This has long been one of the hot-button questions in health care. What should my medical care cost? Here’s the problem: there’s never been enough transparency in pricing to allow us consumers the sort of master price list we so rightfully deserve.
In 2013, for the very first time, the federal government issued a price comparison guide that showed the cost for 100 common procedures at 3,000 different U.S. hospitals in 2011. The amount actually paid by The Center for Medicare and Medicaid (CMS) was also included. It was a start. But what did it really tell us? It showed that the numbers are all over the place – even for hospitals in close vicinity – and that there’s still a very long way to go in achieving any sort of consistency.
So what can we do? For starters, ditch that wait-and-see approach. At Cypress, we keep a close watch on the CMS allowable amounts and compare them to the charges our clients are billed by procedure. Being proactive is paying off. Here’s an example: we had a claim come through requesting nearly $22,000 for the technical portion of an emergency appendectomy. Our team knew this seemed exorbitantly high and consulted those numbers from The CMS to find that the allowable amount for this same procedure was just $3,093.05. That meant the hospital was attempting to collect more than seven times what The CMS deemed fit. We stepped in and saved our client over $15,000.
I’m not sure about you, but I don’t buy much without budgeting first. It only seems right that we should have some idea of the pricing to expect when we undergo medical treatment.
Lucent Health combines best-in-the-industry claims management with a compassionate, human-focused, data-driven care management solution. Find out more about Lucent Health and our approach to care management. Contact us today.