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But that estimate may be too low — it’s probably closer to 65 percent as suggested in a \u003ca href=\"http://ajph.aphapublications.org/doi/full/10.2105/AJPH.2015.302997\" target=\"_blank\">separate national study\u003c/a>, according to Kominski.\u003c/p>\n\u003cp>In California, Medicare and Medi-Cal alone account for roughly 47 percent of health care expenditures.\u003c/p>\n\u003cp>“In California we’ve had a much larger Medi-Cal expansion than anyone expected,” he said, noting that almost one-third of the state’s population is covered by the health program for low-income people.\u003c/p>\n\u003cp>Researchers were surprised, however, to see how big a role was played by county health programs that often serve indigent populations — $10 billion, or nearly 3 percent of the state’s total health care spending.\u003c/p>\n\u003cp>The UCLA researchers counted a “hidden” public expenditure that other federal studies do not: tax subsidies for employer-based health insurance, Kominski added. That makes up another 12 percent of the state’s health care spending, the data shows.\u003c/p>\n\u003cp>Before the Affordable Care Act took effect, it was true that the health care system in California was mostly private, Kominski said.\u003c/p>\n\u003cp>Maribeth Shannon, a director at the California Health Care Foundation, agreed that the ACA greatly accelerated the shift. (California Healthline is an editorially independent publication of the California Health Care Foundation.)\u003c/p>\n\u003cp>It used to be that most Americans were covered by their employer. Today, far fewer are, Shannon said.\u003c/p>\n\u003cp>“It’s a combination of things,” she said. “After the ACA you now have more generous eligibility guidelines for public programs. You also have the factor of an aging population.”\u003c/p>\n\u003cp>A growing national population of people over 65 will mean higher health care costs.\u003c/p>\n\u003cp>People 65 and older are generally covered by Medicare.\u003c/p>\n\u003cp>Because of this new dominance of public spending in health care, the researchers concluded that a single-payer health care system is more feasible than previously believed.\u003c/p>\n\u003cp>“For a majority of Californians, a public-run system is already the reality,” said Andrea Sorensen, a graduate student at the UCLA Fielding School of Public Health, who co-authored the study.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"http://khn.org/\" target=\"_blank\">Kaiser Health News\u003c/a>, which publishes \u003ca href=\"http://www.californiahealthline.org/\" target=\"_blank\">California Healthline\u003c/a>, a service of the \u003ca href=\"http://www.chcf.org/\" target=\"_blank\">California Health Care Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n","disqusIdentifier":"232275 http://ww2.kqed.org/stateofhealth/?p=232275","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/09/02/taxpayers-foot-70-percent-of-californias-health-care-tab-study-finds/","stats":{"hasVideo":false,"hasChartOrMap":false,"hasAudio":false,"hasPolis":false,"wordCount":613,"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"iframeSrcs":[],"paragraphCount":21},"modified":1472843290,"excerpt":"Because of a massive expansion of Medi-Cal, funding for California's health care system has shifted from mostly private to taxpayer funded.","headData":{"twImgId":"","twTitle":"","ogTitle":"","ogImgId":"","twDescription":"","description":"Because of a massive expansion of Medi-Cal, funding for California's health care system has shifted from mostly private to taxpayer funded.","title":"Taxpayers Foot 70 Percent Of California’s Health Care Tab, Study Finds | KQED","ogDescription":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Taxpayers Foot 70 Percent Of California’s Health Care Tab, Study Finds","datePublished":"2016-09-02T12:08:10-07:00","dateModified":"2016-09-02T12:08:10-07:00","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"guestAuthors":[],"slug":"taxpayers-foot-70-percent-of-californias-health-care-tab-study-finds","status":"publish","nprByline":"\u003cstrong>\u003ca href=\"http://khn.org/news/author/ana-b-ibarra/\">Ana B. Ibarra\u003c/a>\u003cbr>\u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>\u003c/strong>","path":"/stateofhealth/232275/taxpayers-foot-70-percent-of-californias-health-care-tab-study-finds","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>This year, taxpayers will cover about 70 percent of what is spent on health care in California, according to \u003ca href=\"http://healthpolicy.ucla.edu/publications/search/pages/detail.aspx?PubID=1547\" target=\"_blank\">a new analysis\u003c/a> released Wednesday by the UCLA Center for Health Policy Research.\u003c/p>\n\u003cp>Many people assume that the U.S. health care system is primarily supported by private dollars, such as insurance premiums from employer-based coverage, said Gerald Kominski, director of the UCLA Center for Health Policy Research and the study’s lead author.\u003c/p>\n\u003cp>But that’s no longer the case, at least in California — mostly because of its massive expansion of Medi-Cal, the state’s version of Medicaid, he said.\u003c/p>\n\u003cp>“There’s this myth that we have a mostly privately funded health care system, but we’re approaching a point in which almost three quarters of this system is funded by public money,” Kominski said. “Now a question to ask ourselves is: when do we reach the tipping point and say ‘this is essentially a public system?’”\u003c/p>\n\u003cp>Of $367 billion estimated to be spent on health care in the state in 2016, $260 billion will be from taxpayer money, according to the research.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Nationwide, public funds paid for about 45 percent of the country’s $3 trillion in health care expenditures in 2014 through public insurance programs such as Medicaid, Medicare and programs for low-income children, according to federal data. But that estimate may be too low — it’s probably closer to 65 percent as suggested in a \u003ca href=\"http://ajph.aphapublications.org/doi/full/10.2105/AJPH.2015.302997\" target=\"_blank\">separate national study\u003c/a>, according to Kominski.\u003c/p>\n\u003cp>In California, Medicare and Medi-Cal alone account for roughly 47 percent of health care expenditures.\u003c/p>\n\u003cp>“In California we’ve had a much larger Medi-Cal expansion than anyone expected,” he said, noting that almost one-third of the state’s population is covered by the health program for low-income people.\u003c/p>\n\u003cp>Researchers were surprised, however, to see how big a role was played by county health programs that often serve indigent populations — $10 billion, or nearly 3 percent of the state’s total health care spending.\u003c/p>\n\u003cp>The UCLA researchers counted a “hidden” public expenditure that other federal studies do not: tax subsidies for employer-based health insurance, Kominski added. That makes up another 12 percent of the state’s health care spending, the data shows.\u003c/p>\n\u003cp>Before the Affordable Care Act took effect, it was true that the health care system in California was mostly private, Kominski said.\u003c/p>\n\u003cp>Maribeth Shannon, a director at the California Health Care Foundation, agreed that the ACA greatly accelerated the shift. (California Healthline is an editorially independent publication of the California Health Care Foundation.)\u003c/p>\n\u003cp>It used to be that most Americans were covered by their employer. Today, far fewer are, Shannon said.\u003c/p>\n\u003cp>“It’s a combination of things,” she said. “After the ACA you now have more generous eligibility guidelines for public programs. You also have the factor of an aging population.”\u003c/p>\n\u003cp>A growing national population of people over 65 will mean higher health care costs.\u003c/p>\n\u003cp>People 65 and older are generally covered by Medicare.\u003c/p>\n\u003cp>Because of this new dominance of public spending in health care, the researchers concluded that a single-payer health care system is more feasible than previously believed.\u003c/p>\n\u003cp>“For a majority of Californians, a public-run system is already the reality,” said Andrea Sorensen, a graduate student at the UCLA Fielding School of Public Health, who co-authored the study.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"http://khn.org/\" target=\"_blank\">Kaiser Health News\u003c/a>, which publishes \u003ca href=\"http://www.californiahealthline.org/\" target=\"_blank\">California Healthline\u003c/a>, a service of the \u003ca href=\"http://www.chcf.org/\" target=\"_blank\">California Health Care Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/232275/taxpayers-foot-70-percent-of-californias-health-care-tab-study-finds","authors":["byline_stateofhealth_232275"],"series":["stateofhealth_2492"],"categories":["stateofhealth_1"],"tags":["stateofhealth_2808","stateofhealth_2519"],"featImg":"stateofhealth_232276","label":"stateofhealth_2492"},"stateofhealth_231161":{"type":"posts","id":"stateofhealth_231161","meta":{"index":"posts_1716263798","site":"stateofhealth","id":"231161","score":null,"sort":[1472668310000]},"parent":0,"labelTerm":{"site":"stateofhealth","term":2492},"blocks":[],"publishDate":1472668310,"format":"standard","disqusTitle":"Update: Lawmakers Pass Measure to End Surprise Out-of-Network Medical Bills","title":"Update: Lawmakers Pass Measure to End Surprise Out-of-Network Medical Bills","headTitle":"Price Check | State of Health | KQED News","content":"\u003cp>\u003cstrong>Update, 5:00 p.m., Wednesday Aug. 31:\u003c/strong>\u003cbr>\nThe California Assembly passed AB 72 late this afternoon. The bill heads next to Gov. Jerry Brown’s desk. It passed by a huge margin with bipartisan support, unlike a similar bill last year which stalled by three votes on the last day of the 2015 legislative session.\u003c/p>\n\u003cp>\u003cstrong>Original Post:\u003c/strong>\u003cbr>\nWhen Nancy Randle prepared for the birth of her third child, she was careful to play by the health insurance rules: She got referrals and went to her insurer's recommended hospital.\u003c/p>\n\u003cp>What she didn’t know was that some doctors, like the one who did a hearing test on her baby, were out of network. She didn’t think to ask. After she came home, she got a surprise bill for that test: $250.\u003c/p>\n\u003cp>\"I didn’t even realize this was a loophole or that it would affect me,\" Randle said.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/280779549\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>The loophole occurs when out-of-network doctors -- anesthesiologists, radiologists and others -- provide care at a patient's in-network hospital or clinic, but charge their out-of-network fees.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>To address the issue, a bipartisan group of state legislators introduced AB 72 to put a stop to surprise, out-of-network bills for non-emergency services. Assemblymember Rob Bonta (D-Alameda) is one of the bill's six co-authors.\u003c/p>\n\u003cp>\"This bill will be the first of its kind in terms of strength of consumer protections, and it will be a model for the rest of the nation,\" Bonta said.\u003c/p>\n\u003cp>If signed into law, patients who go to in-network health facilities will pay in-network prices. Insurance companies would compensate out-of-network doctors for treatment, either at the average procedure rate for the region or at 125 percent of what Medicare pays, whichever is greatest.\u003c/p>\n\u003cp>Bill opposition comes from groups representing doctors, like the Association of American Physicians and Surgeons. Dr. Jane Orient is the executive director.\u003c/p>\n\u003cp>\"The quality of care will go down, and patients will have fewer choices,\" Orient said.\u003c/p>\n\u003cp>She says doctors won’t be compensated at the rate they need to keep their practices running.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>A similar bill failed on the final day of last year’s legislative session, but AB 72 looks like it will see a different outcome, given revisions to last year’s text and wider-ranging support.