53ybQU-CDq9F-hyE2be-25tH2r-6oiMk6-6oiM3g-6onXGL-5zr3ZY-6onXW9-9kVf2j-6oiMcc-53yc11-dHqMtG-cBgFKq-9kSbEZ-a3Qrfu-cBgFCW-cBgFyS-b8pMUx-aBgDAQ-53yc8S-EjCFC-7Vh97k-7Vhboa-7VkmkG-7VkjAo-6onY61-6onXyd-f1H9qJ-6onXuN-6oiLNF-25tDrw-L6Gwo-4bu3uW-4z8pLs-3mkAZ1-6DyhnP-5UDiQq-PiQgG\">\u003cimg class=\"size-large wp-image-21794\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/09/10871254373_07e4989b3c_k-640x424.jpg\" alt=\"(Victor/via Flickr)\" width=\"640\" height=\"424\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Test strips -- the white strip in the photo above -- vary dramatically both in cash price and in insurance coverage. (Victor/via Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Since early this summer, KQED and our partners, KPCC and ClearHealthCosts.com, have been crowdsourcing the costs of common health care procedures.\u003c/p>\n\u003caside class=\"pullquote alignleft\">'Every time someone moves to a new insurer, the pricing will be very different on test strips. Nobody is going to send you a breakdown.' \u003c/aside>\n\u003cp>If you're one of the 29 million people in America who has diabetes, we're turning now to you. We know that many people with diabetes must check their blood sugar, also called glucose, level several times a day.\u003c/p>\n\u003cp>For those of you who don't have diabetes, the reason for frequent checking is because in diabetes, sugar can build up in the bloodstream because the body is not able to process it. That can be dangerous. Depending on the severity of the disease, many people with diabetes must check their glucose level several times a day to make sure it is neither dangerously high nor dangerously low.\u003c/p>\n\u003cp>To \u003ca title=\"http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/checking-your-blood-glucose.html\" href=\"http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/checking-your-blood-glucose.html\" target=\"_blank\">check their blood sugar\u003c/a>, people with diabetes have a glucose meter. Each time they test their blood, a test strip is inserted into the meter. Then they use a special needle to prick a finger and place a drop of blood on a test strip. The meter displays the result.\u003c!--more-->\u003c/p>\n\u003cp>A single strip is not so much money, but testing day in, day out, the money adds up. In addition, like everything else in health care, different insurers cover different brands at different quantities and different co-pays or co-insurance.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"If you rely on our [health care] system,\" said Amy Tenderich, \u003ca title=\"http://www.diabetesmine.com/about\" href=\"http://www.diabetesmine.com/about\" target=\"_blank\">founder and editor of DiabetesMine.com,\u003c/a> a diabetes news, advocacy and community website, \"it's a major thorn in your side, because you have no way of knowing what the real costs are or how anything is calculated.\"\u003c/p>\n\u003cp>Tenderich knows the issue of test strips well. She was diagnosed with Type 1 diabetes in 2003.\u003c/p>\n\u003cp>Early last year, it looked like there was a glimmer of hope in the expense around test strips. Medicare instituted a \u003ca title=\"http://www.medicare.gov/coverage/blood-sugar-test-strips.html\" href=\"http://www.medicare.gov/coverage/blood-sugar-test-strips.html\" target=\"_blank\">competitive bidding process\u003c/a>. That brought the price of test strips down some, but may have created a ripple effect where other private insurers are clamping down on both quantity and variety of strips they cover. (Many in the diabetes community have also sharply criticized the move because they say the lower-cost strips are \u003ca title=\"http://asweetlife.org/riva/blogs/diabetes-management-blogs/the-diabetes-test-strips-crisis-how-cutting-costs-is-robbing-your-health/33603/\" href=\"http://asweetlife.org/riva/blogs/diabetes-management-blogs/the-diabetes-test-strips-crisis-how-cutting-costs-is-robbing-your-health/33603/\" target=\"_blank\">often less accurate\u003c/a>.)\u003c/p>\n\u003cp>Yes, you can\u003ca title=\"https://www.google.com/search?client=safari&rls=en&q=cost+of+diabetes+test+strips&ie=UTF-8&oe=UTF-8&gws_rd=ssl#q=cost+of+diabetes+test+strips&rls=en&tbm=shop\" href=\"https://www.google.com/search?client=safari&rls=en&q=cost+of+diabetes+test+strips&ie=UTF-8&oe=UTF-8&gws_rd=ssl#q=cost+of+diabetes+test+strips&rls=en&tbm=shop\" target=\"_blank\"> search online\u003c/a> and find the cash price for test strips pretty easily. But the variety can be confounding! First in quantity: boxes of 100, boxes of 50, a\u003ca title=\"http://www.totaldiabetessupply.com/glucose-test-strips/accu-chek-compact-glucose-test-strips-51.html?gdftrk=gdfV21446_a_7c1042_a_7c8455_a_7c7553747419&gclid=Cj0KEQjwnZShBRDfxqzr55rcyMEBEiQA1iRNPw_sUeHZuZeniGl06tQlgAqH5E0Y2yN4XctiOKSKV9YaAsZP8P8HAQ\" href=\"http://www.totaldiabetessupply.com/glucose-test-strips/accu-chek-compact-glucose-test-strips-51.html?gdftrk=gdfV21446_a_7c1042_a_7c8455_a_7c7553747419&gclid=Cj0KEQjwnZShBRDfxqzr55rcyMEBEiQA1iRNPw_sUeHZuZeniGl06tQlgAqH5E0Y2yN4XctiOKSKV9YaAsZP8P8HAQ\" target=\"_blank\"> box of 5\u003c/a>1.\u003c/p>\n\u003cp>Then there's price -- two brands I found were $17.17 for 100 count; another box of 50 was $33.79.\u003c/p>\n\u003cp>But cash prices found online are of little help to the millions of Americans who are insured and are restricted to what their insurer covers, both in brand and in quantity. The quantity is strips-per-some-arbitrary-unit-of-time. Maybe it's strips per day or per month, or 60 days, or 90 days.\u003c/p>\n\u003cp>It all depends on what contracts the insurance company has made with test strip manufacturers. Remember that those contracts are sealed; You can't compare insurer to insurer.\u003c/p>\n\u003cp>\"Every time someone moves to a new insurer,\" Tenderich says, \"the pricing will be very different on the drugs I'm taking and the test strips as well. Nobody is going to send you a breakdown. You have no way of knowing how they're calculated.\"\u003c/p>\n\u003cp>That's where PriceCheck comes in.\u003c/p>\n\u003cp>If you have diabetes and you test your blood sugar regularly, \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">please visit PriceCheck\u003c/a> and submit what you paid and what your insurer paid. In addition, please share the specifics of your own insurance -- how many strips a day (or month) your insurer covers and exactly what your co-pay or co-insurance is on test strips. We want to know the limitations of your insurance. Since people with Type 2 diabetes may face strict restrictions on the number of strips they can use, we're also asking people to let us know if they have Type 1 or Type 2 diabetes.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Help us make health costs transparent in California -- \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">visit PriceCheck\u003c/a> and share your costs!\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/21777/shining-light-on-the-cost-of-diabetes-test-strips","authors":["240"],"series":["stateofhealth_2492"],"categories":["stateofhealth_13"],"tags":["stateofhealth_393","stateofhealth_118","stateofhealth_841"],"featImg":"stateofhealth_21794","label":"stateofhealth_2492"},"stateofhealth_21313":{"type":"posts","id":"stateofhealth_21313","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"21313","score":null,"sort":[1410201806000]},"guestAuthors":[],"slug":"stanford-terminates-anthems-contract-anthem-uses-kqed-data-to-cite-stanfords-cost","title":"Stanford Terminates Anthem's Contract; Anthem Uses KQED Data to Cite Stanford's Cost","publishDate":1410201806,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_17341\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/01/96525183-e1390846077644.jpg\">\u003cimg class=\"size-large wp-image-17341\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/01/96525183-640x426.jpg\" alt=\"The Anthem Blue Cross headquarters in Woodland Hills, California. (David McNew/Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The Anthem Blue Cross headquarters in Woodland Hills, California. (David McNew/Getty Images) \u003ccite>(David McNew/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Effective Monday at 12:01a.m., Stanford Health Care terminated its contract with Anthem Blue Cross. Anthem says that roughly 10,000 of its policyholders have used Stanford services in the last year.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Anthem used \u003ca title=\"PriceCheck\" href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">PriceCheck, KQED's crowdsourced guide to health costs\u003c/a>. \u003c/aside>\n\u003cp>In a statement, Anthem said it had requested that \"Stanford agree to a two-week extension of the terminated contract at existing rates.\" Both parties say negotiations are ongoing.\u003c/p>\n\u003cp>Stanford had notified the insurer on Feb. 28, Anthem says, that it intended to terminate the contract.\u003c/p>\n\u003cp>The sticking point appears to be the duration of the contract. Both sides say that they reached agreement on rates for a two-year contract, but Stanford seeks a three-year contract. Because no agreement has been reached on the third year, and because Stanford did not extend its current contract, no contract is in force.\u003c!--more-->\u003c/p>\n\u003cp>James Larkin, spokesman for Stanford, said patients should not worry. \"While our contract did expire last night,\" Larkin said in an email, \"I want to reiterate that Stanford Health Care will continue to welcome Anthem members and honor Anthem¹s in-network co-payment amounts for all of our services and care.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But Larkin would not say whether Stanford would pick up the costs that had been covered by Anthem.\u003c/p>\n\u003cp>Darrel Ng, spokesman for Anthem, said that Anthem patients are potentially responsible for chargemaster rates -- essentially the list price, usually multiples higher than what insurers pay to providers. While Stanford may not charge those high prices, Ng said that if there were later a billing dispute, \"patients would have to hire their own lawyers to advocate on their behalf.