WHYY’s PriceCheck — Frequently asked questions

Q: What is this project?

A: Glad you asked. We’d like you to share your health care prices to help build this community-created guide to prices. Pulse host Maiken Scott walks you through it in this video.

Q: What data do I supply?   My wife had a colonoscopy. There were bills from the gastroenterologist, the facility, the anesthesiologist and the lab.  Should I add all of these together as the “total cost” of the procedure?  Or just  what the gastroenterologist charged?

A: We are most interested in the “all-in” price, just as you probably are.

So if you choose the procedure that most closely matches what she had, and use the total prices charged, paid by insurance and paid by you, then specify a breakdown of other charges in the notes, that would be the best way for us to build a useful data set.

Our partners at Clearhealthcosts.com, who collected the colonoscopy costs in our database, try in every case to get that “all-in” price, for a cash or self-pay patient, though it’s not always available in advance.

Sometimes the individual charges you experience are also remarkable ($1,500 for anesthesia? $2,000 for a facility fee? come on!) so if the notes capture that, it’s awesome.

If you’re not sure we want it, here’s your answer: yes, we want it. Detail is good!

Q: The procedure descriptions are confusing. There are a lot of things named “colonoscopy” on this list. Which one am I supposed to pick?

A: Look on your bill and see if you can find a five-digit code like 77057 or an alphanumeric code like G0202. That’s the closest description used in the medical system to standardize procedure identification. For more about the numbers, here’s a blog post from our partner, Clearhealthcosts.com.

Not every bill has these same codes on it; some have only verbal descriptions.

If you can get a code, that’s good, but if not, use the closest verbal description in our widget – once you start typing, it will give you some suggestions from which to choose.

Q: I want to put in something that’s not on the list. Why can’t I?

A: We’re working to make a database of good, comparable information for the 8,400 major current procedural terminology (CPT) codes used commonly in the medical billing system.

If we had a freeform data field, then that would allow you to put in “hairy toenails” or “I hate my mother-in-law” or anything else you wanted to input. Our database would then be lacking.

So we made a “share” form that has only 8,400 options. Please choose the closest one.

But! If you have something that’s not on the list, use the directions below to tell us about it! We are eager to learn!

Q: My provider is not in this database. Or: I am a provider and I am not in this database. What gives?

A: The provider list comes from Google, and we are aware that it has some faults in it. But the Google Places API that we are using is free, so we can’t go ask for our money back.

Also in fact, many of the provider lists are out of date in health care – there are a lot of mergers and acquisitions and so on.

Generally here are the data points.

Provider (as specific as possible, with address, city, zip, phone, website)
Name of procedure
CPT or HCPCS code
Cash or self-pay price charged
(If you’re sending in personal information, not practice information, tell us what insurance paid and what you paid)
Comments
Email address

Email to pricecheck@whyy.org with “Pricecheck data share” in the subject line.

You can go to this page and download our spreadsheet template and send it on in if you have lots of prices to share.

Q: I tried to enter my information, but it didn’t seem to work.

A: On the first point: if you would feel comfortable in sharing via email, here are the data points: If you return this to us, we’ll put it in for you!

Provider (as specific as possible, with address, city, zip, phone, website)
Name of procedure
CPT or HCPCS code
Cash or self-pay price charged
(If you’re sending in personal information, not practice information, tell us what insurance paid and what you paid)
Comments
Email address

On the second point, here’s how we like to hear reports of malfunctions: Bug (mandatory) or feature (optional)?(bug is if it doesn’t work, feature is if I wish it would do something that was not in our design, like search by insurance company or by provider, instead of procedure)

What it does—be as explicit as possible.
What you would like it to do–be as explicit as possible.
Tell us what device, operating system, browser–be explicit (MacBook Air, OS X 10.6.8, Chrome build 40.0.2214.93 64-bit or iPhone 5S, IOS 7, Safari).
Pictures are great, so if you can attach screenshots, documents and so on, that’s ideal. Arrows are helpful.
Email to info@clearhealthcosts.com with “PriceCheck bug report” in subject line.
Email to pricecheck@whyy.org with “PriceCheck bug report” in subject line.

Q: What I had does not show up in your list.

A: Please pick the closest thing you can find. If you have other questions, email us at pricecheck@whyy.org.

Q: What prices are you interested in? I have a whole bunch of bills.

A: We are interested in all prices.