\u003c/p>\n\n","disqusIdentifier":"231161 http://ww2.kqed.org/stateofhealth/?p=231161","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/08/31/lawmakers-take-up-measure-to-end-surprise-out-of-network-medical-bills/","stats":{"hasVideo":false,"hasChartOrMap":false,"hasAudio":false,"hasPolis":false,"wordCount":431,"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"iframeSrcs":[],"paragraphCount":15},"modified":1472688848,"excerpt":"The Assembly passed AB 72 by a wide margin and with bipartisan support late Wednesday afternoon.","headData":{"twImgId":"","twTitle":"","ogTitle":"","ogImgId":"","twDescription":"","description":"The Assembly passed AB 72 by a wide margin and with bipartisan support late Wednesday afternoon.","title":"Update: Lawmakers Pass Measure to End Surprise Out-of-Network Medical Bills | KQED","ogDescription":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Update: Lawmakers Pass Measure to End Surprise Out-of-Network Medical Bills","datePublished":"2016-08-31T11:31:50-07:00","dateModified":"2016-08-31T17:14:08-07:00","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"guestAuthors":[],"slug":"lawmakers-take-up-measure-to-end-surprise-out-of-network-medical-bills","status":"publish","path":"/stateofhealth/231161/lawmakers-take-up-measure-to-end-surprise-out-of-network-medical-bills","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>Update, 5:00 p.m., Wednesday Aug. 31:\u003c/strong>\u003cbr>\nThe California Assembly passed AB 72 late this afternoon. The bill heads next to Gov. Jerry Brown’s desk. It passed by a huge margin with bipartisan support, unlike a similar bill last year which stalled by three votes on the last day of the 2015 legislative session.\u003c/p>\n\u003cp>\u003cstrong>Original Post:\u003c/strong>\u003cbr>\nWhen Nancy Randle prepared for the birth of her third child, she was careful to play by the health insurance rules: She got referrals and went to her insurer's recommended hospital.\u003c/p>\n\u003cp>What she didn’t know was that some doctors, like the one who did a hearing test on her baby, were out of network. She didn’t think to ask. After she came home, she got a surprise bill for that test: $250.\u003c/p>\n\u003cp>\"I didn’t even realize this was a loophole or that it would affect me,\" Randle said.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/280779549&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/280779549'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The loophole occurs when out-of-network doctors -- anesthesiologists, radiologists and others -- provide care at a patient's in-network hospital or clinic, but charge their out-of-network fees.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>To address the issue, a bipartisan group of state legislators introduced AB 72 to put a stop to surprise, out-of-network bills for non-emergency services. Assemblymember Rob Bonta (D-Alameda) is one of the bill's six co-authors.\u003c/p>\n\u003cp>\"This bill will be the first of its kind in terms of strength of consumer protections, and it will be a model for the rest of the nation,\" Bonta said.\u003c/p>\n\u003cp>If signed into law, patients who go to in-network health facilities will pay in-network prices. Insurance companies would compensate out-of-network doctors for treatment, either at the average procedure rate for the region or at 125 percent of what Medicare pays, whichever is greatest.\u003c/p>\n\u003cp>Bill opposition comes from groups representing doctors, like the Association of American Physicians and Surgeons. Dr. Jane Orient is the executive director.\u003c/p>\n\u003cp>\"The quality of care will go down, and patients will have fewer choices,\" Orient said.\u003c/p>\n\u003cp>She says doctors won’t be compensated at the rate they need to keep their practices running.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>A similar bill failed on the final day of last year’s legislative session, but AB 72 looks like it will see a different outcome, given revisions to last year’s text and wider-ranging support.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/231161/lawmakers-take-up-measure-to-end-surprise-out-of-network-medical-bills","authors":["8648"],"series":["stateofhealth_2492"],"categories":["stateofhealth_11","stateofhealth_2442","stateofhealth_14"],"tags":["stateofhealth_2872","stateofhealth_2808","stateofhealth_2874","stateofhealth_2519","stateofhealth_2873"],"featImg":"stateofhealth_231162","label":"stateofhealth_2492"},"stateofhealth_230664":{"type":"posts","id":"stateofhealth_230664","meta":{"index":"posts_1716263798","site":"stateofhealth","id":"230664","score":null,"sort":[1472490174000]},"parent":0,"labelTerm":{"site":"stateofhealth","term":2492},"blocks":[],"publishDate":1472490174,"format":"standard","disqusTitle":"Maker Of EpiPen To Sell Generic Version For Half The Price","title":"Maker Of EpiPen To Sell Generic Version For Half The Price","headTitle":"Price Check | State of Health | KQED News","content":"\u003cp>Treatment for life-threatening allergic reactions is about to get a little cheaper.\u003c/p>\n\u003cp>Mylan, the maker of the EpiPen, said Monday that it will launch a generic version of the device for half the price of the brand-name product.\u003c/p>\n\u003cp>The company says the generic will hit the market in a few weeks and \u003ca href=\"http://newsroom.mylan.com/2016-08-29-Mylan-to-Launch-First-Generic-to-EpiPen-Auto-Injector-at-a-List-Price-of-300-per-Two-Pack-Carton-a-More-than-50-Discount-to-the-Brand-Product\">cost $300\u003c/a> for a two-pack. That's less than half the price of a two-pack of brand-name EpiPens, which are available at Target pharmacies for about \u003ca href=\"http://www.goodrx.com/epipen?drug-name=EpiPen\">$630\u003c/a>, according to GoodRX.\u003c/p>\n\u003cp>The move by Mylan comes in response to mounting \u003ca href=\"http://www.npr.org/2016/08/27/491647599/mother-calls-epipen-price-hike-a-matter-of-life-and-death\">pressure from consumers \u003c/a>and Congress to lower the drug's price. In less than 10 years, the price for a two-pack of injectors has risen from about $100 to more than $600.\u003c/p>\n\u003cp>\"This helps Mylan with its public relations battle against criticism for sharp price increases on the EpiPen,\" says \u003ca href=\"http://kff.org/person/larry-levitt/\">Larry Levitt\u003c/a>, a health policy analyst at the Kaiser Family Foundation. \"The introduction of a lower-priced generic version may keep competitors out of the market.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Mylan CEO Heather Bresch has spent the past week trying to shift blame for the increased cost of the product away from Mylan and onto insurance companies. The company argued that more people have high-deductible health plans and high copayments on medications now, so they are feeling the pain of price hikes more than they would have in the past.\u003c/p>\n\u003cp>She repeated that Monday in a statement posted on the company's website.\u003c/p>\n\u003cp>\"Because of the complexity and opaqueness of today's branded pharmaceutical supply chain and the increased shifting of costs to patients as a result of high deductible health plans, we determined that bypassing the brand system in this case and offering an additional alternative was the best option,\" the statement read.\u003c/p>\n\u003cp>But lawmakers and consumers didn't buy it. The anger over the price increases was directed solely at Mylan.\u003c/p>\n\u003cp>\"The weirdness of a generic drug company offering a generic version of its own branded but off-patent product is a signal that something is wrong,\" Robert Weissman, president of the consumer group Public Citizen, \u003ca href=\"http://www.huffingtonpost.com/robert-weissman/epipen-makers-latest-offe_b_11760170.html\">wrote in a piece published Monday\u003c/a> by Huffington Post. \"Mylan knows its $600 per set of EpiPens is unsustainable, but aims to continue ripping off some segment of the marketplace — both consumers who do not trust or know about the generic and perhaps some insurers and payers constrained from buying a generic. The announced $300 price for Mylan's generic also comes in too high; the profitable price in Canada is roughly $200 for two, and the price in France is roughly half that.\"\u003c/p>\n\u003cp>He went on to write that the company's action \"is just one more convoluted mechanism to avoid plain talk ... and just cut the price of Epipen.\"\u003c/p>\n\u003cp>The frustration with the rising costs of the EpiPen has been brewing for months. But it exploded last week when activist parents of kids with allergies started a petition called \"\u003ca href=\"http://www.petition2congress.com/20720/stop-epipen-price-gouging/\">Stop the EpiPen Price Gouging\u003c/a>\" that automatically sends letters to members of Congress complaining about the rising costs. Almost 150,000 people have signed it, as of Monday.\u003c/p>\n\u003cp>Several senators and members of Congress responded, asking the Federal Trade Commission to investigate whether the company's pricing policies violate anti-trust laws, and promising their own hearings on Capitol Hill.\u003c/p>\n\u003cp>Mylan said Thursday it would offer discounts of up to $300 to offset consumers' share of the EpiPen's price. But that \u003ca href=\"http://www.npr.org/sections/health-shots/2016/08/25/491372193/discounts-arent-enough-to-halt-outrage-at-high-epipen-prices\">didn't quiet the criticism\u003c/a> of the company.\u003c/p>\n\u003cp>Democratic presidential nominee Hillary Clinton called on the company to lower the price \"immediately.\"\u003c/p>\n\u003cp>Mylan's latest move is meant to calm the anger of consumers and lawmakers, but it may also be a shrewd business decision.\u003c/p>\n\u003cp>By bringing a generic to the market now, it could preemptively steal some market share away from Teva Pharmaceuticals, which is developing its own generic EpiPen. That device is expected to be approved in 2017.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Mylan has a complex history with Teva, which last year \u003ca href=\"http://www.tevapharm.com/news/teva_proposes_to_acquire_mylan_for_82_00_per_share_in_cash_and_stock_04_15.aspx\">tried to buy Mylan\u003c/a> in a hostile takeover. Mylan was able to fight \u003ca href=\"http://www.irishtimes.com/business/health-pharma/mylan-defends-way-it-saw-off-hostile-takeover-1.2309366\">off the acquisition\u003c/a>, in part, because it moved its legal headquarters out of the United States to the Netherlands.\u003c/p>\n\u003cdiv class=\"fullattribution\">\u003cem>Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Maker+Of+EpiPen+To+Sell+Generic+Version+For+Half+The+Price&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/em>\u003c/div>\n\n","disqusIdentifier":"230664 http://ww2.kqed.org/stateofhealth/?p=230664","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/08/29/maker-of-epipen-to-sell-generic-version-for-half-the-price/","stats":{"hasVideo":false,"hasChartOrMap":false,"hasAudio":false,"hasPolis":false,"wordCount":711,"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"iframeSrcs":[],"paragraphCount":20},"modified":1472490174,"excerpt":"Mylan's move comes amid pressure from consumers and Congress to lower the allergy drug's price. In less than 10 years, the price has risen from about $100 to more than $600 for an injector two-pack.","headData":{"twImgId":"","twTitle":"","ogTitle":"","ogImgId":"","twDescription":"","description":"Mylan's move comes amid pressure from consumers and Congress to lower the allergy drug's price. In less than 10 years, the price has risen from about $100 to more than $600 for an injector two-pack.","title":"Maker Of EpiPen To Sell Generic Version For Half The Price | KQED","ogDescription":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Maker Of EpiPen To Sell Generic Version For Half The Price","datePublished":"2016-08-29T10:02:54-07:00","dateModified":"2016-08-29T10:02:54-07:00","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"guestAuthors":[],"slug":"maker-of-epipen-to-sell-generic-version-for-half-the-price","status":"publish","nprApiLink":"http://api.npr.org/query?id=491797051&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprByline":"\u003cstrong> Alison Kodjak \u003c/br> NPR \u003c/strong>","nprStoryDate":"Mon, 29 Aug 2016 11:20:00 -0400","nprLastModifiedDate":"Mon, 29 Aug 2016 12:17:33 -0400","nprHtmlLink":"http://www.npr.org/sections/health-shots/2016/08/29/491797051/maker-of-epipen-to-sell-generic-version-for-half-the-price?ft=nprml&f=491797051","nprImageAgency":"Bloomberg via Getty Images","nprImageCredit":"Daniel Acker","nprStoryId":"491797051","nprRetrievedStory":"1","nprPubDate":"Mon, 29 Aug 2016 12:17:00 -0400","path":"/stateofhealth/230664/maker-of-epipen-to-sell-generic-version-for-half-the-price","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Treatment for life-threatening allergic reactions is about to get a little cheaper.\u003c/p>\n\u003cp>Mylan, the maker of the EpiPen, said Monday that it will launch a generic version of the device for half the price of the brand-name product.