\"\u003c/p>\n\u003cp>CalPERS, the California Public Employees' Retirement System, was critical of Stanford's move. In a statement, Ann Boynton, a deputy executive director, said:\u003c/p>\n\u003cblockquote>\u003cp>\"We are deeply disappointed\u003cspan class=\"Apple-style-span\" style=\"color: #000000\">\u003cspan class=\"Apple-style-span\"> with Stanford Hospital's refusal to agree to reasonable terms that allow our members access to Stanford Hospital's services. Anthem Blue Cross and Stanford Hospital agreed to terms for a 2-year contract and we urge Stanford to sign this agreement. Improving the affordability of health care is critical to all Californians and every part of the delivery system must do its part. Stanford Hospital must become part of this effort.\"\u003c/span>\u003c/span>\u003c/p>\u003c/blockquote>\n\u003cp>\u003cstrong>Use of KQED PriceCheck Data\u003c/strong>\u003c/p>\n\u003cp>On Friday, \u003ca title=\"Stanford Set to Terminate Anthem Blue Cross Contract\" href=\"http://ww2.kqed.org/stateofhealth/2014/09/05/stanford-health-care-terminates-anthem-blue-cross-contract/\" target=\"_blank\">Anthem made public a letter \u003c/a>from its president, Mark Morgan, to the president of Stanford Health Care, Amir Dan Rubin. In the letter Morgan acknowledged that Stanford “does provide excellent care,” but he also noted that Stanford is “one of the most expensive hospitals in the state.”\u003c/p>\n\u003cp>Morgan went on to cite specific\u003ca title=\"Stanford Terminates Contract with Anthem Blue Cross\" href=\"http://ww2.kqed.org/stateofhealth/2014/09/05/stanford-health-care-terminates-anthem-blue-cross-contract/\" target=\"_blank\"> \u003c/a>data about Stanford's costs using KQED \u003ca title=\"PriceCheck\" href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">PriceCheck, a health costs transparency tool\u003c/a> launched in June.\u003c/p>\n\u003cp>From Morgan's letter:\u003c/p>\n\u003cblockquote>\u003cp>According to KQED’s Price Check tool, a lower back MRI (72158 MRI-Lower back/lumbar spine w/ and w/o contrast) cost $5,647 at Stanford, which is nearly eight times what an imaging center in nearby San Jose charges at $724.\u003c/p>\u003c/blockquote>\n\u003cp>Contracts between insurers and providers are typically sealed. So while Anthem certainly has information about Stanford's costs in comparison to other providers, it cannot publicize them without violating its own contracts.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But there is no such bar around \u003ca title=\"PriceCheck\" href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">PriceCheck\u003c/a>, which gives patients an easy way to upload their true costs, including what their insurers paid, to the database. \"The market seems to react when these prices are brought to light,\" Ng said.\u003c/p>\n\n","blocks":[],"excerpt":"Both sides say negotiations are ongoing, but 10,000 patients are potentially affected in the meantime.","status":"publish","parent":0,"modified":1414177212,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":18,"wordCount":600},"headData":{"title":"Stanford Terminates Anthem's Contract; Anthem Uses KQED Data to Cite Stanford's Cost | KQED","description":"Both sides say negotiations are ongoing, but 10,000 patients are potentially affected in the meantime.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Stanford Terminates Anthem's Contract; Anthem Uses KQED Data to Cite Stanford's Cost","datePublished":"2014-09-08T18:43:26.000Z","dateModified":"2014-10-24T19:00:12.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"21313 http://blogs.kqed.org/stateofhealth/?p=21313","disqusUrl":"https://ww2.kqed.org/stateofhealth/2014/09/08/stanford-terminates-anthems-contract-anthem-uses-kqed-data-to-cite-stanfords-cost/","disqusTitle":"Stanford Terminates Anthem's Contract; Anthem Uses KQED Data to Cite Stanford's Cost","path":"/stateofhealth/21313/stanford-terminates-anthems-contract-anthem-uses-kqed-data-to-cite-stanfords-cost","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_17341\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/01/96525183-e1390846077644.jpg\">\u003cimg class=\"size-large wp-image-17341\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/01/96525183-640x426.jpg\" alt=\"The Anthem Blue Cross headquarters in Woodland Hills, California. (David McNew/Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The Anthem Blue Cross headquarters in Woodland Hills, California. (David McNew/Getty Images) \u003ccite>(David McNew/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Effective Monday at 12:01a.m., Stanford Health Care terminated its contract with Anthem Blue Cross. Anthem says that roughly 10,000 of its policyholders have used Stanford services in the last year.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Anthem used \u003ca title=\"PriceCheck\" href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">PriceCheck, KQED's crowdsourced guide to health costs\u003c/a>. \u003c/aside>\n\u003cp>In a statement, Anthem said it had requested that \"Stanford agree to a two-week extension of the terminated contract at existing rates.\" Both parties say negotiations are ongoing.\u003c/p>\n\u003cp>Stanford had notified the insurer on Feb. 28, Anthem says, that it intended to terminate the contract.\u003c/p>\n\u003cp>The sticking point appears to be the duration of the contract. Both sides say that they reached agreement on rates for a two-year contract, but Stanford seeks a three-year contract. Because no agreement has been reached on the third year, and because Stanford did not extend its current contract, no contract is in force.\u003c!--more-->\u003c/p>\n\u003cp>James Larkin, spokesman for Stanford, said patients should not worry. \"While our contract did expire last night,\" Larkin said in an email, \"I want to reiterate that Stanford Health Care will continue to welcome Anthem members and honor Anthem¹s in-network co-payment amounts for all of our services and care.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But Larkin would not say whether Stanford would pick up the costs that had been covered by Anthem.\u003c/p>\n\u003cp>Darrel Ng, spokesman for Anthem, said that Anthem patients are potentially responsible for chargemaster rates -- essentially the list price, usually multiples higher than what insurers pay to providers. While Stanford may not charge those high prices, Ng said that if there were later a billing dispute, \"patients would have to hire their own lawyers to advocate on their behalf.\"\u003c/p>\n\u003cp>CalPERS, the California Public Employees' Retirement System, was critical of Stanford's move. In a statement, Ann Boynton, a deputy executive director, said:\u003c/p>\n\u003cblockquote>\u003cp>\"We are deeply disappointed\u003cspan class=\"Apple-style-span\" style=\"color: #000000\">\u003cspan class=\"Apple-style-span\"> with Stanford Hospital's refusal to agree to reasonable terms that allow our members access to Stanford Hospital's services. Anthem Blue Cross and Stanford Hospital agreed to terms for a 2-year contract and we urge Stanford to sign this agreement. Improving the affordability of health care is critical to all Californians and every part of the delivery system must do its part. Stanford Hospital must become part of this effort.\"\u003c/span>\u003c/span>\u003c/p>\u003c/blockquote>\n\u003cp>\u003cstrong>Use of KQED PriceCheck Data\u003c/strong>\u003c/p>\n\u003cp>On Friday, \u003ca title=\"Stanford Set to Terminate Anthem Blue Cross Contract\" href=\"http://ww2.kqed.org/stateofhealth/2014/09/05/stanford-health-care-terminates-anthem-blue-cross-contract/\" target=\"_blank\">Anthem made public a letter \u003c/a>from its president, Mark Morgan, to the president of Stanford Health Care, Amir Dan Rubin. In the letter Morgan acknowledged that Stanford “does provide excellent care,” but he also noted that Stanford is “one of the most expensive hospitals in the state.”\u003c/p>\n\u003cp>Morgan went on to cite specific\u003ca title=\"Stanford Terminates Contract with Anthem Blue Cross\" href=\"http://ww2.kqed.org/stateofhealth/2014/09/05/stanford-health-care-terminates-anthem-blue-cross-contract/\" target=\"_blank\"> \u003c/a>data about Stanford's costs using KQED \u003ca title=\"PriceCheck\" href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">PriceCheck, a health costs transparency tool\u003c/a> launched in June.\u003c/p>\n\u003cp>From Morgan's letter:\u003c/p>\n\u003cblockquote>\u003cp>According to KQED’s Price Check tool, a lower back MRI (72158 MRI-Lower back/lumbar spine w/ and w/o contrast) cost $5,647 at Stanford, which is nearly eight times what an imaging center in nearby San Jose charges at $724.\u003c/p>\u003c/blockquote>\n\u003cp>Contracts between insurers and providers are typically sealed. So while Anthem certainly has information about Stanford's costs in comparison to other providers, it cannot publicize them without violating its own contracts.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But there is no such bar around \u003ca title=\"PriceCheck\" href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">PriceCheck\u003c/a>, which gives patients an easy way to upload their true costs, including what their insurers paid, to the database. \"The market seems to react when these prices are brought to light,\" Ng said.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/21313/stanford-terminates-anthems-contract-anthem-uses-kqed-data-to-cite-stanfords-cost","authors":["240"],"categories":["stateofhealth_11"],"tags":["stateofhealth_116","stateofhealth_28","stateofhealth_841"],"featImg":"stateofhealth_17341","label":"stateofhealth"},"stateofhealth_21285":{"type":"posts","id":"stateofhealth_21285","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"21285","score":null,"sort":[1409985773000]},"guestAuthors":[],"slug":"stanford-health-care-terminates-anthem-blue-cross-contract","title":"Stanford Health Care Terminates Anthem Blue Cross Contract","publishDate":1409985773,"format":"aside","headTitle":"Price Check | State of Health | KQED News","labelTerm":{"term":2492,"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_21288\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://commons.wikimedia.org/wiki/File:Stanford_Medical_Center.JPG\">\u003cimg class=\"size-large wp-image-21288\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/09/Stanford_Medical_Center-640x470.jpg\" alt=\"As many as 10,000 patients may be affected by Stanford Health Care's termination of its contract with Anthem Blue Cross. (Robert Skolmen/Wikimedia Commons)\" width=\"640\" height=\"470\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">As many as 10,000 patients may be affected by Stanford Health Care's termination of its contract with Anthem Blue Cross. (Robert Skolmen/Wikimedia Commons)\u003c/figcaption>\u003c/figure>\n\u003cp>Stanford Hospital and Clinics -- now known as Stanford Health Care -- is ending its contract with Anthem Blue Cross effective Sunday night at midnight. The move could affect 10,000 patients.