Continuing on to the discussion on the deeply complex U.S. healthcare system from our previous post, here is a list of tools that can offer some clarity and guidance when navigating the convoluted landscape of American healthcare.
Please note that these tools are a compilation of options gathered through personal research and readings intended to supplement your knowledge. This compilation is by no means exhaustive, and the information provided should be treated as a reference point or for personal use only.
The email and letter templates provided here serve as a guidepost to enhance the understanding of navigating this complex healthcare system. Feel free to utilize the information in this post as needed and modify it according to your requirements.
Healthcare Procedure Tools
- Healthcare Bluebook – This is a prominent resource for medical pricing. By collecting data from various sources such as patients, doctors, and hospitals, it calculates a “fair price” for different procedures based on location. It provides insights into how this “fair price” is determined, including the inclusion of doctor fees. Keep in mind that the quoted price from Healthcare Bluebook is not a guarantee, but it can be a useful tool for negotiation with hospitals or insurance providers. I have personally found this site helpful.
- ClearHealthCosts – This platform uses crowdsourcing to gather information on medical procedure prices. As it relies on self-reporting, the data may be fragmentary. However, it still serves as a valuable research resource. Some of the blog posts on this platform offer detailed information and make for an interesting read.
- Fair Health – A nonprofit organization that utilizes a database of insurance claims to provide an overview of physician charges for different medical procedures. Similar to Healthcare Bluebook, Fair Health’s pricing is based on zip codes. Keep in mind that if all your doctors charge inflated rates for a procedure, Fair Health’s quotes may reflect those high prices.
- Care Guide Advocates – Formerly known as Pratter, Prices Matter, this website focuses on finding cash prices for procedures based on your location. Please note that the website may have undergone changes since it was taken over by Care Guide Advocates.
- Medibid – If you have a High Deductible Health Plan (HDHP) and are likely to pay for a procedure out of pocket, Medibid can be a valuable resource. It functions as a marketplace where you can request a procedure, and doctors offer competitive prices.
Prescription Drug Tools
- GoodRx – This is one of the most commonly used platforms to search for cash prices of drugs in the area.
- PharmacyChecker – This platform connects patients to overseas mail-order pharmacies that have been vetted for quality. It can be a useful resource for patients interested in importing medicines.
Vetting For Hospitals
- NYT Hospital Pricing – A quick and straightforward tool to help assess the pricing of hospitals (area specific) for different procedures. It provides information on Medicare hospital payments for various procedures, allowing to compare how much hospitals typically bill patients compared to the Medicare rate.
- The Leapfrog Group – This voluntary program for hospitals offers insights into a variety of quality issues and enables you to evaluate how your hospital performs. Not all hospitals participate in this program, which raises questions about those that choose not to.
- Hospital Compare – Recently launched by Medicare, this website allows consumers to examine various measures of hospital quality.
Are These Tests Really Necessary?
Here are some resources to help determine whether certain tests are truly necessary:
- US Preventive Services Task Force
- Choosing Wisely
- Cochrane
Sample Letters for Unethical Practices:
- For a Surprise Out-of-Network Bill:
Dear Sir/Madam,
I am writing to address the enclosed bills for out-of-network services that were provided during my admission to _______ Medical Center, a hospital that is within my insurance network. It is important to note that I specifically chose _______ Medical Center because it falls within my network coverage. Regrettably, I was not informed about the out-of-network status of the providers involved and did not provide consent to be treated by any out-of-network providers.
Given that I did not give informed consent for treatment beyond the terms and network of my insurance policy, I kindly request that you contact my insurer to resolve the payment matter. I am willing to pay only the portion of the bill that I would have been responsible for had the services been provided in-network.
I urge you to cease any further attempts to collect payment for a bill that I am not obligated to pay due to the lack of prior notification regarding the out-of-network status. Should I receive any additional notices or attempts to collect this bill, I will not hesitate to report this collection effort to the ________ State Department of Insurance and _______ State Department of Consumer Affairs.
Thank you for your attention to this matter.
Sincerely,
2. To Obtain Medical Records and Itemized Bills:
Dear Sir/Madam,
I am writing to express my concerns regarding the repeated requests I have made for my medical records and itemized bill, which I have yet to receive. As a patient, it is my right to obtain these records in any form I request under the Health Insurance Portability and Accountability Act (HIPAA) within a reasonable timeframe of thirty days, and I am willing to pay a reasonable handling and processing fee for this service.
I kindly request your immediate attention to this matter and ask that you promptly provide me with the requested medical records and itemized bill. Failure to do so would leave me with no choice but to file a complaint with the federal Health and Human Services’ Office for Civil Rights, which investigates and prosecutes HIPAA violations.
Thank you for your prompt action in resolving this issue.
Sincerely,
3. To Question Ridiculous Billing Charges
Dear Sir/Madam,
I am writing to express my strong objection to the excessive charges for the procedure I underwent at _____ facility. The total amount billed to my insurer/me is $___, which includes several itemized charges that significantly exceed the norms for our nation and our region. For instance, I was billed $___ for___, $____for____, and $____ for ____ . According to the Healthcare Bluebook, a “fair price” for these services is $____ and $____. Additionally, my bill includes charges for treatments that I did not receive, such as $ for ____ and $___ for ____.
Before making any payment, I kindly request that your billing and coding department thoroughly review my medical chart to revise the charges accordingly or provide a detailed explanation for the size and nature of these entries. As a loyal customer of your hospital for many years, I have always appreciated the excellent care I have received. However, if these billing issues are not promptly addressed and resolved, I will be compelled to report them to the state attorney general or the consumer protection agency to investigate possible fraudulent or abusive practices.
I trust that you will take my concerns seriously and take immediate action to rectify this matter. I look forward to a swift resolution and a fair and accurate billing statement.
Thank you for your attention to this issue.
Sincerely,