\u003c/p>\n\u003cp>The company says the generic will hit the market in a few weeks and \u003ca href=\"http://newsroom.mylan.com/2016-08-29-Mylan-to-Launch-First-Generic-to-EpiPen-Auto-Injector-at-a-List-Price-of-300-per-Two-Pack-Carton-a-More-than-50-Discount-to-the-Brand-Product\">cost $300\u003c/a> for a two-pack. That's less than half the price of a two-pack of brand-name EpiPens, which are available at Target pharmacies for about \u003ca href=\"http://www.goodrx.com/epipen?drug-name=EpiPen\">$630\u003c/a>, according to GoodRX.\u003c/p>\n\u003cp>The move by Mylan comes in response to mounting \u003ca href=\"http://www.npr.org/2016/08/27/491647599/mother-calls-epipen-price-hike-a-matter-of-life-and-death\">pressure from consumers \u003c/a>and Congress to lower the drug's price. In less than 10 years, the price for a two-pack of injectors has risen from about $100 to more than $600.\u003c/p>\n\u003cp>\"This helps Mylan with its public relations battle against criticism for sharp price increases on the EpiPen,\" says \u003ca href=\"http://kff.org/person/larry-levitt/\">Larry Levitt\u003c/a>, a health policy analyst at the Kaiser Family Foundation. \"The introduction of a lower-priced generic version may keep competitors out of the market.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Mylan CEO Heather Bresch has spent the past week trying to shift blame for the increased cost of the product away from Mylan and onto insurance companies. The company argued that more people have high-deductible health plans and high copayments on medications now, so they are feeling the pain of price hikes more than they would have in the past.\u003c/p>\n\u003cp>She repeated that Monday in a statement posted on the company's website.\u003c/p>\n\u003cp>\"Because of the complexity and opaqueness of today's branded pharmaceutical supply chain and the increased shifting of costs to patients as a result of high deductible health plans, we determined that bypassing the brand system in this case and offering an additional alternative was the best option,\" the statement read.\u003c/p>\n\u003cp>But lawmakers and consumers didn't buy it. The anger over the price increases was directed solely at Mylan.\u003c/p>\n\u003cp>\"The weirdness of a generic drug company offering a generic version of its own branded but off-patent product is a signal that something is wrong,\" Robert Weissman, president of the consumer group Public Citizen, \u003ca href=\"http://www.huffingtonpost.com/robert-weissman/epipen-makers-latest-offe_b_11760170.html\">wrote in a piece published Monday\u003c/a> by Huffington Post. \"Mylan knows its $600 per set of EpiPens is unsustainable, but aims to continue ripping off some segment of the marketplace — both consumers who do not trust or know about the generic and perhaps some insurers and payers constrained from buying a generic. The announced $300 price for Mylan's generic also comes in too high; the profitable price in Canada is roughly $200 for two, and the price in France is roughly half that.\"\u003c/p>\n\u003cp>He went on to write that the company's action \"is just one more convoluted mechanism to avoid plain talk ... and just cut the price of Epipen.\"\u003c/p>\n\u003cp>The frustration with the rising costs of the EpiPen has been brewing for months. But it exploded last week when activist parents of kids with allergies started a petition called \"\u003ca href=\"http://www.petition2congress.com/20720/stop-epipen-price-gouging/\">Stop the EpiPen Price Gouging\u003c/a>\" that automatically sends letters to members of Congress complaining about the rising costs. Almost 150,000 people have signed it, as of Monday.\u003c/p>\n\u003cp>Several senators and members of Congress responded, asking the Federal Trade Commission to investigate whether the company's pricing policies violate anti-trust laws, and promising their own hearings on Capitol Hill.\u003c/p>\n\u003cp>Mylan said Thursday it would offer discounts of up to $300 to offset consumers' share of the EpiPen's price. But that \u003ca href=\"http://www.npr.org/sections/health-shots/2016/08/25/491372193/discounts-arent-enough-to-halt-outrage-at-high-epipen-prices\">didn't quiet the criticism\u003c/a> of the company.\u003c/p>\n\u003cp>Democratic presidential nominee Hillary Clinton called on the company to lower the price \"immediately.\"\u003c/p>\n\u003cp>Mylan's latest move is meant to calm the anger of consumers and lawmakers, but it may also be a shrewd business decision.\u003c/p>\n\u003cp>By bringing a generic to the market now, it could preemptively steal some market share away from Teva Pharmaceuticals, which is developing its own generic EpiPen. That device is expected to be approved in 2017.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Mylan has a complex history with Teva, which last year \u003ca href=\"http://www.tevapharm.com/news/teva_proposes_to_acquire_mylan_for_82_00_per_share_in_cash_and_stock_04_15.aspx\">tried to buy Mylan\u003c/a> in a hostile takeover. Mylan was able to fight \u003ca href=\"http://www.irishtimes.com/business/health-pharma/mylan-defends-way-it-saw-off-hostile-takeover-1.2309366\">off the acquisition\u003c/a>, in part, because it moved its legal headquarters out of the United States to the Netherlands.\u003c/p>\n\u003cdiv class=\"fullattribution\">\u003cem>Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Maker+Of+EpiPen+To+Sell+Generic+Version+For+Half+The+Price&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/em>\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/230664/maker-of-epipen-to-sell-generic-version-for-half-the-price","authors":["byline_stateofhealth_230664"],"series":["stateofhealth_2492"],"categories":["stateofhealth_13"],"tags":["stateofhealth_2868","stateofhealth_2865"],"featImg":"stateofhealth_230668","label":"stateofhealth_2492"},"stateofhealth_205822":{"type":"posts","id":"stateofhealth_205822","meta":{"index":"posts_1716263798","site":"stateofhealth","id":"205822","score":null,"sort":[1467334618000]},"parent":0,"labelTerm":{"site":"stateofhealth","term":2492},"blocks":[],"publishDate":1467334618,"format":"aside","disqusTitle":"Northern California Has Highest Costs in the U.S. to Deliver a Baby","title":"Northern California Has Highest Costs in the U.S. to Deliver a Baby","headTitle":"Price Check | State of Health | KQED News","content":"\u003cp>Sacramento and the San Francisco Bay Area ranked as the most expensive places to have a baby of 30 major metropolitan regions in the U.S. according to \u003ca href=\"http://www.castlighthealth.com/press-releases/new-study-shows-huge-cost-differences-for-having-a-baby-often-in-the-same-city/\" target=\"_blank\">an analysis\u003c/a> released Thursday.\u003c/p>\n\u003cp>Sacramento came in first (congrats to you) where a vaginal birth cost $15,420 on average. The San Francisco Bay Area was a close second at $15,204. Minneapolis trailed in third place by almost $4,000, coming in at $11,527, and the least expensive of the 30 largest metropolitan areas surveyed was Kansas City, Missouri, where a vaginal delivery costs an avery $6,075.\u003c/p>\n\u003cp>These are \"routine vaginal deliveries,\" folks. Again, those are \"average\" costs. We'll get to the variation within regions further down.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-full wp-image-206296\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/VaginalRoutine-e1467324299747.jpg\" alt=\"VaginalRoutine\" width=\"1920\" height=\"1484\">\u003c/p>\n\u003cp>The numbers were crunched by San Francisco-based Castlight, a health care information company. They looked at medical claims data as well as other information. Since Castlight primarily works with self-insured large companies, it says the costs it crunched include both the employee's out-of-pocket costs and what the employer paid for the delivery.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Birth by Cesarean section typically cost more than vaginal deliveries and did in this survey as well. Sacramento was first at $27,067; the Bay Area was second at $21,799. Portland, Oregon trailed in third at $18,066. The least expensive of the metropolitan areas was Pittsburgh, Penn. at $6,891.\u003c/p>\n\u003cp>Here's the national C-section map:\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-full wp-image-206320\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/top_30_cities_delivery_maps_csection-e1467325171879.jpg\" alt=\"top_30_cities_delivery_maps_csection\" width=\"1920\" height=\"1484\">\u003c/p>\n\u003cp>But Castlight didn't actually stop at the 30 biggest metropolitan areas. They surveyed 190 areas across the country, including 13 in California.\u003c/p>\n\u003cp>While Sacramento and the Bay Area are the most expensive major regions to have a baby, other, smaller, California cities rank even higher.\u003c/p>\n\u003cp>Here's the list for routine vaginal deliveries in California:\u003c/p>\n\u003cp>Merced $19,191\u003cbr>\nSalinas $17,772\u003cbr>\nSacramento-Yolo $15,420\u003cbr>\nSF-Oakland-San Jose $15,204\u003cbr>\nStockton-Lodi $13,972\u003cbr>\nSan Luis Obispo-Atascadero-Paso Robles $13,926\u003cbr>\nSanta Barbara-Santa Maria-Lompoc $12,219\u003cbr>\nBakersfield $11,055\u003cbr>\nLos Angeles-Riverside-Orange $10,285\u003cbr>\nModesto $9,903\u003cbr>\nSan Diego $9,709\u003cbr>\nChico-Paradise $7,839\u003cbr>\nFresno $7,278\u003c/p>\n\u003cp>In addition to the cost difference between areas, there's tremendous cost variation within regions, too. In the Bay Area, the range for a vaginal delivery is $7,700 to $28,000, a four-fold difference. In Sacramento, it's $4,560 to $24,549, a five-fold difference.\u003c/p>\n\u003cp>Feeling ill yet?\u003c/p>\n\u003cp>If you're wondering why this happens, Kristin Torres Mowat, senior vice president at Castlight, chalked it up to the \"obscure, dysfunctional and inefficient health care market.\"\u003c/p>\n\u003cp>[contextly_sidebar id=\"smGr7FZlFDM9IcWYJVq0A3jdEsPJrPIH\"]In Northern California, consolidation on the provider side -- both doctors and hospitals -- helps them to wield market power and drive up costs.\u003c/p>\n\u003cp>The most recent evidence came earlier this month \u003ca href=\"http://inq.sagepub.com/content/53/0046958016651555.full\" target=\"_blank\">in a study\u003c/a> from USC health economists who pointed, again, to the market power of Sutter Health and Dignity Health.\u003c/p>\n\u003cp>\"Over time, they have acquired physician practices, outpatient clinics, hospitals and have a disproportionate share in the market,\" Mowat said.\u003c/p>\n\u003cp>(Disclaimer that data from Kaiser Permanente was not included in the USC study.)\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Mowat advised that consumers ask for an estimate of costs early in their pregnancy, but that estimate is not always easy to get.\u003c/p>\n\n","disqusIdentifier":"205822 http://ww2.kqed.org/stateofhealth/?p=205822","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/06/30/northern-california-has-highest-costs-in-the-u-s-to-deliver-a-baby/","stats":{"hasVideo":false,"hasChartOrMap":false,"hasAudio":false,"hasPolis":false,"wordCount":545,"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"iframeSrcs":[],"paragraphCount":22},"modified":1467336735,"excerpt":"A new analysis finds that the Bay Area and Sacramento are the two most expensive places in 30 major metropolitan areas nationwide to give birth.","headData":{"twImgId":"","twTitle":"","ogTitle":"","ogImgId":"","twDescription":"","description":"A new analysis finds that the Bay Area and Sacramento are the two most expensive places in 30 major metropolitan areas nationwide to give birth.","title":"Northern California Has Highest Costs in the U.S. to Deliver a Baby | KQED","ogDescription":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Northern California Has Highest Costs in the U.S. to Deliver a Baby","datePublished":"2016-06-30T17:56:58-07:00","dateModified":"2016-06-30T18:32:15-07:00","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"guestAuthors":[],"slug":"northern-california-has-highest-costs-in-the-u-s-to-deliver-a-baby","status":"publish","path":"/stateofhealth/205822/northern-california-has-highest-costs-in-the-u-s-to-deliver-a-baby","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Sacramento and the San Francisco Bay Area ranked as the most expensive places to have a baby of 30 major metropolitan regions in the U.S. according to \u003ca href=\"http://www.castlighthealth.com/press-releases/new-study-shows-huge-cost-differences-for-having-a-baby-often-in-the-same-city/\" target=\"_blank\">an analysis\u003c/a> released Thursday.\u003c/p>\n\u003cp>Sacramento came in first (congrats to you) where a vaginal birth cost $15,420 on average. The San Francisco Bay Area was a close second at $15,204. Minneapolis trailed in third place by almost $4,000, coming in at $11,527, and the least expensive of the 30 largest metropolitan areas surveyed was Kansas City, Missouri, where a vaginal delivery costs an avery $6,075.