\u003c/p>\n\u003cp>According to both Stanford and Anthem spokespersons the two sides had reached agreement on a two-year contract. But Stanford seeks a third year; Anthem does not. The two parties could not come to terms as of Friday, so there is no new contract.\u003c/p>\n\u003cp>Stanford said the current contract ends Sunday, and since they do not have a deal for a new contract, they opted to terminate.\u003c/p>\n\u003cp>But, Anthem sees the termination of the contract as unnecessary. \"Nothing compels (Stanford) to terminate on Sunday night,\" said Anthem spokesman Darrel Ng.\u003c!--more-->\u003c/p>\n\u003cp>In a letter sent Friday to Stanford Health Care president Amir Dan Rubin, Anthem's president Mark Morgan wrote:\u003c/p>\n\u003cblockquote>\u003cp>\"I respectfully request that Stanford Health Care rescind its contract termination so that our members can have uninterrupted care. We have already agreed on terms for the next two years, and it would be unfortunate to subject our members to any disruption in their care during prolonged negotiations.\"\u003c/p>\u003c/blockquote>\n\u003cp>Morgan also wrote that if Stanford moves forward with termination of its contract, \"Anthem members will be liable for chargemaster rates.\" Chargemaster rates are essentially the list price, usually multiples higher than what insurers pay to providers.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Stanford spokesman James Larkin insisted there would \"be no impact on Anthem's patients\" treated at Stanford, and that Anthem patients would continue to pay in-network rates.\u003c/p>\n\u003cp>While Morgan acknowledged that Stanford \"does provide excellent care,\" he also noted that Stanford is \"one of the most expensive hospitals in the state.\"\u003c/p>\n\u003cp>In his letter, Morgan cited data from KQED's \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">PriceCheck project\u003c/a> where patients can share health care costs they have paid and that their insurers have paid. Morgan noted:\u003c/p>\n\u003cblockquote>\u003cp>According to KQED's Price Check tool, a lower back MRI (72158 MRI-Lower back/lumbar spine w/ and w/o contrast) cost $5,647 at Stanford, which is nearly eight times what an imaging center in nearby San Jose charges at $724.\u003c/p>\u003c/blockquote>\n\u003cp>Indeed, there is an entry in PriceCheck for a $5,647 lower back MRI at Stanford. This appears to be the chargemaster price, as the person who uploaded the information noted that the rate paid by the insurer (in this case, Aetna) was $2925.15. Here's a screenshot of the entry:\u003c/p>\n\u003cfigure id=\"attachment_21291\" class=\"wp-caption aligncenter\" style=\"max-width: 483px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/09/Screen-Shot-2014-09-05-at-11.36.52-PM.png\">\u003cimg class=\"size-full wp-image-21291\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/09/Screen-Shot-2014-09-05-at-11.36.52-PM.png\" alt=\"A screenshot of a consumer's price charged for a lower back MRI at Stanford, from KQED's PriceCheck project. \" width=\"483\" height=\"235\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/09/Screen-Shot-2014-09-05-at-11.36.52-PM.png 483w, https://ww2.kqed.org/app/uploads/sites/27/2014/09/Screen-Shot-2014-09-05-at-11.36.52-PM-400x195.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/09/Screen-Shot-2014-09-05-at-11.36.52-PM-320x156.png 320w\" sizes=\"(max-width: 483px) 100vw, 483px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A screenshot of a consumer's price charged for a lower back MRI at Stanford, from KQED's PriceCheck project.\u003c/figcaption>\u003c/figure>\n\u003cp>It's unclear if the termination will truly come to pass. \"This will almost certainly be resolved by Sunday,\" Larkin told the \u003ca href=\"http://www.mercurynews.com/health/ci_26477782/health-insurance-spat-surfaces-between-anthem-and-stanford\" target=\"_blank\">San Jose Mercury News\u003c/a>.\u003c/p>\n\u003cp>Long and fraught negotiations between major hospitals and giant insurance companies are common. Stanford terminated its contract with Anthem \u003ca href=\"http://www.paloaltoonline.com/news/2011/09/02/stanford-hospitals-terminate-blue-cross-coverage\" target=\"_blank\">in 2011\u003c/a>, and Larkin told State of Health that Stanford was \"three months out of contract\" with significant disruptions to patients at that time.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Lucille Packard Children's Hospital is not affected. Anthem and Stanford Health Care had previously reached agreement on a two-year deal.\u003c/p>\n\n","blocks":[],"excerpt":"The termination takes effect Sunday at midnight; 10,000 patients are potentially affected.","status":"publish","parent":0,"modified":1410221480,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":17,"wordCount":540},"headData":{"title":"Stanford Health Care Terminates Anthem Blue Cross Contract | KQED","description":"The termination takes effect Sunday at midnight; 10,000 patients are potentially affected.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Stanford Health Care Terminates Anthem Blue Cross Contract","datePublished":"2014-09-06T06:42:53.000Z","dateModified":"2014-09-09T00:11:20.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"21285 http://blogs.kqed.org/stateofhealth/?p=21285","disqusUrl":"https://ww2.kqed.org/stateofhealth/2014/09/05/stanford-health-care-terminates-anthem-blue-cross-contract/","disqusTitle":"Stanford Health Care Terminates Anthem Blue Cross Contract","path":"/stateofhealth/21285/stanford-health-care-terminates-anthem-blue-cross-contract","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_21288\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://commons.wikimedia.org/wiki/File:Stanford_Medical_Center.JPG\">\u003cimg class=\"size-large wp-image-21288\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/09/Stanford_Medical_Center-640x470.jpg\" alt=\"As many as 10,000 patients may be affected by Stanford Health Care's termination of its contract with Anthem Blue Cross. (Robert Skolmen/Wikimedia Commons)\" width=\"640\" height=\"470\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">As many as 10,000 patients may be affected by Stanford Health Care's termination of its contract with Anthem Blue Cross. (Robert Skolmen/Wikimedia Commons)\u003c/figcaption>\u003c/figure>\n\u003cp>Stanford Hospital and Clinics -- now known as Stanford Health Care -- is ending its contract with Anthem Blue Cross effective Sunday night at midnight. The move could affect 10,000 patients.\u003c/p>\n\u003cp>According to both Stanford and Anthem spokespersons the two sides had reached agreement on a two-year contract. But Stanford seeks a third year; Anthem does not. The two parties could not come to terms as of Friday, so there is no new contract.\u003c/p>\n\u003cp>Stanford said the current contract ends Sunday, and since they do not have a deal for a new contract, they opted to terminate.\u003c/p>\n\u003cp>But, Anthem sees the termination of the contract as unnecessary. \"Nothing compels (Stanford) to terminate on Sunday night,\" said Anthem spokesman Darrel Ng.\u003c!--more-->\u003c/p>\n\u003cp>In a letter sent Friday to Stanford Health Care president Amir Dan Rubin, Anthem's president Mark Morgan wrote:\u003c/p>\n\u003cblockquote>\u003cp>\"I respectfully request that Stanford Health Care rescind its contract termination so that our members can have uninterrupted care. We have already agreed on terms for the next two years, and it would be unfortunate to subject our members to any disruption in their care during prolonged negotiations.\"\u003c/p>\u003c/blockquote>\n\u003cp>Morgan also wrote that if Stanford moves forward with termination of its contract, \"Anthem members will be liable for chargemaster rates.\" Chargemaster rates are essentially the list price, usually multiples higher than what insurers pay to providers.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Stanford spokesman James Larkin insisted there would \"be no impact on Anthem's patients\" treated at Stanford, and that Anthem patients would continue to pay in-network rates.\u003c/p>\n\u003cp>While Morgan acknowledged that Stanford \"does provide excellent care,\" he also noted that Stanford is \"one of the most expensive hospitals in the state.\"\u003c/p>\n\u003cp>In his letter, Morgan cited data from KQED's \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">PriceCheck project\u003c/a> where patients can share health care costs they have paid and that their insurers have paid. Morgan noted:\u003c/p>\n\u003cblockquote>\u003cp>According to KQED's Price Check tool, a lower back MRI (72158 MRI-Lower back/lumbar spine w/ and w/o contrast) cost $5,647 at Stanford, which is nearly eight times what an imaging center in nearby San Jose charges at $724.\u003c/p>\u003c/blockquote>\n\u003cp>Indeed, there is an entry in PriceCheck for a $5,647 lower back MRI at Stanford. This appears to be the chargemaster price, as the person who uploaded the information noted that the rate paid by the insurer (in this case, Aetna) was $2925.15. Here's a screenshot of the entry:\u003c/p>\n\u003cfigure id=\"attachment_21291\" class=\"wp-caption aligncenter\" style=\"max-width: 483px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/09/Screen-Shot-2014-09-05-at-11.36.52-PM.png\">\u003cimg class=\"size-full wp-image-21291\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/09/Screen-Shot-2014-09-05-at-11.36.52-PM.png\" alt=\"A screenshot of a consumer's price charged for a lower back MRI at Stanford, from KQED's PriceCheck project. \" width=\"483\" height=\"235\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/09/Screen-Shot-2014-09-05-at-11.36.52-PM.png 483w, https://ww2.kqed.org/app/uploads/sites/27/2014/09/Screen-Shot-2014-09-05-at-11.36.52-PM-400x195.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/09/Screen-Shot-2014-09-05-at-11.36.52-PM-320x156.png 320w\" sizes=\"(max-width: 483px) 100vw, 483px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A screenshot of a consumer's price charged for a lower back MRI at Stanford, from KQED's PriceCheck project.\u003c/figcaption>\u003c/figure>\n\u003cp>It's unclear if the termination will truly come to pass. \"This will almost certainly be resolved by Sunday,\" Larkin told the \u003ca href=\"http://www.mercurynews.com/health/ci_26477782/health-insurance-spat-surfaces-between-anthem-and-stanford\" target=\"_blank\">San Jose Mercury News\u003c/a>.