Consumers Union researcher needs help grading health price estimators

Doris Peter says her own medical bills have been close to what the price tools predicted. (Photo: iStock)
Doris Peter says her own medical bills have been close to what the price tools predicted. (Photo: iStock)

Doris Peter needs help.

The Consumer Reports researcher has set up many health-related rating programs for the Yonkers, New York-based publication. Recently, she worked on an effort to grade a total of 16 New York state health care cost estimator tools, including 11 tools posted by insurers and five by stand-alone companies.

Her team also graded stand-alone health care cost estimation websites. Peter’s team looked at factors such as how easy the tools were to use and whether the tools gave users with health coverage an idea of what their out-of-pocket costs might be.

Related: 3 reasons health care costs are still a mystery

The team could not grade how well the price estimates matched what patients actually paid for care.

To measure the accuracy of the price estimates, Peter needs hundreds, or maybe thousands, of people to look for health care cost estimates online, get care, and then show members of her team copies of the original cost estimates, along with copies of the actual medical bills.

“We’ve definitely thought about it,” Peter said. “The hard part of is finding people.”

When Consumer Reporters has organized similar mystery shopper projects in the past, it’s had to pay as stipends of as much as $100 per shopper. 

“Just to get a handful of people was a chore,” Peter said.

Only five of 40 consumers Consumer Reporters brought in just to test cost estimator tool usability had even tried using a cost estimator tool before.

Peter said she’d be thrilled if broker, large employer or other entity could help Consumer Reports find mystery health care shoppers who would show it their care cost estimates and their actual bills.

Cost estimator limitations

Health insurers and independent companies have been offering cost estimator tools for more than a decade.

For the tool developers, one major obstacle as been patient resistance. Some patients have high-deductible health plans, and a strong incentive to shop for affordable care. But a majority of patients still have coverage that minimizes their out-of-pocket costs, and reduces their interest in shopping for care based on price.

Patients have no practical way to shop for some types of care, such as emergency care for a heart attack.

When patients do shop for anything beyond routine office visits, they may know too little about all of the services they will need to look for each service separately. They may simply look for an in-network specialist and in-network hospital and hope for the best.

Even when patients care about cost and do use the tools, they may have trouble getting realistic cost estimates. Some tools give only the providers’ full, sky-high fees, not the much lower fees the providers have agreed to charge health plans.

Some providers, and especially those with cash only or concierge practices do post price lists.

The Wedge of Freedom, a St. Paul, Minnesota-based organization, offers a directory of providers who try to avoid seeking reimbursement from Medicare, Medicaid or private insurers. The providers ask many of their patients to file the claims for reimbursement themselves. Some of those providers do post their prices. Most of those practices ask patients to pay a flat annual fee for access to preventive care and routine primary care, rather than asking the patients to pay separate fees for each service used.

But patients seeking care under managed care plans from providers with conventional practices are usually billed on a fee-for-service basis. Even if an online cost estimator gives the correct price of a specific service a patient will be getting, such as a basic office visit, the estimators might not reflect the complete bundle of services a provider will bill for.

Peter said she tested cost estimators by comparing their estimates with the cost of her own medical care. Her care cost about what the estimators had predicted.

She has met other people who have reported big conflicts between the predictions and the actual costs, but she has not had access to those patients’ bills. 

Related:

On the Third Hand: Prices

Taking advantage of health care transparency trends

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