\u003c/p>\n\u003cp>These are \"routine vaginal deliveries,\" folks. Again, those are \"average\" costs. We'll get to the variation within regions further down.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-full wp-image-206296\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/VaginalRoutine-e1467324299747.jpg\" alt=\"VaginalRoutine\" width=\"1920\" height=\"1484\">\u003c/p>\n\u003cp>The numbers were crunched by San Francisco-based Castlight, a health care information company. They looked at medical claims data as well as other information. Since Castlight primarily works with self-insured large companies, it says the costs it crunched include both the employee's out-of-pocket costs and what the employer paid for the delivery.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Birth by Cesarean section typically cost more than vaginal deliveries and did in this survey as well. Sacramento was first at $27,067; the Bay Area was second at $21,799. Portland, Oregon trailed in third at $18,066. The least expensive of the metropolitan areas was Pittsburgh, Penn. at $6,891.\u003c/p>\n\u003cp>Here's the national C-section map:\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-full wp-image-206320\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/top_30_cities_delivery_maps_csection-e1467325171879.jpg\" alt=\"top_30_cities_delivery_maps_csection\" width=\"1920\" height=\"1484\">\u003c/p>\n\u003cp>But Castlight didn't actually stop at the 30 biggest metropolitan areas. They surveyed 190 areas across the country, including 13 in California.\u003c/p>\n\u003cp>While Sacramento and the Bay Area are the most expensive major regions to have a baby, other, smaller, California cities rank even higher.\u003c/p>\n\u003cp>Here's the list for routine vaginal deliveries in California:\u003c/p>\n\u003cp>Merced $19,191\u003cbr>\nSalinas $17,772\u003cbr>\nSacramento-Yolo $15,420\u003cbr>\nSF-Oakland-San Jose $15,204\u003cbr>\nStockton-Lodi $13,972\u003cbr>\nSan Luis Obispo-Atascadero-Paso Robles $13,926\u003cbr>\nSanta Barbara-Santa Maria-Lompoc $12,219\u003cbr>\nBakersfield $11,055\u003cbr>\nLos Angeles-Riverside-Orange $10,285\u003cbr>\nModesto $9,903\u003cbr>\nSan Diego $9,709\u003cbr>\nChico-Paradise $7,839\u003cbr>\nFresno $7,278\u003c/p>\n\u003cp>In addition to the cost difference between areas, there's tremendous cost variation within regions, too. In the Bay Area, the range for a vaginal delivery is $7,700 to $28,000, a four-fold difference. In Sacramento, it's $4,560 to $24,549, a five-fold difference.\u003c/p>\n\u003cp>Feeling ill yet?\u003c/p>\n\u003cp>If you're wondering why this happens, Kristin Torres Mowat, senior vice president at Castlight, chalked it up to the \"obscure, dysfunctional and inefficient health care market.\"\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>In Northern California, consolidation on the provider side -- both doctors and hospitals -- helps them to wield market power and drive up costs.\u003c/p>\n\u003cp>The most recent evidence came earlier this month \u003ca href=\"http://inq.sagepub.com/content/53/0046958016651555.full\" target=\"_blank\">in a study\u003c/a> from USC health economists who pointed, again, to the market power of Sutter Health and Dignity Health.\u003c/p>\n\u003cp>\"Over time, they have acquired physician practices, outpatient clinics, hospitals and have a disproportionate share in the market,\" Mowat said.\u003c/p>\n\u003cp>(Disclaimer that data from Kaiser Permanente was not included in the USC study.)\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Mowat advised that consumers ask for an estimate of costs early in their pregnancy, but that estimate is not always easy to get.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/205822/northern-california-has-highest-costs-in-the-u-s-to-deliver-a-baby","authors":["240"],"series":["stateofhealth_2492"],"categories":["stateofhealth_2442","stateofhealth_13"],"tags":["stateofhealth_482","stateofhealth_2519"],"featImg":"stateofhealth_206296","label":"stateofhealth_2492"},"stateofhealth_116325":{"type":"posts","id":"stateofhealth_116325","meta":{"index":"posts_1716263798","site":"stateofhealth","id":"116325","score":null,"sort":[1448918589000]},"parent":0,"labelTerm":{},"blocks":[],"publishDate":1448918589,"format":"standard","disqusTitle":"Patients Want To Price-Shop For Care, But Online Tools Unreliable","title":"Patients Want To Price-Shop For Care, But Online Tools Unreliable","headTitle":"Price Check | State of Health | KQED News","content":"\u003cp>Kate and Scott Savett were trying to be responsible when they needed some medical care. They live about an hour north of Philadelphia with their dog, Frankie. Scott, 43, is a chemist and designs software for labs; Kate, 37, works in life insurance.\u003c/p>\n\u003cp>They buy their health insurance through Scott's job, and to keep their premiums affordable, they chose a high-deductible plan. They understood from the beginning that this would mean shopping carefully when they needed care, because costs can vary a lot among doctors and hospitals.\u003c/p>\n\u003cp>For years the couple didn't use their insurance much — but that all changed this year.\u003c/p>\n\u003cfigure id=\"attachment_116326\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/cost-calculator-1-04d8443fd5934c64fa38d6ff6cbe9a21e21b9101.jpg\">\u003cimg class=\"wp-image-116326 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/cost-calculator-1-04d8443fd5934c64fa38d6ff6cbe9a21e21b9101-400x300.jpg\" alt=\"Kate and Scott Savett, of Allentown, PA, at an event of the Greater Delaware Valley chapter of the National MS Society, in Philadelphia, PA.\" width=\"400\" height=\"300\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/11/cost-calculator-1-04d8443fd5934c64fa38d6ff6cbe9a21e21b9101-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/cost-calculator-1-04d8443fd5934c64fa38d6ff6cbe9a21e21b9101-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/cost-calculator-1-04d8443fd5934c64fa38d6ff6cbe9a21e21b9101-1440x1080.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/cost-calculator-1-04d8443fd5934c64fa38d6ff6cbe9a21e21b9101-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/cost-calculator-1-04d8443fd5934c64fa38d6ff6cbe9a21e21b9101-960x720.jpg 960w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Kate and Scott Savett, of Allentown, Pennsylvania, at an event of the Greater Delaware Valley chapter of the National MS Society, in Philadelphia. \u003ccite>(Bastiaan Slabbers for NPR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Kate was diagnosed with multiple sclerosis in January. Doctors did a lot of tests and then follow-up tests. On top of that, Scott needed some imaging tests for a spinal issue.\u003c/p>\n\u003cp>Under their insurance plan, the two have to pay in full for the first $3,000 of their combined care. After that, they still have to pay 20 percent of the cost, until they reach a total of $8,000 in out-of-pocket expenses.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>That experience made them want to find the best care for the best deal. But how?\u003c/p>\n\u003cp>They investigated, using an online cost estimator offered through their insurance company.\u003c/p>\n\u003cp>Scott logs in to use the tool, and searches for the typical cost of MRI scans in his region. The online calculator tells him the average cost is $1,270; the lowest is $512 and the \"above average\" is $1,790.\u003c/p>\n\u003cp>The tool then produced a list of different providers and an estimate of how much they will specifically charge under the plan the Savetts have.\u003c/p>\n\u003cp>At first, this kind of information seemed great to the couple. But it quickly proved to be quite the headache.\u003c/p>\n\u003cp>A few days before Kate was scheduled to have her first MRI, she and Scott got a call from the radiology office, saying that the scan would cost them $2,400. They were shocked — the online calculator had told them it would only be about $500.\u003c/p>\n\u003cp>What's the source of the disconnect?\u003c/p>\n\u003cp>A hospital had bought the imaging center and raised the price.\u003c/p>\n\u003cp>[contextly_sidebar id=\"wCEqkhB9BfZ9A3fRaUew9qoV5lT8Q2Dl\"]There were misquotes on other procedures, too. The Savetts received some bills from health providers that were as much as $1,000 higher than the price the online calculator had led them to expect. Another time, they couldn't find any listings at all for a procedure one of them needed.\u003c/p>\n\u003cp>The two quickly plowed through their $3,000 deductible. Financial planning became increasingly difficult. They delayed buying a new water heater for their house.\u003c/p>\n\u003cp>\"It's hard for us to pull the trigger on that, knowing that another bill could be coming around the corner,\" Kate says.\u003c/p>\n\u003cp>It's unclear how common these inaccuracies with online estimators are, but the tools \u003cem>are\u003c/em> becoming more popular, as patients shoulder a bigger share of the cost of their medical care. Outside companies are developing the online calculators, and most insurers offer them.\u003c/p>\n\u003cp>\"Each one of them — whether it's Aetna, United, Cigna — they all have something,\" says \u003ca href=\"http://www.hci3.org/about_hci3/team/francois-de-brantes-ms-mba-executive-director\" target=\"_blank\">Francois de Brantes\u003c/a>, director of the Health Care Incentives Improvement Institute, a nonprofit based in Connecticut. De Brantes has been \u003ca href=\"http://www.catalyzepaymentreform.org/images/Accuracy.pdf\" target=\"_blank\">paying close attention\u003c/a> to price-transparency tools.\u003c/p>\n\u003cp>\"There's lots and lots of variability in the information that's provided to consumers,\" he says.\u003c/p>\n\u003cp>Some of the estimators reflect an aggregate range of possible costs; others are based on historic pricing, or claims data from varying sources. Many, he says, are limited in the type of procedures they include.\u003c/p>\n\u003cp>[contextly_sidebar id=\"zWQnsaE6HJNkAsxDX37CJ1nbtNWIcaEb\"]As for \u003ca href=\"http://www.uhc.com/individual-and-family/why-uhc/programs-tools/myhealthcare-cost-estimator\" target=\"_blank\">United Healthare's cost estimator\u003c/a> — the one the Savetts used — Craig Hankins, the insurer's vice president of consumer engagement products, gives it an 8 out of 10 in terms of accuracy.\u003c/p>\n\u003cp>\"Right now, I would say if we look at our tool, relative to others that are offered, I would say ours is average — if not above average — in terms of breadth of services as well as accuracy,\" Hankins says.\u003c/p>\n\u003cp>UHC's cost calculator is based on current information, he says, adding that it is in the insurer's interest to have the online tool work. If members get care at an acceptable cost, that saves everyone money.\u003c/p>\n\u003cp>But, he says, the tool has limits — it's hard to predict what a particular doctor will actually \u003cem>do\u003c/em> during an exam, treatment, or office visit, and how he or she will bill for it.\u003c/p>\n\u003cp>That gets at a deeper challenge with these online estimators, says David Newman, director of the nonprofit \u003ca href=\"http://www.healthcostinstitute.org/\" target=\"_blank\">Health Care Cost Institute\u003c/a>, in Washington, D.C. The way billing and reimbursement work in health care is extremely complicated, he says.\u003c/p>\n\u003cp>\"There are 8,000 procedure codes, tens of thousands of diagnostic codes, a million different providers, and hundreds of insurance companies,\" says Newman. Calculators are often based on one specific procedure, so they may not reflect all that happens and is billed for during a visit. In that way, he says, \"this is probably going to be as good as it gets.\"\u003c/p>\n\u003cp>But de Brantes thinks much more improvement is possible.\u003c/p>\n\u003cp>\"It's not that difficult. It really — technologically — is not that difficult at all,\" he says.\u003c/p>\n\u003cp>The information people like the Savetts are seeking exists in the health care system, de Brantes says, even if in some cases it is hidden behind contract agreements. The bigger problem, he says, is that there is no internal pressure to make the online calculator work as well as it could. Health care has thrived in an opaque environment where costs are hard to find.