\u003c/p>\n\u003cp>Long and fraught negotiations between major hospitals and giant insurance companies are common. Stanford terminated its contract with Anthem \u003ca href=\"http://www.paloaltoonline.com/news/2011/09/02/stanford-hospitals-terminate-blue-cross-coverage\" target=\"_blank\">in 2011\u003c/a>, and Larkin told State of Health that Stanford was \"three months out of contract\" with significant disruptions to patients at that time.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Lucille Packard Children's Hospital is not affected. Anthem and Stanford Health Care had previously reached agreement on a two-year deal.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/21285/stanford-health-care-terminates-anthem-blue-cross-contract","authors":["240"],"series":["stateofhealth_2492"],"categories":["stateofhealth_11"],"tags":["stateofhealth_116","stateofhealth_28","stateofhealth_841"],"featImg":"stateofhealth_21288","label":"stateofhealth_2492"},"stateofhealth_20994":{"type":"posts","id":"stateofhealth_20994","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"20994","score":null,"sort":[1408979656000]},"guestAuthors":[],"slug":"iud-costs-vary-by-600-in-bay-area-what-did-you-pay","title":"IUD Costs Vary by $600 in Bay Area; What Did You Pay?","publishDate":1408979656,"format":"aside","headTitle":"Price Check | State of Health | KQED News","labelTerm":{"term":2492,"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_15557\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/MD001975.jpg\">\u003cimg class=\"size-large wp-image-15557\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/MD001975-640x640.jpg\" alt=\"Intrauterine devices are one of the most effective forms of birth control, but are relatively underutilized, at least in the United States. (Spike Mafford/Getty Images)\" width=\"640\" height=\"640\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Intrauterine devices are one of the most effective forms of birth control. (Spike Mafford/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>If you're one of the 62 million American women of \u003ca href=\"www.guttmacher.org/pubs/fb_contr_use.html#9\" target=\"_blank\">childbearing age\u003c/a>, we have a question for you: How much do you pay for birth control? Did you know you might be able to save perhaps hundreds of dollars on your contraceptive method, just by asking? Let's back up. We've reached the halfway point in our PriceCheck project.\u003c/p>\n\u003cp>We're shining a light on notoriously opaque and highly variable health care costs. We're asking you, the members of our community, to share what you've paid for common procedures including \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/11/pricecheck-what-insurance-companies-are-paying-for-mammograms/\" target=\"_blank\">mammograms\u003c/a> and \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/24/pricecheck-how-much-does-a-back-mri-cost/\" target=\"_blank\">back MRIs\u003c/a>. We found that both screening mammograms and back MRIs could vary in price ten-fold. Now we're moving on to a new health care service: IUDs.\u003c/p>\n\u003cp>We're asking you to share what you paid for your IUD. The two most widely-used IUDs are Mirena (a hormonally-based IUD) and ParaGard (a non-hormonal product). Both are more than 99 percent effective in preventing pregnancy. Our PriceCheck partner, ClearHealthCosts.com, has surveyed health care providers and lists cash prices for these IUDs in our \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">PriceCheck database\u003c/a>.\u003c!--more--> [contextly_sidebar id=\"psJwnuCzaS7EPHqra7NYt7I2Omxunr8o\"]\u003c/p>\n\u003cp>We've already found that if you're not insured and are paying out-of-pocket for an IUD, these cash prices in the Bay Area range from about $600 to about $1,200. But we also know that what insurers pay for health care tests and treatments varies widely. We're asking you to share what your insurer paid -- and what your copay was.\u003c/p>\n\u003cp>Right about now you might be thinking that IUDs are supposed to be covered at no copay under rules established by the Affordable Care Act. Isn't that right?\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>That would be both yes -- and no.\u003c/p>\n\u003cp>Yes, the Affordable Care Act mandates coverage of birth contraceptive methods for all women. On \u003ca href=\"https://www.healthcare.gov/what-are-my-birth-control-benefits/\" target=\"_blank\">healthcare.gov\u003c/a>, it says that plans on the health insurance marketplace, which would include Covered California, \"must cover the services without charging a copayment, coinsurance, or deductible when they are provided by an in-network provider.\"\u003c/p>\n\u003cp>Yet, just 1.4 million of California's 38 million residents are insured through Covered California. While other people with private insurance should get the same benefit, it won't be true for everyone. That's because many people are in so-called \"grandfathered\" plans -- plans that have been around since before the ACA was signed into law in March, 2010, and so do not have to follow all the regulations required by the ACA. You've also probably heard of the \u003ca href=\"http://www.npr.org/blogs/health/2014/06/30/327065968/hobby-lobby-ruling-cuts-into-contraceptive-mandate\" target=\"_blank\">Hobby Lobby\u003c/a> case allowing some businesses to file a religious objection to providing contraceptives. Some religious nonprofits may also be exempt.\u003c/p>\n\u003caside class=\"pullquote alignright\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/series/price-check/\" target=\"_blank\">Read more stories \u003c/a>on health care cost variation from our PriceCheck project.\u003c/aside>\n\u003cp>In addition, \u003ca href=\"http://www.plannedparenthood.org/about-us/newsroom/the-affordable-care-act\" target=\"_blank\">some plans cover some, but not all\u003c/a>, of all the FDA-approved contraceptive services. If you want to know what specific methods are covered under your plan, you call call the member services number on the back of your insurance card.\u003c/p>\n\u003cp>The National Women's Law Center \u003ca href=\"http://www.nwlc.org/resource/how-find-out-if-your-health-plan-covering-women%E2%80%99s-preventive-services-no-co-pay-required-he\" target=\"_blank\">provides this extremely helpful phone guide\u003c/a> for you to use, to help make sure you're getting all the answers you need. ClearHealthCosts \u003ca href=\"http://clearhealthcosts.com/blog/2014/07/much-iud-cost-covered-one-patient-paid-2-24-another-730/\" target=\"_blank\">details some early submissions\u003c/a> we've already received from women who shared the cost of their IUD. Despite having insurance, one woman paid the entire $730 cost of her IUD because she had not yet met her deductible.Another woman was charged $2.24, but will also have to pay $197 for the six-week follow up appointment. A third woman says the entire cost of her IUD was paid by insurance.\u003c/p>\n\u003cp>The more women who shared what they paid, the more it helps other women be informed consumers. We invite you to share what you paid. It’s helpful if you have your “explanation of benefits” from your insurance company (\u003ca style=\"font-weight: bold;color: #114999\" href=\"http://ww2.kqed.org/stateofhealth/2014/07/18/explaining-the-health-insurance-explanation-of-benefits/\" target=\"_blank\">Find out more about EOBs here\u003c/a>.) Then \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">visit PriceCheck\u003c/a> and share.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Help us make health costs transparent in California!\u003c/p>\n\n","blocks":[],"excerpt":"While Obamacare mandates no-cost birth control, that's not the case for everyone.","status":"publish","parent":0,"modified":1411774993,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":14,"wordCount":684},"headData":{"title":"IUD Costs Vary by $600 in Bay Area; What Did You Pay? | KQED","description":"While Obamacare mandates no-cost birth control, that's not the case for everyone.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"IUD Costs Vary by $600 in Bay Area; What Did You Pay?","datePublished":"2014-08-25T15:14:16.000Z","dateModified":"2014-09-26T23:43:13.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"20994 http://blogs.kqed.org/stateofhealth/?p=20994","disqusUrl":"https://ww2.kqed.org/stateofhealth/2014/08/25/iud-costs-vary-by-600-in-bay-area-what-did-you-pay/","disqusTitle":"IUD Costs Vary by $600 in Bay Area; What Did You Pay?","path":"/stateofhealth/20994/iud-costs-vary-by-600-in-bay-area-what-did-you-pay","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_15557\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/MD001975.jpg\">\u003cimg class=\"size-large wp-image-15557\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/MD001975-640x640.jpg\" alt=\"Intrauterine devices are one of the most effective forms of birth control, but are relatively underutilized, at least in the United States. (Spike Mafford/Getty Images)\" width=\"640\" height=\"640\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Intrauterine devices are one of the most effective forms of birth control. (Spike Mafford/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>If you're one of the 62 million American women of \u003ca href=\"www.guttmacher.org/pubs/fb_contr_use.html#9\" target=\"_blank\">childbearing age\u003c/a>, we have a question for you: How much do you pay for birth control? Did you know you might be able to save perhaps hundreds of dollars on your contraceptive method, just by asking? Let's back up. We've reached the halfway point in our PriceCheck project.\u003c/p>\n\u003cp>We're shining a light on notoriously opaque and highly variable health care costs. We're asking you, the members of our community, to share what you've paid for common procedures including \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/11/pricecheck-what-insurance-companies-are-paying-for-mammograms/\" target=\"_blank\">mammograms\u003c/a> and \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/24/pricecheck-how-much-does-a-back-mri-cost/\" target=\"_blank\">back MRIs\u003c/a>. We found that both screening mammograms and back MRIs could vary in price ten-fold. Now we're moving on to a new health care service: IUDs.