Provide names of other journalists involved.
Writer: Matthew Brady Other journalists involved: Kristy Broering, Sue Wiltz, Gretchen Becker, Michael Schroeder and John Nalley
List date(s) this work was published or aired.
1-Oct-12
Provide a brief synopsis of the story or stories, including any significant findings.
The health care system often withholds the tools consumers need to make smart decisions before deciding who to see and what health care to buy. Insurance companies quietly negotiate various rates with health providers, with both groups resistant to divulging prices for proprietary reasons and because they aren’t the same for all consumers. As we reported the story, we were surprised to learn one California hospital bills $182,955 for an uncomplicated appendectomy, while another billed $1,529. In Maine, one hospital charges $4,041 for a colonoscopy; another, $1,483. However, with high-deductible insurance plans gaining a stronger foothold among all plans — increasing from 10 to 23 percent in seven years — more consumers stuck with out-of-pocket charges are demanding to know costs of health care upfront. Through consumer anecdotes, we explore how patients can save money, from making sure which hospital is in network prior to an emergency to using online pricing tools, fighting medical bill errors and negotiating unfair costs.
Explain types of documents, data or Internet resources used. Were FOI or public records act requests required? How did this affect the work?
Our online poll revealed that while 91 percent of Angie’s List members say it’s somewhat or very important to determine costs before a procedure or treatment, only 12 percent had used an online price comparison tool to shop for health care. Forty-nine percent of respondents also don’t think providers are good about communicating costs unless consumers are proactive about requesting them. The details revealed consumers want to shop around for health care, but may not be sure how to go about it, and the reason for our story. To provide background on why consumers are paying more out of pocket, we used data regarding high-deductible and traditional insurance plans from the nonprofit Employee Benefit Research Institute in Washington, D.C. We also got more on insurance plans from The Kaiser Family Foundation and Health Research & Educational Trust. We wanted to specifically look at health care prices, so we used a variety of online pricing tools offered by several states; Healthcare Blue Book, which provided us with low, fair and high prices for procedures; and looked at studies examining health care costs. We used websites like Healthcare.gov to look at how the Affordable Care Act affects out-of-network emergency room services. To confirm that hospital providers are limited from asking too many details about a patient’s insurance coverage, we looked at the federal law from the Department of Health and Human Services. We also read the New York State Department of Finance March 2012 report titled, “How New Yorkers Are Getting Stuck with Unexpected Medical Bills from Out-of-Network Providers,” which details an investigation of 2,000 consumer complaints in that state. One of our members also sent us copies of her medical bills showing us where the billing errors occurred. Although we used many public documents, none required a formal request.
Explain types of human sources used.
We found patients who were fed up with the high cost of health care and who took the extra steps to find ways to reduce their costs. For example, we spoke to Augie Hong in San Francisco, who got an out-of-network bill for $60,000. After taking his case to the hospital CEO, he ended up paying only $6,000 out of pocket. Another consumer, Candice Butcher of Salem, Va., took her son to an in-network hospital, but the physician’s assistant he saw was out-of-network. She appealed to the ER physician’s group, which cut the bill 30 percent. And Clara, a member in Colorado, hired three billing and medical advocates, who found $150,000 in errors and overcharges on her son’s medical bills. To round out the reporting, we spoke to representatives from these hospitals. We also interviewed doctors, billing advocates, insurance companies, researchers who look at medical costs and pricing transparency experts.
Results:
After our story published, we heard from numerous consumers and doctors. Dr. John I. Allen, a gastroenterologist in Plymouth, Minn., thanked us and said: “Price and quality transparency in medicine is long overdue. …On our website, we provide a link to the business office and this leads to a ‘Request a Price Quote.’ There you can find our current price list.” Angie’s List member Elana Ellcessor of Centennial, Colo., wrote to applaud us for addressing the issue, and told us how she questioned her dentist about the cost of pulling two teeth for her son. “The fact I asked them about it got them to drop the examination fee,” she says. “I told them I was never coming back.”
Follow-up (if any). Have you run a correction or clarification on the report or has anyone come forward to challenge its accuracy? If so, please explain.
We have not run any corrections or clarifications, and no one has challenged the story’s accuracy.
Advice to other journalists planning a similar story or project.
Finding consumers willing to speak to us about their medical expenses proved to be difficult. We contacted many Angie’s List members who had submitted negative reviews about their medical billing experiences, but ultimately many were pleased with their medical care and declined to comment. To find consumer sources, we recommend talking to medical and billing advocates (and give them plenty of notice) requesting to speak with one of their clients. With any health care story you do, ask consumers to look at their bill (or even send you their medical bill) so you can give a clear picture of what a procedure or treatment costs. Also, ask health care providers about costs of treatments and procedures. If a physician can’t provide the information, ask if there’s someone in his or her office who can. We also recommend giving yourself several months to tackle the project, interviewing as many sources as possible so that you have a clear understanding of pricing transparency in health care.