\u003c/p>\n\u003cp>But the needle is starting to move. Employers are demanding these tools for their employees. And several \u003ca href=\"http://www.npr.org/sections/health-shots/2014/11/05/360351551/how-much-is-that-mri-really-massachusetts-shines-a-light\" target=\"_blank\">states mandate\u003c/a> public reporting of \u003ca href=\"http://www.npr.org/sections/health-shots/2014/02/12/276001379/elusive-goal-a-transparent-price-list-for-health-care\" target=\"_blank\">price information\u003c/a>.\u003c/p>\n\u003cp>As for Scott and Kate Savett, the current climate has turned each of them into a new breed of health care consumer: a savvy one.\u003c/p>\n\u003cp>Scott says he knows they are approaching their $8,000 out-of- pocket cap for the year, which means insurance will soon cover the entire cost of their care. But he doesn't want to give in. He wants to see improvements.\u003c/p>\n\u003cp>\"I would rather crawl to that $8,000 cap than sprint to it,\" he says. \"I know we're going to get there this year, unfortunately, but to blow it all on an MRI that's excessively priced rubs me the wrong way.\"\u003c/p>\n\u003cp>A few weeks after we first talked, Savett received a bill for his MRI. Turns out, it's pretty close to what the estimator predicted it would be — $1,100. He says he will keep using the tool. But he sees it as an imperfect clue rather than a price tag.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story is part of NPR's reporting partnership with WHYY's \u003ca href=\"http://www.newsworks.org/index.php/thepulse\" target=\"_blank\">The Pulse\u003c/a> and \u003c/em>\u003ca href=\"http://www.kaiserhealthnews.org\" target=\"_blank\">Kaiser Health News\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">\u003c/div>\n\n","disqusIdentifier":"116325 http://ww2.kqed.org/stateofhealth/?p=116325","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/11/30/patients-want-to-price-shop-for-care-but-online-tools-unreliable/","stats":{"hasVideo":false,"hasChartOrMap":false,"hasAudio":false,"hasPolis":false,"wordCount":1184,"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"iframeSrcs":[],"paragraphCount":37},"modified":1448929129,"excerpt":"Savvy patients want the best medical care for the best deal, and online calculators seem like a great way to compare the cost of common scans and procedures. But many are inaccurate.","headData":{"twImgId":"","twTitle":"","ogTitle":"","ogImgId":"","twDescription":"","description":"Savvy patients want the best medical care for the best deal, and online calculators seem like a great way to compare the cost of common scans and procedures. But many are inaccurate.","title":"Patients Want To Price-Shop For Care, But Online Tools Unreliable | KQED","ogDescription":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Patients Want To Price-Shop For Care, But Online Tools Unreliable","datePublished":"2015-11-30T13:23:09-08:00","dateModified":"2015-11-30T16:18:49-08:00","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"guestAuthors":[],"slug":"patients-want-to-price-shop-for-care-but-online-tools-unreliable","status":"publish","sourceUrl":"http://www.npr.org/sections/health-shots/2015/11/30/453087857/patients-want-to-price-shop-for-care-but-online-tools-unreliable","nprApiLink":"http://api.npr.org/query?id=453087857&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprByline":"Elana Gordon","nprStoryDate":"Mon, 30 Nov 2015 04:54:00 -0500","nprLastModifiedDate":"Mon, 30 Nov 2015 14:33:55 -0500","nprHtmlLink":"http://www.npr.org/sections/health-shots/2015/11/30/453087857/patients-want-to-price-shop-for-care-but-online-tools-unreliable?ft=nprml&f=453087857","nprAudio":"http://pd.npr.org/anon.npr-mp3/npr/me/2015/11/20151130_me_patients_want_to_price-shop_for_care_but_online_tools_unreliable.mp3?orgId=432&topicId=1128&d=305&p=3&story=453087857&t=progseg&e=457831498&seg=5&ft=nprml&f=453087857","source":"NPR","nprAudioM3u":"http://api.npr.org/m3u/1457837780-c9e430.m3u?orgId=432&topicId=1128&d=305&p=3&story=453087857&t=progseg&e=457831498&seg=5&ft=nprml&f=453087857","nprStoryId":"453087857","nprRetrievedStory":"1","nprPubDate":"Mon, 30 Nov 2015 14:33:00 -0500","path":"/stateofhealth/116325/patients-want-to-price-shop-for-care-but-online-tools-unreliable","audioUrl":"http://pd.npr.org/anon.npr-mp3/npr/me/2015/11/20151130_me_patients_want_to_price-shop_for_care_but_online_tools_unreliable.mp3?orgId=432&topicId=1128&d=305&p=3&story=453087857&t=progseg&e=457831498&seg=5&ft=nprml&f=453087857","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Kate and Scott Savett were trying to be responsible when they needed some medical care. They live about an hour north of Philadelphia with their dog, Frankie. Scott, 43, is a chemist and designs software for labs; Kate, 37, works in life insurance.\u003c/p>\n\u003cp>They buy their health insurance through Scott's job, and to keep their premiums affordable, they chose a high-deductible plan. They understood from the beginning that this would mean shopping carefully when they needed care, because costs can vary a lot among doctors and hospitals.\u003c/p>\n\u003cp>For years the couple didn't use their insurance much — but that all changed this year.\u003c/p>\n\u003cfigure id=\"attachment_116326\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/cost-calculator-1-04d8443fd5934c64fa38d6ff6cbe9a21e21b9101.jpg\">\u003cimg class=\"wp-image-116326 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/cost-calculator-1-04d8443fd5934c64fa38d6ff6cbe9a21e21b9101-400x300.jpg\" alt=\"Kate and Scott Savett, of Allentown, PA, at an event of the Greater Delaware Valley chapter of the National MS Society, in Philadelphia, PA.\" width=\"400\" height=\"300\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/11/cost-calculator-1-04d8443fd5934c64fa38d6ff6cbe9a21e21b9101-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/cost-calculator-1-04d8443fd5934c64fa38d6ff6cbe9a21e21b9101-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/cost-calculator-1-04d8443fd5934c64fa38d6ff6cbe9a21e21b9101-1440x1080.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/cost-calculator-1-04d8443fd5934c64fa38d6ff6cbe9a21e21b9101-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/cost-calculator-1-04d8443fd5934c64fa38d6ff6cbe9a21e21b9101-960x720.jpg 960w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Kate and Scott Savett, of Allentown, Pennsylvania, at an event of the Greater Delaware Valley chapter of the National MS Society, in Philadelphia. \u003ccite>(Bastiaan Slabbers for NPR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Kate was diagnosed with multiple sclerosis in January. Doctors did a lot of tests and then follow-up tests. On top of that, Scott needed some imaging tests for a spinal issue.\u003c/p>\n\u003cp>Under their insurance plan, the two have to pay in full for the first $3,000 of their combined care. After that, they still have to pay 20 percent of the cost, until they reach a total of $8,000 in out-of-pocket expenses.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>That experience made them want to find the best care for the best deal. But how?\u003c/p>\n\u003cp>They investigated, using an online cost estimator offered through their insurance company.\u003c/p>\n\u003cp>Scott logs in to use the tool, and searches for the typical cost of MRI scans in his region. The online calculator tells him the average cost is $1,270; the lowest is $512 and the \"above average\" is $1,790.\u003c/p>\n\u003cp>The tool then produced a list of different providers and an estimate of how much they will specifically charge under the plan the Savetts have.\u003c/p>\n\u003cp>At first, this kind of information seemed great to the couple. But it quickly proved to be quite the headache.\u003c/p>\n\u003cp>A few days before Kate was scheduled to have her first MRI, she and Scott got a call from the radiology office, saying that the scan would cost them $2,400. They were shocked — the online calculator had told them it would only be about $500.\u003c/p>\n\u003cp>What's the source of the disconnect?\u003c/p>\n\u003cp>A hospital had bought the imaging center and raised the price.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>There were misquotes on other procedures, too. The Savetts received some bills from health providers that were as much as $1,000 higher than the price the online calculator had led them to expect. Another time, they couldn't find any listings at all for a procedure one of them needed.\u003c/p>\n\u003cp>The two quickly plowed through their $3,000 deductible. Financial planning became increasingly difficult. They delayed buying a new water heater for their house.\u003c/p>\n\u003cp>\"It's hard for us to pull the trigger on that, knowing that another bill could be coming around the corner,\" Kate says.\u003c/p>\n\u003cp>It's unclear how common these inaccuracies with online estimators are, but the tools \u003cem>are\u003c/em> becoming more popular, as patients shoulder a bigger share of the cost of their medical care. Outside companies are developing the online calculators, and most insurers offer them.\u003c/p>\n\u003cp>\"Each one of them — whether it's Aetna, United, Cigna — they all have something,\" says \u003ca href=\"http://www.hci3.org/about_hci3/team/francois-de-brantes-ms-mba-executive-director\" target=\"_blank\">Francois de Brantes\u003c/a>, director of the Health Care Incentives Improvement Institute, a nonprofit based in Connecticut. De Brantes has been \u003ca href=\"http://www.catalyzepaymentreform.org/images/Accuracy.pdf\" target=\"_blank\">paying close attention\u003c/a> to price-transparency tools.\u003c/p>\n\u003cp>\"There's lots and lots of variability in the information that's provided to consumers,\" he says.\u003c/p>\n\u003cp>Some of the estimators reflect an aggregate range of possible costs; others are based on historic pricing, or claims data from varying sources. Many, he says, are limited in the type of procedures they include.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>As for \u003ca href=\"http://www.uhc.com/individual-and-family/why-uhc/programs-tools/myhealthcare-cost-estimator\" target=\"_blank\">United Healthare's cost estimator\u003c/a> — the one the Savetts used — Craig Hankins, the insurer's vice president of consumer engagement products, gives it an 8 out of 10 in terms of accuracy.\u003c/p>\n\u003cp>\"Right now, I would say if we look at our tool, relative to others that are offered, I would say ours is average — if not above average — in terms of breadth of services as well as accuracy,\" Hankins says.\u003c/p>\n\u003cp>UHC's cost calculator is based on current information, he says, adding that it is in the insurer's interest to have the online tool work. If members get care at an acceptable cost, that saves everyone money.\u003c/p>\n\u003cp>But, he says, the tool has limits — it's hard to predict what a particular doctor will actually \u003cem>do\u003c/em> during an exam, treatment, or office visit, and how he or she will bill for it.\u003c/p>\n\u003cp>That gets at a deeper challenge with these online estimators, says David Newman, director of the nonprofit \u003ca href=\"http://www.healthcostinstitute.org/\" target=\"_blank\">Health Care Cost Institute\u003c/a>, in Washington, D.C. The way billing and reimbursement work in health care is extremely complicated, he says.\u003c/p>\n\u003cp>\"There are 8,000 procedure codes, tens of thousands of diagnostic codes, a million different providers, and hundreds of insurance companies,\" says Newman. Calculators are often based on one specific procedure, so they may not reflect all that happens and is billed for during a visit. In that way, he says, \"this is probably going to be as good as it gets.\"\u003c/p>\n\u003cp>But de Brantes thinks much more improvement is possible.\u003c/p>\n\u003cp>\"It's not that difficult. It really — technologically — is not that difficult at all,\" he says.\u003c/p>\n\u003cp>The information people like the Savetts are seeking exists in the health care system, de Brantes says, even if in some cases it is hidden behind contract agreements. The bigger problem, he says, is that there is no internal pressure to make the online calculator work as well as it could. Health care has thrived in an opaque environment where costs are hard to find.\u003c/p>\n\u003cp>But the needle is starting to move. Employers are demanding these tools for their employees. And several \u003ca href=\"http://www.npr.org/sections/health-shots/2014/11/05/360351551/how-much-is-that-mri-really-massachusetts-shines-a-light\" target=\"_blank\">states mandate\u003c/a> public reporting of \u003ca href=\"http://www.npr.org/sections/health-shots/2014/02/12/276001379/elusive-goal-a-transparent-price-list-for-health-care\" target=\"_blank\">price information\u003c/a>.\u003c/p>\n\u003cp>As for Scott and Kate Savett, the current climate has turned each of them into a new breed of health care consumer: a savvy one.