\u003c/p>\n\u003cp>We're asking you to share what you paid for your IUD. The two most widely-used IUDs are Mirena (a hormonally-based IUD) and ParaGard (a non-hormonal product). Both are more than 99 percent effective in preventing pregnancy. Our PriceCheck partner, ClearHealthCosts.com, has surveyed health care providers and lists cash prices for these IUDs in our \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">PriceCheck database\u003c/a>.\u003c!--more--> \u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>We've already found that if you're not insured and are paying out-of-pocket for an IUD, these cash prices in the Bay Area range from about $600 to about $1,200. But we also know that what insurers pay for health care tests and treatments varies widely. We're asking you to share what your insurer paid -- and what your copay was.\u003c/p>\n\u003cp>Right about now you might be thinking that IUDs are supposed to be covered at no copay under rules established by the Affordable Care Act. Isn't that right?\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>That would be both yes -- and no.\u003c/p>\n\u003cp>Yes, the Affordable Care Act mandates coverage of birth contraceptive methods for all women. On \u003ca href=\"https://www.healthcare.gov/what-are-my-birth-control-benefits/\" target=\"_blank\">healthcare.gov\u003c/a>, it says that plans on the health insurance marketplace, which would include Covered California, \"must cover the services without charging a copayment, coinsurance, or deductible when they are provided by an in-network provider.\"\u003c/p>\n\u003cp>Yet, just 1.4 million of California's 38 million residents are insured through Covered California. While other people with private insurance should get the same benefit, it won't be true for everyone. That's because many people are in so-called \"grandfathered\" plans -- plans that have been around since before the ACA was signed into law in March, 2010, and so do not have to follow all the regulations required by the ACA. You've also probably heard of the \u003ca href=\"http://www.npr.org/blogs/health/2014/06/30/327065968/hobby-lobby-ruling-cuts-into-contraceptive-mandate\" target=\"_blank\">Hobby Lobby\u003c/a> case allowing some businesses to file a religious objection to providing contraceptives. Some religious nonprofits may also be exempt.\u003c/p>\n\u003caside class=\"pullquote alignright\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/series/price-check/\" target=\"_blank\">Read more stories \u003c/a>on health care cost variation from our PriceCheck project.\u003c/aside>\n\u003cp>In addition, \u003ca href=\"http://www.plannedparenthood.org/about-us/newsroom/the-affordable-care-act\" target=\"_blank\">some plans cover some, but not all\u003c/a>, of all the FDA-approved contraceptive services. If you want to know what specific methods are covered under your plan, you call call the member services number on the back of your insurance card.\u003c/p>\n\u003cp>The National Women's Law Center \u003ca href=\"http://www.nwlc.org/resource/how-find-out-if-your-health-plan-covering-women%E2%80%99s-preventive-services-no-co-pay-required-he\" target=\"_blank\">provides this extremely helpful phone guide\u003c/a> for you to use, to help make sure you're getting all the answers you need. ClearHealthCosts \u003ca href=\"http://clearhealthcosts.com/blog/2014/07/much-iud-cost-covered-one-patient-paid-2-24-another-730/\" target=\"_blank\">details some early submissions\u003c/a> we've already received from women who shared the cost of their IUD. Despite having insurance, one woman paid the entire $730 cost of her IUD because she had not yet met her deductible.Another woman was charged $2.24, but will also have to pay $197 for the six-week follow up appointment. A third woman says the entire cost of her IUD was paid by insurance.\u003c/p>\n\u003cp>The more women who shared what they paid, the more it helps other women be informed consumers. We invite you to share what you paid. It’s helpful if you have your “explanation of benefits” from your insurance company (\u003ca style=\"font-weight: bold;color: #114999\" href=\"http://ww2.kqed.org/stateofhealth/2014/07/18/explaining-the-health-insurance-explanation-of-benefits/\" target=\"_blank\">Find out more about EOBs here\u003c/a>.) Then \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">visit PriceCheck\u003c/a> and share.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Help us make health costs transparent in California!\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/20994/iud-costs-vary-by-600-in-bay-area-what-did-you-pay","authors":["240"],"series":["stateofhealth_2492"],"categories":["stateofhealth_13"],"tags":["stateofhealth_625","stateofhealth_393","stateofhealth_841"],"featImg":"stateofhealth_15558","label":"stateofhealth_2492"},"stateofhealth_20549":{"type":"posts","id":"stateofhealth_20549","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"20549","score":null,"sort":[1407347638000]},"guestAuthors":[],"slug":"map-see-what-different-providers-charge-for-common-health-care-procedures","title":"Map: See What Different Providers Charge for Common Health Care Procedures","publishDate":1407347638,"format":"aside","headTitle":"Price Check | State of Health | KQED News","labelTerm":{"term":2492,"site":"stateofhealth"},"content":"\u003cp>Here's a truism: Health care costs are wildly variable and utterly confusing. That's why KQED joined forces with \u003ca href=\"http://www.scpr.org/\" target=\"_blank\">KPCC\u003c/a> and \u003ca href=\"http://clearhealthcosts.com\" target=\"_blank\">ClearHealthCosts.com\u003c/a> to \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/kqed-launches-project-to-help-make-health-costs-transparent/\" target=\"_blank\">launch PriceCheck\u003c/a>. For the last six weeks we've asked you to submit your costs for common procedures. To compare apples-to-apples, we asked how much your provider charged, how much your insurer paid and how much you paid for common procedures. And you've responded! \u003c/p>\n\u003cp>You've showed us that \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/01/pricecheck-how-much-for-a-back-mri-in-the-bay-area-255-or-3700/\" target=\"_blank\">back MRIs can cost\u003c/a> anywhere between $255 and $3,700 in the Bay Area. And that \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/kqed-launches-project-to-help-make-health-costs-transparent/\" target=\"_blank\">screening mammograms range\u003c/a> from $125 to $801.\u003c/p>\n\u003cp>We've also surveyed hundreds of providers for cash prices — also known as self-pay — throughout California. Now you can sort through our data below as well as \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">search on our site\u003c/a>. Please help us build our database by \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">submitting your health care costs\u003c/a>.\u003c/p>\n\u003cp>\u003ciframe src=\"//kqednews.cartodb.com/viz/160ba4aa-1c29-11e4-bb6c-0e10bcd91c2b/embed_map?title=false&description=false&search=false&shareable=true&cartodb_logo=true&layer_selector=false&legends=true&scrollwheel=true&fullscreen=true&sublayer_options=1&sql=&sw_lat=32.75956202565003&sw_lon=-125.22216796875&ne_lat=39.8000959563483&ne_lon=-114.45556640625\" width=\"100%\" height=\"520\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\">\u003c/iframe>\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>To see more providers in your area, zoom in on the map using the arrows or your mouse wheel. Hover over each dot to see the provider name and procedure. Click to find out how much was charged. This map will update once a day with new information.\u003c/p>\n\n","blocks":[],"excerpt":null,"status":"publish","parent":0,"modified":1409863896,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":true,"iframeSrcs":["//kqednews.cartodb.com/viz/160ba4aa-1c29-11e4-bb6c-0e10bcd91c2b/embed_map"],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":8,"wordCount":196},"headData":{"title":"Map: See What Different Providers Charge for Common Health Care Procedures | KQED","description":"Here's a truism: Health care costs are wildly variable and utterly confusing. That's why KQED joined forces with KPCC and ClearHealthCosts.com to launch PriceCheck. For the last six weeks we've asked you to submit your costs for common procedures. To compare apples-to-apples, we asked how much your provider charged, how much your insurer paid and","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Map: See What Different Providers Charge for Common Health Care Procedures","datePublished":"2014-08-06T17:53:58.000Z","dateModified":"2014-09-04T20:51:36.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"20549 http://blogs.kqed.org/stateofhealth/?p=20549","disqusUrl":"https://ww2.kqed.org/stateofhealth/2014/08/06/map-see-what-different-providers-charge-for-common-health-care-procedures/","disqusTitle":"Map: See What Different Providers Charge for Common Health Care Procedures","path":"/stateofhealth/20549/map-see-what-different-providers-charge-for-common-health-care-procedures","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Here's a truism: Health care costs are wildly variable and utterly confusing. That's why KQED joined forces with \u003ca href=\"http://www.scpr.org/\" target=\"_blank\">KPCC\u003c/a> and \u003ca href=\"http://clearhealthcosts.com\" target=\"_blank\">ClearHealthCosts.com\u003c/a> to \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/kqed-launches-project-to-help-make-health-costs-transparent/\" target=\"_blank\">launch PriceCheck\u003c/a>. For the last six weeks we've asked you to submit your costs for common procedures. To compare apples-to-apples, we asked how much your provider charged, how much your insurer paid and how much you paid for common procedures. And you've responded! \u003c/p>\n\u003cp>You've showed us that \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/01/pricecheck-how-much-for-a-back-mri-in-the-bay-area-255-or-3700/\" target=\"_blank\">back MRIs can cost\u003c/a> anywhere between $255 and $3,700 in the Bay Area. And that \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/kqed-launches-project-to-help-make-health-costs-transparent/\" target=\"_blank\">screening mammograms range\u003c/a> from $125 to $801.\u003c/p>\n\u003cp>We've also surveyed hundreds of providers for cash prices — also known as self-pay — throughout California. Now you can sort through our data below as well as \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">search on our site\u003c/a>. Please help us build our database by \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">submitting your health care costs\u003c/a>.