We’re focusing early in our project on mammograms, colonoscopies and MRI’s, but we built the software to let you tell us what you’re interested in.

We’ll be expanding our reporting depending on what we learn and what you tell us you’re interested in.

Q: What about quality? My provider is better than anybody else.

A: We believe you. But there should be some better way than you telling us they’re great.

Quality measurements for health care providers, hospitals, surgical centers and so on are a hot topic.

Everybody’s got a favorite source (Yelp? healthgrades.com? AHRQ? Leapfrog? Consumer Reports? U.S. News and World Report? HEDIS? HCAHPS? your insurance company’s quality rankings? Your Facebook friends?) but the bottom line seems to be this: There’s a cacophony of competing sources of measurement, none of them definitive or over-arching. So we were interested to see this recent study revealing the outcome of the latest government effort to resolve the problem, as described by Alexandra Robbins in The Atlantic.

The Department of Health and Human Services is wrestling with this, and to hear Robbins tell it, they labored mightily and brought forth a mouse. If you have a favorite quality supplier, please tell us — and tell us why they are better than others.

From where we sit, there’s not much that is really actionable by individuals, or accepted and embraced by the clinician world.

Price without quality is incomplete. In our view, bringing price out of the shadows speeds a thoughtful quality discussion: What makes that $6,000 MRI so much better than the $300 one?

Q: Why would anyone care about a cash or self-pay price? Now that insurance is extended to many – if not all – under the Affordable Care Act, isn’t everybody paying a slight copay or co-insurance, so the cash price matters not a bit to anyone?

A: First, not everyone is insured. And not all providers are in network.Also, with rising deductibles and rising coinsurance, much more of the price is being paid by insured people.

Also, if you’re responsible for co-insurance of, say, 20 percent on a procedure, you might want to know if you’re paying 20 percent of $300 or 20 percent of $6,000.

We’ve heard of people on a high-deductible plan who routinely ask to pay the cash rate instead of the negotiated rate. Here’s one example: One person who responded to our California PriceCheck survey wrote: “I was told procedure would be 1850. I have a 7500 deductaible[sic]. So I talked to the office mgr who said if I paid upfront and agreed not to report the procedure to Blue Cross, that it would be $580.”

Of course, if you haven’t met your deductible, you may be paying full freight, even perhaps the chargemaster price. That’s right: insured people are paying the chargemaster price. Some of them might prefer to pay a lower, cash or self-pay rate. Here’s a blog post about that.

We heard of one insurance company whose online pricing tool explains the coinsurance for simple procedures: an MRI, for example, in our New York City backyard could cost $42.50 in coinsurance, or $253. Since coinsurance is 10 percent, that also reveals the reimbursement rate by the insurance company. Here’s a blog post about that.

There are a number of reasons that people might be interested in the cash or self-pay price, including the question of whether their insurance premiums are giving them access to the highest rate, rather than the lowest, until they have met their deductible.

Q: Has anybody ever done this before?

A: In reporting on this issue, we journalists from Clearhealthcosts.com have already partnered with public radio stations in San Francisco, Los Angeles and New York City  to build community-created databases of prices, and to do in-depth reporting on this issue. Click the links for examples.

Also, here’s some of the coverage of the California partnership, including links to our Harvard Business Review/New England Journal of Medicine coverage, and our JAMA Internal Medicine coverage, as well as NPR and other coverage.

We have  collected cash or self-pay prices at Clearhealthcosts.com via a direct provider survey for several years. On the front page of our website, you can see links to our price lists of 30-35 common, “shoppable” procedures in the New York area; we also have pricing from seven other metro areas, which you can access via the search box at the top of the front page.

That search tool also gives you the Medicare reimbursement rate for any one of the 8,400 procedures in the government’s Medicare reimbursement data set, in any U.S. locale.

Q: O.K., I’m in. What did you want me to do again?

A: To contribute to or search our PriceCheck database, click here to go to the page displaying the form for entering and searching the data.

Our project page, collecting all our coverage, is on this page.

If you have lots of prices to contribute, you can download our handy spreadsheet on this page.

Q: I have a suggestion/question/comment that you didn’t address here.

Put it in the interactive form, or email to pricecheck@whyy.org, or info@clearhealthcosts.com.

Do you have other questions? Email us at pricecheck@whyy.org, or info@clearhealthcosts.com,or call us at  (267) 225-7299.