\u003c/p>\n\u003cp>Scott says he knows they are approaching their $8,000 out-of- pocket cap for the year, which means insurance will soon cover the entire cost of their care. But he doesn't want to give in. He wants to see improvements.\u003c/p>\n\u003cp>\"I would rather crawl to that $8,000 cap than sprint to it,\" he says. \"I know we're going to get there this year, unfortunately, but to blow it all on an MRI that's excessively priced rubs me the wrong way.\"\u003c/p>\n\u003cp>A few weeks after we first talked, Savett received a bill for his MRI. Turns out, it's pretty close to what the estimator predicted it would be — $1,100. He says he will keep using the tool. But he sees it as an imperfect clue rather than a price tag.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This story is part of NPR's reporting partnership with WHYY's \u003ca href=\"http://www.newsworks.org/index.php/thepulse\" target=\"_blank\">The Pulse\u003c/a> and \u003c/em>\u003ca href=\"http://www.kaiserhealthnews.org\" target=\"_blank\">Kaiser Health News\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/116325/patients-want-to-price-shop-for-care-but-online-tools-unreliable","authors":["byline_stateofhealth_116325"],"series":["stateofhealth_2492"],"categories":["stateofhealth_2442"],"tags":["stateofhealth_799"],"featImg":"stateofhealth_116348","label":"source_stateofhealth_116325"},"stateofhealth_99041":{"type":"posts","id":"stateofhealth_99041","meta":{"index":"posts_1716263798","site":"stateofhealth","id":"99041","score":null,"sort":[1446058816000]},"parent":0,"labelTerm":{"site":"stateofhealth","term":2492},"blocks":[],"publishDate":1446058816,"format":"standard","disqusTitle":"PriceCheck: How Much for That Flu Shot?","title":"PriceCheck: How Much for That Flu Shot?","headTitle":"Price Check | State of Health | KQED News","content":"\u003cp>It's that time of year. And I don't mean pray for rain (although on the health desk, we're doing that, too). Flu season is ramping up.\u003c/p>\n\u003cp>To protect yourself, the \u003ca href=\"http://flu%20shot%20recommendation%20cdc\" target=\"_blank\">Centers for Disease Control recommends\u003c/a> that everyone over 6 months get a flu vaccine. While not 100 percent effective, it can keep you from getting the flu -- or, if you do get sick, it can mean a more mild course of illness and help you avoid serious complications, including hospitalization and even death.\u003c/p>\n\u003caside class=\"pullquote alignright\">\nShare what you paid for a flu shot on \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">KQED's PriceCheck\u003c/a>\u003cbr>\n\u003c/aside>\n\u003cp> When it comes to flu shots, we're also concerned about health care costs. On our \"\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">PriceCheck\u003c/a>\" project, we're \u003ca href=\"http://ww2.kqed.org/stateofhealth/series/price-check/\" target=\"_blank\">crowdsourcing prices \u003c/a>for everything from mammograms to colonoscopies.\u003c/p>\n\u003cp>Now we're looking at cost of flu shots. We want to know what you were charged, what your insurer paid and what you paid (if anything) for your flu vaccine.\u003c/p>\n\u003cp>Under the Affordable Care Act, flu shots are supposed to be covered by your insurance, with no copay or other costs out of your pocket. But the \u003ca href=\"http://www.hhs.gov/answers/affordable-care-act/will-the-aca-cover-my-flu-shot/index.html\" target=\"_blank\">Department of Health and Human Services specifies \u003c/a>to check with your insurance company in advance. \"Some insurance plans only cover vaccines given by your doctor or at a limited set of locations,\" HHS says.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>So, what's your story? We want to know. A \u003ca href=\"http://www.slate.com/articles/health_and_science/medical_examiner/2015/09/pharmacy_flu_vaccine_health_insurance_policies_should_cover_drug_store_shots.single.html\" target=\"_blank\">Slate reporter detailed \u003c/a>the hell he went through in trying to find out why coverage for his flu shot was declined. It wasn't supposed to be.\u003c/p>\n\u003cp>If you go to your own doctor, the shot should be covered, but plenty of people might rather get the flu shot while they're out running errands and pop into any one of a number of big box stores or pharmacies that offer them. Here are a few places, with currently-advertised prices:\u003c/p>\n\u003cul>\n\u003cli>\u003ca href=\"http://www.walgreens.com/topic/healthcare-clinic/price-menu.jsp\" target=\"_blank\">Walgreens\u003c/a>: $31.99 per dose for ages 2+; mentions insurance, although does not explicitly say plans are accepted\u003c/li>\n\u003cli>\u003ca href=\"http://www.target.com/c/flu-shots-pharmacy-health/-/N-4yn83\" target=\"_blank\">Target\u003c/a>: $24.99 per shot; \"most insurance accepted\"\u003c/li>\n\u003cli>\u003ca href=\"http://www.costco.com/Pharmacy/adult-immunization-program.html\" target=\"_blank\">Costco\u003c/a>: $14.99; \"many insurance companies cover immunizations given at the pharmacy\"\u003c/li>\n\u003cli>\u003ca href=\"http://www.walmart.com/cp/Immunizations-Flu-Shots/1228302\" target=\"_blank\">Walmart\u003c/a>: $25.00; \"most insurance plans accepted\"\u003c/li>\n\u003cli>\u003ca href=\"http://www.safeway.com/ShopStores/Flu-Shots.page\" target=\"_blank\">Safeway\u003c/a>: While Safeway does not show on its website how much they'll charge, it does offer a \"10% off groceries\" coupon (unless you live in New Jersey, sorry).\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>How Much Did You Pay?\u003c/strong>\u003c/p>\n\u003cp>The prices above are \"charged prices.\" These may differ from what your insurer pays -- and then there's the question of out-of-pocket costs for you. And are these large chains even \"in network\" for you?\u003c/p>\n\u003cp>We want to know -- after you get your flu shot (or if you've already done it), please visit our \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">PriceCheck page\u003c/a>. On the left side of the form, type in \"Flu shot\" under \"procedure or supplies\" then continue down the form filling in where you had received the vaccine and, perhaps most importantly, the three cost items: \"total price charged;\" \"insurance paid;\" and \"you paid.\" Please tell us more about your experience in the \"comments\" box -- and do leave an email address so we can contact you if we have questions.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Thanks for helping us make health costs transparent. We'll write in a future post about what we learn regarding flu shot costs.\u003c/p>\n\n","disqusIdentifier":"99041 http://ww2.kqed.org/stateofhealth/?p=99041","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/10/28/pricecheck-how-much-for-that-flu-shot/","stats":{"hasVideo":false,"hasChartOrMap":false,"hasAudio":false,"hasPolis":false,"wordCount":546,"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"iframeSrcs":[],"paragraphCount":13},"modified":1446135063,"excerpt":"KQED is crowdsourcing the prices for various medical tests and procedures. Now we're turning to flu shots.","headData":{"twImgId":"","twTitle":"","ogTitle":"","ogImgId":"","twDescription":"","description":"KQED is crowdsourcing the prices for various medical tests and procedures. Now we're turning to flu shots.","title":"PriceCheck: How Much for That Flu Shot? | KQED","ogDescription":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"PriceCheck: How Much for That Flu Shot?","datePublished":"2015-10-28T12:00:16-07:00","dateModified":"2015-10-29T09:11:03-07:00","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"guestAuthors":[],"slug":"pricecheck-how-much-for-that-flu-shot","status":"publish","path":"/stateofhealth/99041/pricecheck-how-much-for-that-flu-shot","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>It's that time of year. And I don't mean pray for rain (although on the health desk, we're doing that, too). Flu season is ramping up.\u003c/p>\n\u003cp>To protect yourself, the \u003ca href=\"http://flu%20shot%20recommendation%20cdc\" target=\"_blank\">Centers for Disease Control recommends\u003c/a> that everyone over 6 months get a flu vaccine. While not 100 percent effective, it can keep you from getting the flu -- or, if you do get sick, it can mean a more mild course of illness and help you avoid serious complications, including hospitalization and even death.\u003c/p>\n\u003caside class=\"pullquote alignright\">\nShare what you paid for a flu shot on \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">KQED's PriceCheck\u003c/a>\u003cbr>\n\u003c/aside>\n\u003cp> When it comes to flu shots, we're also concerned about health care costs. On our \"\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">PriceCheck\u003c/a>\" project, we're \u003ca href=\"http://ww2.kqed.org/stateofhealth/series/price-check/\" target=\"_blank\">crowdsourcing prices \u003c/a>for everything from mammograms to colonoscopies.\u003c/p>\n\u003cp>Now we're looking at cost of flu shots. We want to know what you were charged, what your insurer paid and what you paid (if anything) for your flu vaccine.\u003c/p>\n\u003cp>Under the Affordable Care Act, flu shots are supposed to be covered by your insurance, with no copay or other costs out of your pocket. But the \u003ca href=\"http://www.hhs.gov/answers/affordable-care-act/will-the-aca-cover-my-flu-shot/index.html\" target=\"_blank\">Department of Health and Human Services specifies \u003c/a>to check with your insurance company in advance. \"Some insurance plans only cover vaccines given by your doctor or at a limited set of locations,\" HHS says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>So, what's your story? We want to know. A \u003ca href=\"http://www.slate.com/articles/health_and_science/medical_examiner/2015/09/pharmacy_flu_vaccine_health_insurance_policies_should_cover_drug_store_shots.single.html\" target=\"_blank\">Slate reporter detailed \u003c/a>the hell he went through in trying to find out why coverage for his flu shot was declined. It wasn't supposed to be.\u003c/p>\n\u003cp>If you go to your own doctor, the shot should be covered, but plenty of people might rather get the flu shot while they're out running errands and pop into any one of a number of big box stores or pharmacies that offer them. Here are a few places, with currently-advertised prices:\u003c/p>\n\u003cul>\n\u003cli>\u003ca href=\"http://www.walgreens.com/topic/healthcare-clinic/price-menu.jsp\" target=\"_blank\">Walgreens\u003c/a>: $31.99 per dose for ages 2+; mentions insurance, although does not explicitly say plans are accepted\u003c/li>\n\u003cli>\u003ca href=\"http://www.target.com/c/flu-shots-pharmacy-health/-/N-4yn83\" target=\"_blank\">Target\u003c/a>: $24.99 per shot; \"most insurance accepted\"\u003c/li>\n\u003cli>\u003ca href=\"http://www.costco.com/Pharmacy/adult-immunization-program.html\" target=\"_blank\">Costco\u003c/a>: $14.99; \"many insurance companies cover immunizations given at the pharmacy\"\u003c/li>\n\u003cli>\u003ca href=\"http://www.walmart.com/cp/Immunizations-Flu-Shots/1228302\" target=\"_blank\">Walmart\u003c/a>: $25.00; \"most insurance plans accepted\"\u003c/li>\n\u003cli>\u003ca href=\"http://www.safeway.com/ShopStores/Flu-Shots.page\" target=\"_blank\">Safeway\u003c/a>: While Safeway does not show on its website how much they'll charge, it does offer a \"10% off groceries\" coupon (unless you live in New Jersey, sorry).\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>How Much Did You Pay?\u003c/strong>\u003c/p>\n\u003cp>The prices above are \"charged prices.\" These may differ from what your insurer pays -- and then there's the question of out-of-pocket costs for you. And are these large chains even \"in network\" for you?\u003c/p>\n\u003cp>We want to know -- after you get your flu shot (or if you've already done it), please visit our \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">PriceCheck page\u003c/a>. On the left side of the form, type in \"Flu shot\" under \"procedure or supplies\" then continue down the form filling in where you had received the vaccine and, perhaps most importantly, the three cost items: \"total price charged;\" \"insurance paid;\" and \"you paid.\" Please tell us more about your experience in the \"comments\" box -- and do leave an email address so we can contact you if we have questions.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Thanks for helping us make health costs transparent. We'll write in a future post about what we learn regarding flu shot costs.