\u003c/p>\n\u003cp>\u003ciframe src=\"//kqednews.cartodb.com/viz/160ba4aa-1c29-11e4-bb6c-0e10bcd91c2b/embed_map?title=false&description=false&search=false&shareable=true&cartodb_logo=true&layer_selector=false&legends=true&scrollwheel=true&fullscreen=true&sublayer_options=1&sql=&sw_lat=32.75956202565003&sw_lon=-125.22216796875&ne_lat=39.8000959563483&ne_lon=-114.45556640625\" width=\"100%\" height=\"520\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\">\u003c/iframe>\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>To see more providers in your area, zoom in on the map using the arrows or your mouse wheel. Hover over each dot to see the provider name and procedure. Click to find out how much was charged. This map will update once a day with new information.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/20549/map-see-what-different-providers-charge-for-common-health-care-procedures","authors":["199"],"series":["stateofhealth_2492"],"categories":["stateofhealth_14","stateofhealth_13"],"tags":["stateofhealth_482","stateofhealth_539","stateofhealth_841"],"featImg":"stateofhealth_20558","label":"stateofhealth_2492"},"stateofhealth_20251":{"type":"posts","id":"stateofhealth_20251","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"20251","score":null,"sort":[1405712328000]},"guestAuthors":[],"slug":"explaining-the-health-insurance-explanation-of-benefits","title":"Explaining the Health Insurance 'Explanation of Benefits'","publishDate":1405712328,"format":"aside","headTitle":"Price Check | State of Health | KQED News","labelTerm":{"term":2492,"site":"stateofhealth"},"content":"\u003cp>\u003cstrong>By Lynne Shallcross\u003c/strong>\u003c/p>\n\u003cp>We are wrapping up the first phase of our PriceCheck project. The goal is to \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/kqed-launches-project-to-help-make-health-costs-transparent/\" target=\"_blank\">shine a light \u003c/a>on costs of common health care procedures in California. We're starting with screening mammograms, and already we've found that the cash price (for people who are uninsured or have gone out of network) varies from a low of $60 at the H. Claude Hudson Comprehensive Health Center in Los Angeles, a county-run clinic, to $801 at U.C. San Francisco on the high end.\u003c/p>\n\u003cp>Together with\u003ca href=\"http://www.scpr.org/blogs/health\" target=\"_blank\"> KPCC\u003c/a> in Los Angeles and \u003ca href=\"http://clearhealthcosts.com\" target=\"_blank\">ClearHealthCosts.com\u003c/a>, we're also asking you, the members of our community, to \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">share what you've been charged\u003c/a> -- and what your provider has been paid -- for common health procedures.\u003c/p>\n\u003cp>In order to do that, you need to get familiar with your insurance company's \"explanation of benefits\" or EOB. That's the form your insurer sends to explain what was paid, to whom, at what level and why.\u003c/p>\n\u003cp>Here's a typical EOB, that we've marked with some explanations below:\u003c/p>\n\u003cfigure id=\"attachment_20256\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/EOB_2.jpg\">\u003cimg class=\"size-large wp-image-20256\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/EOB_2-640x800.jpg\" alt=\"An explanation of benefits from Anthem Blue Cross. \" width=\"640\" height=\"800\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">An explanation of benefits from Anthem Blue Cross.\u003c/figcaption>\u003c/figure>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>For help in decoding the EOB, we talked to Pat Palmer, founder and CEO of \u003ca href=\"http://billadvocates.com\" target=\"_blank\">Medical Billing Advocates of America\u003c/a>.\u003c/p>\n\u003cp>The information included on an EOB isn’t consistent from one health care insurance company to the next, Palmer says, and they often include abbreviations and other language difficult for the average consumer to understand.\u003c/p>\n\u003cp>We've numbered items above and here are the descriptions of each:\u003c/p>\n\u003cp>1. \"Paid Amount.\" This is the total amount of money that the insurance company has paid directly to the provider, Palmer says. Or, in an out-of-network situation, it may be paid to the member. If you scan farther across that line to the right, you’ll see who the insurance company paid; in this case, it’s Mills Hospital.\u003c/p>\n\u003cp>2. \"Total Billed.\" These are the amounts being billed to the insurance company by the provider for each service — in this case, $51.50 for mammography (likely what the physician was paid to interpret the mammogram, although it does not say) and $365.12 for the screening mammogram (likely the facility fee for the patient to have the mammogram done, although it does not say). The charges are then totaled below the line.\u003c/p>\n\u003cp>In addition to an EOB, individuals will usually receive an itemized bill from their provider(s). Palmer says it’s important to be sure the total billed amount on the EOB — in this case, $416.62 — matches the total billed amount on the itemized bill from the provider.\u003c/p>\n\u003cp>3. \"Patient Savings.\" This is the difference between what the provider charged for this service and the amount they agreed to accept as a participating provider of your health insurance plan. That's because when a doctor or other provider agrees to contract with an insurer, they agree to accept reimbursement at a lower price than the charged price. In American medicine, the amounts charged by providers generally bear little relation to what they are ultimately paid.\u003c/p>\n\u003cp>There should always be a code that identifies the reason for the savings, Palmer says. And although it’s a little hard to see, there is a “01” that follows each charge in this column — that “01” corresponds to the “detail message” in the box below. “It’s usually clearer than that,” Palmer says, adding that consumers reading this EOB may miss that little “01” mark after the charge. “It’s usually a separate column that says ‘remark’ or ‘reason,’ and they’ll put the ‘01’ in there.”\u003c/p>\n\u003cp>In this case, Palmer says the “01” remark indicates that the provider billed more than was allowed under their agreement with the insurer, and the individual is not responsible for the difference.\u003c/p>\n\u003cp>4. \"Applied to Deductible.\" Many health plans require members to pay out a certain amount of money, a “deductible,” before the insurance will begin paying, Palmer says. If the individual has not met the deductible and has to pay for these medical services, the amount that is being applied toward his or her deductible would be in this column. But the Affordable Care Act mandates that some services are provided outside the deductible, at no cost to patients. These services include some cancer screening tests, such as a mammogram. In this EOB, we see that the patient has no amount applied to deductible.\u003c/p>\n\u003cp>But even if the service is being applied to the deductible, Palmer says that the amount that goes in the “applied to deductible” column will be the lesser, agreed-upon amount — not the higher, original amount that the provider billed.\u003c/p>\n\u003cp>5. \"Coinsurance, Copayment Amount.\" This may vary depending on what health insurance you have. Sometimes, members must make a copay for an office visit, for example. That is a flat fee. Other services may require coinsurance, a percentage of the cost of the service. If the member on this EOB had been required to pay a copay or a coinsurance for the service, the amount would be listed here.\u003c/p>\n\u003cp>6.\"Claims Payment.\" The amounts in this column break down what the insurance company paid to the provider for each service, with a total at the bottom.\u003c/p>\n\u003cp>7. Palmer says this is an important part of this EOB. In this case, it’s the insurance company telling the member that it is not his or her responsibility to pay the difference in price between the agreed-upon charges for these services and the amount the provider billed. “It’s very easy to read this [as], ‘It is your responsibility to pay $104’ — somebody could misread it and think they owe $104.15,” Palmer says. “That word ‘not’ should be bold or stand out a lot more.” On some EOBs, Palmer says there is an additional line that says what the patient’s payment responsibility is; in this case, it would list it as $0.\u003c/p>\n\u003cp>But your EOB might look different from the example above. Or a mailed EOB may look different from what you see online. The above example is a mailed EOB from Anthem Blue Cross, a major health insurer in California. Below is an online EOB, which is also from Anthem Blue Cross, yet it looks quite different. (The numbers in the EOB below line up with the explanations we've provided.)\u003c/p>\n\u003cp>Numbers 1, 2, 4 and 5 line up with explanations we have provided. But there are no terms on this EOB that line up with 3, 6 and 7 above. Yes, we know this is confusing.\u003c/p>\n\u003cfigure id=\"attachment_20262\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/OnlineEOBrevised.jpg\">\u003cimg class=\"size-large wp-image-20262\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/OnlineEOBrevised-640x639.jpg\" alt=\"An Explanation of Benefits from Anthem Blue Cross, retrieved online.\" width=\"640\" height=\"639\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">An Explanation of Benefits from Anthem Blue Cross, retrieved online.\u003c/figcaption>\u003c/figure>\n\u003cp>Other things Palmer suggests paying attention to on an EOB:\u003c/p>\n\u003cp>• Look at the “provider of services” and “place of service,” listed on the first EOB in this post as “Mills Hospital” and “outpatient.” Palmer says insurance companies often pay a different rate depending on whether the service was provided in an inpatient setting, outpatient setting or a doctor’s office. “The insurance company is the one that wrote this up, and they may have miscoded the place of service,” Palmer says. “When they do, it will vary on how much your plan pays and how much you’re responsible for.”