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/99041/pricecheck-how-much-for-that-flu-shot","authors":["240"],"series":["stateofhealth_2492"],"categories":["stateofhealth_12"],"tags":["stateofhealth_385","stateofhealth_2519"],"featImg":"stateofhealth_99067","label":"stateofhealth_2492"},"stateofhealth_95454":{"type":"posts","id":"stateofhealth_95454","meta":{"index":"posts_1716263798","site":"stateofhealth","id":"95454","score":null,"sort":[1445446385000]},"parent":0,"labelTerm":{},"blocks":[],"publishDate":1445446385,"format":"standard","disqusTitle":"Yes, Shopping for Health Care is Hard, But Don't Give Up","title":"Yes, Shopping for Health Care is Hard, But Don't Give Up","headTitle":"Price Check | State of Health | KQED News","content":"\u003cp>\u003cem>Editor's note: this essay comes to us from our \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">PriceCheck\u003c/a> partner, Jeanne Pinder, the founder of \u003ca href=\"https://clearhealthcosts.com\" target=\"_blank\">ClearHealthCosts\u003c/a>. Her mission is improving transparency in health prices by giving consumers more power by lifting the veil on the opaque world of health care prices.\u003c/em>\u003c/p>\n\u003cp>Yes, people are shopping for health care. Some are better at it than others, and some providers and payers (read: doctors and insurers) are better than others about revealing information. We're always interested to hear when people who haven't encountered these truths come up against the real world. So when Sarah Kliff, the well-respected health care writer for Vox.com, wrote about her experience \u003ca href=\"http://www.vox.com/2015/10/19/9567991/health-care-shopping-mri\" target=\"_blank\">trying to get a better price for an MRI\u003c/a>, I was really interested.\u003c/p>\n\u003cp>In her story Kliff said she had a fracture that hadn't healed properly. After she spent weeks in a walking cast and saw little improvement, her doctor recommended an MRI. Kliff scheduled an MRI at an academic center, then heard from her insurance company that they had a better choice that was less expensive. That's where she went.\u003c/p>\n\u003cp>[contextly_sidebar id=\"hGVGNvKrsTsPnj7fRdvTeNOueVtv99Gh\"]But when she returned to her doctor for the results, he said that it was hard to for him to get the MRI scan, because he wasn't familiar with the facility she went to. She waited for awhile as the offices straightened this out. Then the doctor told her that the quality of the MRI was a little blurry, and he wanted a better version (that could have been done at the expensive academic medical center where she was first sent!). Still, the scan was good enough for the doctor to diagnose a fracture.\u003c/p>\n\u003cp>In Sarah's story she concluded that shopping for health care is hard.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>At \u003ca href=\"https://clearhealthcosts.com\" target=\"_blank\">ClearHealthCosts\u003c/a>, the company I founded, we've been studying and writing about this for years now, so I have a few observations.\u003c/p>\n\u003cp>My questions for Sarah:\u003c/p>\n\u003cul>\n\u003cli>Having been directed to a different MRI provider by the insurance company, did you ask the doctor if the quality at that provider is OK? This system is a mess, and we often hear of people being steered to a provider for reasons of money (the doctor's in-network, or the gastrointestinal doctor owns an interest in the GI center where she sends patients for a colonoscopy, etc) or for reasons of quality (this place has old machines; please don't go there).\u003c/li>\n\u003cli>Did you ask the same quality question of the insurance company that sent you to a different provider?\u003c/li>\n\u003cli>As a reporter, did you ask why there were no quality metrics posted publicly or made available in other ways? Quality metrics are in their infancy.\u003c/li>\n\u003c/ul>\n\u003cp>I also wonder if MRIs at the academic medical center where she was first sent ever has blurry scans.\u003c/p>\n\u003cp>I have a friend who works at a prestigious New York City hospital. When I asked him about the quality question, he laughed and said \"Every MRI that comes into [our hospital from another center] gets a sticker up in the corner that says, \"Poor quality. Must re-do,\" or words to that effect.\u003c/p>\n\u003cp>[contextly_sidebar id=\"PAvOhcs5QFWfXqbeuQwNRmx1NEHCybJ3\"]To his credit, he seemed shamefaced about this –- not gloating, but truly just acknowledging that this is common practice and that it’s ridiculous that every single MRI not performed at his hospital would be flawed.\u003c/p>\n\u003cp>Kliff said she’d saved her insurer money by going cheaper. But the insurer has power to save money itself: It contracts with both the expensive MRI provider and the inexpensive MRI provider. Why doesn’t it simply refuse to pay the higher rate? The answer, of course, depends on who you talk to: the expensive provider has market power; the expensive provider needs to get paid more because its care is better; the expensive provider needs to be compensated for uncompensated care, etc.\u003c/p>\n\u003cp>But the truth is: the money that Kliff saved her insurance company will not be finding its way back to her soon. High prices benefit many in the marketplace by creating an artificial view of pricing, and by scaring the pants off people. (“A $6,000 MRI? Wow, glad I have insurance, and glad they negotiated it down to $2,000! Whew!”)\u003c/p>\n\u003cp>For many people, having choice in where they go for health care is a foreign experience.\u003c/p>\n\u003cp>It's especially foreign for people who have not used much health care recently -- and also for younger people. They just haven't got as many health issues and may be more trusting than someone like me, who, at 61, has had her share of health care experiences.\u003c/p>\n\u003cp>Sarah's conclusion: \"My own health care experience is far from unique. But it was a helpful, first-person demonstration of how shopping for health care might not be a zero-sum game, and that even with basic services, there can be clear winners and losers.\"\u003c/p>\n\u003cp>My conclusion: Yes, it's hard. But we have to keep trying.\u003c/p>\n\u003cp>My advice to anyone who is trying to get good quality -- at a fair price:\u003c/p>\n\u003cul>\n\u003cli>Ask about quality.\u003cbr>\nIf they won't give you an answer, ask again.\u003cbr>\nAsk why not.\u003cbr>\nAsk who's making money off this.\u003c/li>\n\u003cli>Yes, the system makes it hard to get at the right answer. But that does not mean we should give up trying.\u003c/li>\n\u003c/ul>\n\u003cp>There are baby steps toward bringing more cost and quality transparency to health care. Here are some sites (in addition to PriceCheck or ClearHealthCosts):\u003c/p>\n\u003cul>\n\u003cli>\u003ca href=\"https://healthcarebluebook.com/page_ConsumerFront.aspx\" target=\"_blank\">Healthcare Bluebook\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"http://www.cahealthcarecompare.org/search.jsp\" target=\"_blank\">California Healthcare Compare\u003c/a>\u003c/li>\n\u003c/ul>\n\u003cp>\u003c/p>\n\u003cp>People are saving money by asking questions about price. It won't always work perfectly, but I hear every day from people who have saved money by asking some questions and doing some research.\u003c/p>\n\n","disqusIdentifier":"95454 http://ww2.kqed.org/stateofhealth/?p=95454","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/10/21/yes-shopping-for-health-care-is-hard-but-dont-give-up/","stats":{"hasVideo":false,"hasChartOrMap":false,"hasAudio":false,"hasPolis":false,"wordCount":968,"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"iframeSrcs":[],"paragraphCount":21},"modified":1445447420,"excerpt":null,"headData":{"twImgId":"","twTitle":"","ogTitle":"","ogImgId":"","twDescription":"","description":"Editor's note: this essay comes to us from our PriceCheck partner, Jeanne Pinder, the founder of ClearHealthCosts. Her mission is improving transparency in health prices by giving consumers more power by lifting the veil on the opaque world of health care prices. Yes, people are shopping for health care. Some are better at it than","title":"Yes, Shopping for Health Care is Hard, But Don't Give Up | KQED","ogDescription":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Yes, Shopping for Health Care is Hard, But Don't Give Up","datePublished":"2015-10-21T09:53:05-07:00","dateModified":"2015-10-21T10:10:20-07:00","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"guestAuthors":[],"slug":"yes-shopping-for-health-care-is-hard-but-dont-give-up","status":"publish","sourceUrl":"https://clearhealthcosts.com","nprByline":"Jeanne Pinder","source":"ClearHealthCosts","path":"/stateofhealth/95454/yes-shopping-for-health-care-is-hard-but-dont-give-up","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>Editor's note: this essay comes to us from our \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">PriceCheck\u003c/a> partner, Jeanne Pinder, the founder of \u003ca href=\"https://clearhealthcosts.com\" target=\"_blank\">ClearHealthCosts\u003c/a>. Her mission is improving transparency in health prices by giving consumers more power by lifting the veil on the opaque world of health care prices.\u003c/em>\u003c/p>\n\u003cp>Yes, people are shopping for health care. Some are better at it than others, and some providers and payers (read: doctors and insurers) are better than others about revealing information. We're always interested to hear when people who haven't encountered these truths come up against the real world. So when Sarah Kliff, the well-respected health care writer for Vox.com, wrote about her experience \u003ca href=\"http://www.vox.com/2015/10/19/9567991/health-care-shopping-mri\" target=\"_blank\">trying to get a better price for an MRI\u003c/a>, I was really interested.\u003c/p>\n\u003cp>In her story Kliff said she had a fracture that hadn't healed properly. After she spent weeks in a walking cast and saw little improvement, her doctor recommended an MRI. Kliff scheduled an MRI at an academic center, then heard from her insurance company that they had a better choice that was less expensive. That's where she went.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>But when she returned to her doctor for the results, he said that it was hard to for him to get the MRI scan, because he wasn't familiar with the facility she went to. She waited for awhile as the offices straightened this out. Then the doctor told her that the quality of the MRI was a little blurry, and he wanted a better version (that could have been done at the expensive academic medical center where she was first sent!). Still, the scan was good enough for the doctor to diagnose a fracture.\u003c/p>\n\u003cp>In Sarah's story she concluded that shopping for health care is hard.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>At \u003ca href=\"https://clearhealthcosts.com\" target=\"_blank\">ClearHealthCosts\u003c/a>, the company I founded, we've been studying and writing about this for years now, so I have a few observations.\u003c/p>\n\u003cp>My questions for Sarah:\u003c/p>\n\u003cul>\n\u003cli>Having been directed to a different MRI provider by the insurance company, did you ask the doctor if the quality at that provider is OK? This system is a mess, and we often hear of people being steered to a provider for reasons of money (the doctor's in-network, or the gastrointestinal doctor owns an interest in the GI center where she sends patients for a colonoscopy, etc) or for reasons of quality (this place has old machines; please don't go there).\u003c/li>\n\u003cli>Did you ask the same quality question of the insurance company that sent you to a different provider?\u003c/li>\n\u003cli>As a reporter, did you ask why there were no quality metrics posted publicly or made available in other ways? Quality metrics are in their infancy.\u003c/li>\n\u003c/ul>\n\u003cp>I also wonder if MRIs at the academic medical center where she was first sent ever has blurry scans.\u003c/p>\n\u003cp>I have a friend who works at a prestigious New York City hospital. When I asked him about the quality question, he laughed and said \"Every MRI that comes into [our hospital from another center] gets a sticker up in the corner that says, \"Poor quality. Must re-do,\" or words to that effect.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>To his credit, he seemed shamefaced about this –- not gloating, but truly just acknowledging that this is common practice and that it’s ridiculous that every single MRI not performed at his hospital would be flawed.\u003c/p>\n\u003cp>Kliff said she’d saved her insurer money by going cheaper. But the insurer has power to save money itself: It contracts with both the expensive MRI provider and the inexpensive MRI provider. Why doesn’t it simply refuse to pay the higher rate? The answer, of course, depends on who you talk to: the expensive provider has market power; the expensive provider needs to get paid more because its care is better; the expensive provider needs to be compensated for uncompensated care, etc.