\u003c/p>\n\u003cp>• Look for a \u003ca href=\"http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt.page\" target=\"_blank\">CPT code\u003c/a> (Current Procedural Terminology). CPT codes were developed by the American Medical Association and identify the health care service provided. Palmer says that most times, insurance companies print either a “type of service” (as is listed on the first EOB) or a CPT code. And Palmer says having one, but not both, makes it a bit more difficult to determine if the provider is billing for the right services. Note that the online EOB above does list both a CPT code and a procedure code.\u003c/p>\n\u003cp>Palmer gives the example of a chest x-ray. If “type of service” is listed as chest x-ray, the individual can’t tell if the charge is for one view or three views, and the price will differ depending. Palmer says it’s often a good idea to call the insurance company to get the CPT code. If the CPT code is written on your EOB, instead of a description of service, Palmer says it’s easy to Google that code and see if it matches up with the service you received.\u003c/p>\n\u003caside class=\"pullquote alignright\">Learn more: \u003ca href=\"http://ww2.kqed.org/stateofhealth/series/price-check/\" target=\"_blank\">read all our PriceCheck coverage\u003c/a>. \u003c/aside>\n\u003cp>• Pay close attention to the message or comment box, Palmer says, and be sure you understand why a certain amount is not payable. If an insurance company says something is not payable, it could be a non-covered service that the individual is responsible for. Or, it could be a charge above what the provider and insurer agreed upon, meaning the individual does not have to pay. “Knowing that reason tells you whether you are responsible or not responsible for it,” Palmer says.\u003c/p>\n\u003cp>• Double-check the calculations on the EOB. Know the benefits that are part of your plan, Palmer says, and keep track of any payments you’ve made toward a deductible. Know where you are in your progress of meeting your deductible and when the insurance company is supposed to start paying.\u003c/p>\n\u003cp>If you scour your EOB and you do find an error, Palmer says you should determine who made the error -- the provider or the insurer -- and then follow up with them to correct the error.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Finding and correcting an error on an EOB may mean that you, as the individual member, aren’t overcharged, Palmer says. But it also may mean that the insurance company isn’t overcharged by the provider. While our natural instinct may not be to save a health insurance company some money, Palmer says that insurance companies will make profits regardless — so expensive errors only translate to higher premiums passed on to members down the road.\u003c/p>\n\n","blocks":[],"excerpt":"The \"explanation of benefits\" is provided by your insurance company to detail what it has paid to providers and what if your responsibility to pay.","status":"publish","parent":0,"modified":1409865426,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":32,"wordCount":1721},"headData":{"title":"Explaining the Health Insurance 'Explanation of Benefits' | KQED","description":"The "explanation of benefits" is provided by your insurance company to detail what it has paid to providers and what if your responsibility to pay.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Explaining the Health Insurance 'Explanation of Benefits'","datePublished":"2014-07-18T19:38:48.000Z","dateModified":"2014-09-04T21:17:06.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"20251 http://blogs.kqed.org/stateofhealth/?p=20251","disqusUrl":"https://ww2.kqed.org/stateofhealth/2014/07/18/explaining-the-health-insurance-explanation-of-benefits/","disqusTitle":"Explaining the Health Insurance 'Explanation of Benefits'","path":"/stateofhealth/20251/explaining-the-health-insurance-explanation-of-benefits","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>By Lynne Shallcross\u003c/strong>\u003c/p>\n\u003cp>We are wrapping up the first phase of our PriceCheck project. The goal is to \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/kqed-launches-project-to-help-make-health-costs-transparent/\" target=\"_blank\">shine a light \u003c/a>on costs of common health care procedures in California. We're starting with screening mammograms, and already we've found that the cash price (for people who are uninsured or have gone out of network) varies from a low of $60 at the H. Claude Hudson Comprehensive Health Center in Los Angeles, a county-run clinic, to $801 at U.C. San Francisco on the high end.\u003c/p>\n\u003cp>Together with\u003ca href=\"http://www.scpr.org/blogs/health\" target=\"_blank\"> KPCC\u003c/a> in Los Angeles and \u003ca href=\"http://clearhealthcosts.com\" target=\"_blank\">ClearHealthCosts.com\u003c/a>, we're also asking you, the members of our community, to \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">share what you've been charged\u003c/a> -- and what your provider has been paid -- for common health procedures.\u003c/p>\n\u003cp>In order to do that, you need to get familiar with your insurance company's \"explanation of benefits\" or EOB. That's the form your insurer sends to explain what was paid, to whom, at what level and why.\u003c/p>\n\u003cp>Here's a typical EOB, that we've marked with some explanations below:\u003c/p>\n\u003cfigure id=\"attachment_20256\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/EOB_2.jpg\">\u003cimg class=\"size-large wp-image-20256\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/EOB_2-640x800.jpg\" alt=\"An explanation of benefits from Anthem Blue Cross. \" width=\"640\" height=\"800\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">An explanation of benefits from Anthem Blue Cross.\u003c/figcaption>\u003c/figure>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>For help in decoding the EOB, we talked to Pat Palmer, founder and CEO of \u003ca href=\"http://billadvocates.com\" target=\"_blank\">Medical Billing Advocates of America\u003c/a>.\u003c/p>\n\u003cp>The information included on an EOB isn’t consistent from one health care insurance company to the next, Palmer says, and they often include abbreviations and other language difficult for the average consumer to understand.\u003c/p>\n\u003cp>We've numbered items above and here are the descriptions of each:\u003c/p>\n\u003cp>1. \"Paid Amount.\" This is the total amount of money that the insurance company has paid directly to the provider, Palmer says. Or, in an out-of-network situation, it may be paid to the member. If you scan farther across that line to the right, you’ll see who the insurance company paid; in this case, it’s Mills Hospital.\u003c/p>\n\u003cp>2. \"Total Billed.\" These are the amounts being billed to the insurance company by the provider for each service — in this case, $51.50 for mammography (likely what the physician was paid to interpret the mammogram, although it does not say) and $365.12 for the screening mammogram (likely the facility fee for the patient to have the mammogram done, although it does not say). The charges are then totaled below the line.\u003c/p>\n\u003cp>In addition to an EOB, individuals will usually receive an itemized bill from their provider(s). Palmer says it’s important to be sure the total billed amount on the EOB — in this case, $416.62 — matches the total billed amount on the itemized bill from the provider.\u003c/p>\n\u003cp>3. \"Patient Savings.\" This is the difference between what the provider charged for this service and the amount they agreed to accept as a participating provider of your health insurance plan. That's because when a doctor or other provider agrees to contract with an insurer, they agree to accept reimbursement at a lower price than the charged price. In American medicine, the amounts charged by providers generally bear little relation to what they are ultimately paid.\u003c/p>\n\u003cp>There should always be a code that identifies the reason for the savings, Palmer says. And although it’s a little hard to see, there is a “01” that follows each charge in this column — that “01” corresponds to the “detail message” in the box below. “It’s usually clearer than that,” Palmer says, adding that consumers reading this EOB may miss that little “01” mark after the charge. “It’s usually a separate column that says ‘remark’ or ‘reason,’ and they’ll put the ‘01’ in there.”\u003c/p>\n\u003cp>In this case, Palmer says the “01” remark indicates that the provider billed more than was allowed under their agreement with the insurer, and the individual is not responsible for the difference.\u003c/p>\n\u003cp>4. \"Applied to Deductible.\" Many health plans require members to pay out a certain amount of money, a “deductible,” before the insurance will begin paying, Palmer says. If the individual has not met the deductible and has to pay for these medical services, the amount that is being applied toward his or her deductible would be in this column. But the Affordable Care Act mandates that some services are provided outside the deductible, at no cost to patients. These services include some cancer screening tests, such as a mammogram. In this EOB, we see that the patient has no amount applied to deductible.\u003c/p>\n\u003cp>But even if the service is being applied to the deductible, Palmer says that the amount that goes in the “applied to deductible” column will be the lesser, agreed-upon amount — not the higher, original amount that the provider billed.\u003c/p>\n\u003cp>5. \"Coinsurance, Copayment Amount.\" This may vary depending on what health insurance you have. Sometimes, members must make a copay for an office visit, for example. That is a flat fee. Other services may require coinsurance, a percentage of the cost of the service. If the member on this EOB had been required to pay a copay or a coinsurance for the service, the amount would be listed here.\u003c/p>\n\u003cp>6.\"Claims Payment.\" The amounts in this column break down what the insurance company paid to the provider for each service, with a total at the bottom.\u003c/p>\n\u003cp>7. Palmer says this is an important part of this EOB. In this case, it’s the insurance company telling the member that it is not his or her responsibility to pay the difference in price between the agreed-upon charges for these services and the amount the provider billed. “It’s very easy to read this [as], ‘It is your responsibility to pay $104’ — somebody could misread it and think they owe $104.15,” Palmer says. “That word ‘not’ should be bold or stand out a lot more.” On some EOBs, Palmer says there is an additional line that says what the patient’s payment responsibility is; in this case, it would list it as $0.\u003c/p>\n\u003cp>But your EOB might look different from the example above. Or a mailed EOB may look different from what you see online. The above example is a mailed EOB from Anthem Blue Cross, a major health insurer in California. Below is an online EOB, which is also from Anthem Blue Cross, yet it looks quite different. (The numbers in the EOB below line up with the explanations we've provided.)\u003c/p>\n\u003cp>Numbers 1, 2, 4 and 5 line up with explanations we have provided. But there are no terms on this EOB that line up with 3, 6 and 7 above. Yes, we know this is confusing.\u003c/p>\n\u003cfigure id=\"attachment_20262\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/OnlineEOBrevised.jpg\">\u003cimg class=\"size-large wp-image-20262\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/OnlineEOBrevised-640x639.jpg\" alt=\"An Explanation of Benefits from Anthem Blue Cross, retrieved online.\" width=\"640\" height=\"639\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">An Explanation of Benefits from Anthem Blue Cross, retrieved online.\u003c/figcaption>\u003c/figure>\n\u003cp>Other things Palmer suggests paying attention to on an EOB:\u003c/p>\n\u003cp>• Look at the “provider of services” and “place of service,” listed on the first EOB in this post as “Mills Hospital” and “outpatient.” Palmer says insurance companies often pay a different rate depending on whether the service was provided in an inpatient setting, outpatient setting or a doctor’s office. “The insurance company is the one that wrote this up, and they may have miscoded the place of service,” Palmer says. “When they do, it will vary on how much your plan pays and how much you’re responsible for.”\u003c/p>\n\u003cp>• Look for a \u003ca href=\"http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt.page\" target=\"_blank\">CPT code\u003c/a> (Current Procedural Terminology). CPT codes were developed by the American Medical Association and identify the health care service provided. Palmer says that most times, insurance companies print either a “type of service” (as is listed on the first EOB) or a CPT code. And Palmer says having one, but not both, makes it a bit more difficult to determine if the provider is billing for the right services. Note that the online EOB above does list both a CPT code and a procedure code.\u003c/p>\n\u003cp>Palmer gives the example of a chest x-ray. If “type of service” is listed as chest x-ray, the individual can’t tell if the charge is for one view or three views, and the price will differ depending. Palmer says it’s often a good idea to call the insurance company to get the CPT code. If the CPT code is written on your EOB, instead of a description of service, Palmer says it’s easy to Google that code and see if it matches up with the service you received.\u003c/p>\n\u003caside class=\"pullquote alignright\">Learn more: \u003ca href=\"http://ww2.kqed.org/stateofhealth/series/price-check/\" target=\"_blank\">read all our PriceCheck coverage\u003c/a>. \u003c/aside>\n\u003cp>• Pay close attention to the message or comment box, Palmer says, and be sure you understand why a certain amount is not payable. If an insurance company says something is not payable, it could be a non-covered service that the individual is responsible for. Or, it could be a charge above what the provider and insurer agreed upon, meaning the individual does not have to pay. “Knowing that reason tells you whether you are responsible or not responsible for it,” Palmer says.\u003c/p>\n\u003cp>• Double-check the calculations on the EOB. Know the benefits that are part of your plan, Palmer says, and keep track of any payments you’ve made toward a deductible. Know where you are in your progress of meeting your deductible and when the insurance company is supposed to start paying.\u003c/p>\n\u003cp>If you scour your EOB and you do find an error, Palmer says you should determine who made the error -- the provider or the insurer -- and then follow up with them to correct the error.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Finding and correcting an error on an EOB may mean that you, as the individual member, aren’t overcharged, Palmer says. But it also may mean that the insurance company isn’t overcharged by the provider. While our natural instinct may not be to save a health insurance company some money, Palmer says that insurance companies will make profits regardless — so expensive errors only translate to higher premiums passed on to members down the road.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/20251/explaining-the-health-insurance-explanation-of-benefits","authors":["8344"],"series":["stateofhealth_2492"],"categories":["stateofhealth_13"],"tags":["stateofhealth_799","stateofhealth_28","stateofhealth_176","stateofhealth_841"],"featImg":"stateofhealth_20260","label":"stateofhealth_2492"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. 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You ask the questions. You decide what Bay Curious investigates. And you join us on the journey to find the answers.","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Bay-Curious-Podcast-Tile-703x703-1.jpg","imageAlt":"\"KQED Bay Curious","officialWebsiteLink":"/news/series/baycurious","meta":{"site":"news","source":"kqed","order":"4"},"link":"/podcasts/baycurious","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/bay-curious/id1172473406","npr":"https://www.npr.org/podcasts/500557090/bay-curious","rss":"https://ww2.kqed.org/news/category/bay-curious-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93dzIua3FlZC5vcmcvbmV3cy9jYXRlZ29yeS9iYXktY3VyaW91cy1wb2RjYXN0L2ZlZWQvcG9kY2FzdA","stitcher":"https://www.stitcher.com/podcast/kqed/bay-curious","spotify":"https://open.spotify.com/show/6O76IdmhixfijmhTZLIJ8k"}},"bbc-world-service":{"id":"bbc-world-service","title":"BBC World Service","info":"The day's top stories from BBC News compiled twice daily in the week, once at weekends.","airtime":"MON-FRI 9pm-10pm, TUE-FRI 1am-2am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/BBC-World-Service-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.bbc.co.uk/sounds/play/live:bbc_world_service","meta":{"site":"news","source":"BBC World Service"},"link":"/radio/program/bbc-world-service","subscribe":{"apple":"https://itunes.apple.com/us/podcast/global-news-podcast/id135067274?mt=2","tuneIn":"https://tunein.com/radio/BBC-World-Service-p455581/","rss":"https://podcasts.files.bbci.co.uk/p02nq0gn.rss"}},"code-switch-life-kit":{"id":"code-switch-life-kit","title":"Code Switch / Life Kit","info":"\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />","airtime":"SUN 9pm-10pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Code-Switch-Life-Kit-Podcast-Tile-360x360-1.jpg","meta":{"site":"radio","source":"npr"},"link":"/radio/program/code-switch-life-kit","subscribe":{"apple":"https://podcasts.apple.com/podcast/1112190608?mt=2&at=11l79Y&ct=nprdirectory","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubnByLm9yZy9yc3MvcG9kY2FzdC5waHA_aWQ9NTEwMzEy","spotify":"https://open.spotify.com/show/3bExJ9JQpkwNhoHvaIIuyV","rss":"https://feeds.npr.org/510312/podcast.xml"}},"commonwealth-club":{"id":"commonwealth-club","title":"Commonwealth Club of California Podcast","info":"The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.","airtime":"THU 10pm, FRI 1am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.commonwealthclub.org/podcasts","meta":{"site":"news","source":"Commonwealth Club of California"},"link":"/radio/program/commonwealth-club","subscribe":{"apple":"https://itunes.apple.com/us/podcast/commonwealth-club-of-california-podcast/id976334034?mt=2","google":"https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw","tuneIn":"https://tunein.com/radio/Commonwealth-Club-of-California-p1060/"}},"considerthis":{"id":"considerthis","title":"Consider This","tagline":"Make sense of the day","info":"Make sense of the day. Every weekday afternoon, Consider This helps you consider the major stories of the day in less than 15 minutes, featuring the reporting and storytelling resources of NPR. Plus, KQED’s Bianca Taylor brings you the local KQED news you need to know.","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Consider-This-Podcast-Tile-703x703-1.jpg","imageAlt":"Consider This from NPR and KQED","officialWebsiteLink":"/podcasts/considerthis","meta":{"site":"news","source":"kqed","order":"7"},"link":"/podcasts/considerthis","subscribe":{"apple":"https://podcasts.apple.com/podcast/id1503226625?mt=2&at=11l79Y&ct=nprdirectory","npr":"https://rpb3r.app.goo.gl/coronavirusdaily","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM1NS9wb2RjYXN0LnhtbA","spotify":"https://open.spotify.com/show/3Z6JdCS2d0eFEpXHKI6WqH"}},"forum":{"id":"forum","title":"Forum","tagline":"The conversation starts here","info":"KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.","airtime":"MON-FRI 9am-11am, 10pm-11pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg","imageAlt":"KQED Forum with Mina Kim and Alexis Madrigal","officialWebsiteLink":"/forum","meta":{"site":"news","source":"kqed","order":"8"},"link":"/forum","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/kqeds-forum/id73329719","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz","npr":"https://www.npr.org/podcasts/432307980/forum","stitcher":"https://www.stitcher.com/podcast/kqedfm-kqeds-forum-podcast","rss":"https://feeds.megaphone.fm/KQINC9557381633"}},"freakonomics-radio":{"id":"freakonomics-radio","title":"Freakonomics Radio","info":"Freakonomics Radio is a one-hour award-winning podcast and public-radio project hosted by Stephen Dubner, with co-author Steve Levitt as a regular guest. 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You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg","imageAlt":"KQED MindShift: How We Will Learn","officialWebsiteLink":"/mindshift/","meta":{"site":"news","source":"kqed","order":"2"},"link":"/podcasts/mindshift","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/mindshift-podcast/id1078765985","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5","npr":"https://www.npr.org/podcasts/464615685/mind-shift-podcast","stitcher":"https://www.stitcher.com/podcast/kqed/stories-teachers-share","spotify":"https://open.spotify.com/show/0MxSpNYZKNprFLCl7eEtyx"}},"morning-edition":{"id":"morning-edition","title":"Morning Edition","info":"\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. 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