\u003c/p>\n\u003cp>But the truth is: the money that Kliff saved her insurance company will not be finding its way back to her soon. High prices benefit many in the marketplace by creating an artificial view of pricing, and by scaring the pants off people. (“A $6,000 MRI? Wow, glad I have insurance, and glad they negotiated it down to $2,000! Whew!”)\u003c/p>\n\u003cp>For many people, having choice in where they go for health care is a foreign experience.\u003c/p>\n\u003cp>It's especially foreign for people who have not used much health care recently -- and also for younger people. They just haven't got as many health issues and may be more trusting than someone like me, who, at 61, has had her share of health care experiences.\u003c/p>\n\u003cp>Sarah's conclusion: \"My own health care experience is far from unique. But it was a helpful, first-person demonstration of how shopping for health care might not be a zero-sum game, and that even with basic services, there can be clear winners and losers.\"\u003c/p>\n\u003cp>My conclusion: Yes, it's hard. But we have to keep trying.\u003c/p>\n\u003cp>My advice to anyone who is trying to get good quality -- at a fair price:\u003c/p>\n\u003cul>\n\u003cli>Ask about quality.\u003cbr>\nIf they won't give you an answer, ask again.\u003cbr>\nAsk why not.\u003cbr>\nAsk who's making money off this.\u003c/li>\n\u003cli>Yes, the system makes it hard to get at the right answer. But that does not mean we should give up trying.\u003c/li>\n\u003c/ul>\n\u003cp>There are baby steps toward bringing more cost and quality transparency to health care. Here are some sites (in addition to PriceCheck or ClearHealthCosts):\u003c/p>\n\u003cul>\n\u003cli>\u003ca href=\"https://healthcarebluebook.com/page_ConsumerFront.aspx\" target=\"_blank\">Healthcare Bluebook\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"http://www.cahealthcarecompare.org/search.jsp\" target=\"_blank\">California Healthcare Compare\u003c/a>\u003c/li>\n\u003c/ul>\n\u003cp>\u003c/p>\n\u003cp>People are saving money by asking questions about price. It won't always work perfectly, but I hear every day from people who have saved money by asking some questions and doing some research.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/95454/yes-shopping-for-health-care-is-hard-but-dont-give-up","authors":["byline_stateofhealth_95454"],"series":["stateofhealth_2492"],"categories":["stateofhealth_2442","stateofhealth_13"],"tags":["stateofhealth_393","stateofhealth_799"],"featImg":"stateofhealth_95829","label":"source_stateofhealth_95454"},"stateofhealth_81449":{"type":"posts","id":"stateofhealth_81449","meta":{"index":"posts_1716263798","site":"stateofhealth","id":"81449","score":null,"sort":[1442858453000]},"parent":0,"labelTerm":{},"blocks":[],"publishDate":1442858453,"format":"standard","disqusTitle":"Attention Shoppers! New Calif. Website Details Costs, Quality of Medical Procedures","title":"Attention Shoppers! New Calif. Website Details Costs, Quality of Medical Procedures","headTitle":"Price Check | State of Health | KQED News","content":"\u003cp>Having a baby in California?\u003c/p>\n\u003cp>Your average out-of-pocket costs for an uncomplicated birth could cost a lot less in San Mateo County ($920) than in Alameda County ($1,300), Santa Clara County ($1,500) or Orange County ($1,800).\u003c/p>\n\u003cp>Thinking about a knee replacement?\u003c/p>\n\u003cp>You’ll find a surprisingly wide variation in quality ratings among Bay Area hospitals for the procedure.\u003c/p>\n\u003cp>These are among the insights from a new consumer website unveiled Monday by the California Department of Insurance to help Californians better shop for health care based on both quality and price.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The site, \u003ca href=\"http://www.cahealthcarecompare.org/search.jsp\" target=\"_blank\">California Healthcare Compare\u003c/a>, was created for the state insurance agency by UC San Francisco researchers and Consumer Reports with a federal grant from the Centers for Medicare & Medicaid Services.\u003c/p>\n\u003cp>The site provides information on quality for five common conditions or procedures: childbirth, hip and knee replacement, colon cancer screening, diabetes and back pain. And it gives cost information -- by county for 100 procedures, ranging from treating a broken ankle to cancer chemotherapy.\u003c/p>\n\u003cp>“When it comes to health care cost and quality, it’s really a black box for consumers. They don’t know how much they’re going to pay,” said Doris Peter, director of the \u003ca href=\"http://consumerhealthchoices.org/a-look-at-the-health-ratings-center/\" target=\"_blank\">Consumer Reports Health Ratings Center\u003c/a>. “This website is a first step toward providing this information.”\u003c/p>\n\u003cp>Websites to help consumers evaluate the quality of hospitals and other health providers have been around for years. But they often focus on cost or quality, not both, and remain a work in progress – even as consumers with high-deductible health plans under the Affordable Care Act are looking for better information to make smart health care decisions.\u003c/p>\n\u003cp>Nationally, the Centers for Medicare & Medicaid Services’ \u003ca href=\"https://www.medicare.gov/hospitalcompare/search.html\" target=\"_blank\">HospitalCompare\u003c/a> website offers data on quality for 4,000 hospitals, allowing patients to review how well hospitals treat conditions like asthma, heart attacks, stroke or pneumonia, among other measures.\u003c/p>\n\u003cp>Californians also can find health care quality -- but not cost -- data at \u003ca href=\"http://www.calqualitycare.org/\" target=\"_blank\">CalQualityCare.org\u003c/a>, which provides information on the state’s hospitals, doctor groups, nursing homes, assisted living facilities, home health and hospice services, adult day care, and services for the developmentally disabled. The site is run by the Oakland-based California HealthCare Foundation.\u003c/p>\n\u003cp>Patients can find the sites complicated to use, and providers \u003ca href=\"http://www.modernhealthcare.com/article/20140531/MAGAZINE/305319980\" target=\"_blank\">have pushed back\u003c/a> against some quality rating methodologies. Rather than scrutinizing a website, consumers often will rely on personal recommendations from their physicians or friends and family to decide on where to have a procedure done.\u003c/p>\n\u003cp>Data on health care costs, much of it closely held by health insurers, can be even harder to gather and share with the public, although many ventures are trying, including \u003ca href=\"https://healthcarebluebook.com\" target=\"_blank\">Healthcare Bluebook\u003c/a> and \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">KQED's PriceCheck,\u003c/a> a crowdsourcing collaboration with KPCC in Los Angeles and with \u003ca href=\"http://clearhealthcosts.com/\" target=\"_blank\">ClearHealthCosts.com\u003c/a>, a health care cost transparency startup.\u003c/p>\n\u003cp>The creators of the California Department of Insurance’s new site, California Healthcare Compare, are trying to push past those hurdles.\u003c/p>\n\u003cp>They’ve gathered health quality and cost data from state and federal agencies, including HospitalCompare, the \u003ca href=\"http://www.nbch.org/PPR-Case-Study---Integrated-Health-Association\" target=\"_blank\">Integrated Healthcare Association\u003c/a>, \u003ca href=\"https://www.cmqcc.org/maternal-data-center\">California Maternal Quality Care Collaborative\u003c/a> and insurance claims data.\u003c/p>\n\u003cp>Cost data is available for all counties except Kern, which had only one insurer at the time the cost data was last collected, in 2013.\u003c/p>\n\u003cp>In a written statement, California Insurance Commissioner Dave Jones said: \"This is ... a first step toward convincing doctors, hospitals and insurers and legislators of the benefits of sharing more detailed price information to allow consumers faced with high deductible plans to make better decisions.\"\u003c/p>\n\u003cp>While California Healthcare Compare aims to be more comprehensive than other data sources, its usefulness for consumers remains to be seen. While the site breaks down average out-of-pocket costs for consumers and average costs that insurers pay, it can be difficult for consumers to figure out what their own costs will be.\u003c/p>\n\u003cp>The site helpfully links consumers to online out-of-pocket cost calculators maintained by major insurers, including Kaiser Permanente, Aetna and Anthem Blue Cross, but some insurers still lack them. In addition, the site averages the low out-of-pocket costs of Medi-Cal patients with those of privately insured patients, which can be far higher. And consumers may find the disconnect between the total cost of a procedure – what insurers and consumers jointly pay to a provider – and their own out-of-pocket costs to be confusing.\u003c/p>\n\u003cp>Take total knee replacements. In Alameda County, where the surgery’s total average cost for consumers and employers is listed as more than $55,000 – the highest in the state -- the site estimates average out-of-pocket costs at only $86. In comparison, the total cost for the same surgery in Santa Clara County is just under $40,000 – but the average out-of-pocket cost is about $300.\u003c/p>\n\u003cp>The site will evolve over time if funding can be sustained, said Dr. R. Adams Dudley, director of the UCSF Center for Healthcare Value, which led the project. He hopes to add quality and cost data for many more conditions, and also provide cost data for individual hospitals and doctors’ groups.\u003c/p>\n\u003cp>What’s important is to continue the push to make health care cost and quality information more transparent, he said.\u003c/p>\n\u003cp>Public reporting of some quality measures, such as the rate of hospital-acquired infections, has forced providers to improve. Consumers wondering why their insurers pay so much for procedures in one county compared with another might talk to their company’s human resources department, which in turn can question insurers about those costs.\u003c/p>\n\u003cp>“These are the kind of conversations we want people to be having and the kind of shopping we want them to be doing,” Dudley said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Barbara Feder Ostrov reported this story for \u003c/em>\u003ca href=\"http://khn.org\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>, a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003ca href=\"http://www.kff.org/\">\u003cstrong>\u003cem>Kaiser Family Foundation\u003c/em>\u003c/strong>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\n","disqusIdentifier":"81449 http://ww2.kqed.org/stateofhealth/?p=81449","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/09/21/attention-shoppers-new-calif-website-details-costs-quality-of-medical-procedures/","stats":{"hasVideo":false,"hasChartOrMap":false,"hasAudio":false,"hasPolis":false,"wordCount":1009,"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"iframeSrcs":[],"paragraphCount":27},"modified":1443118468,"excerpt":"To help consumers, the California insurance department unveils a website showing wide variation in costs and quality of medical services statewide. ","headData":{"twImgId":"","twTitle":"","ogTitle":"","ogImgId":"","twDescription":"","description":"To help consumers, the California insurance department unveils a website showing wide variation in costs and quality of medical services statewide. ","title":"Attention Shoppers! New Calif. Website Details Costs, Quality of Medical Procedures | KQED","ogDescription":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Attention Shoppers! New Calif. Website Details Costs, Quality of Medical Procedures","datePublished":"2015-09-21T11:00:53-07:00","dateModified":"2015-09-24T11:14:28-07:00","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"guestAuthors":[],"slug":"attention-shoppers-new-calif-website-details-costs-quality-of-medical-procedures","status":"publish","sourceUrl":"www.khn.org","nprByline":"Barbara Feder Ostrov","source":"Kaiser Health News","path":"/stateofhealth/81449/attention-shoppers-new-calif-website-details-costs-quality-of-medical-procedures","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Having a baby in California?\u003c/p>\n\u003cp>Your average out-of-pocket costs for an uncomplicated birth could cost a lot less in San Mateo County ($920) than in Alameda County ($1,300), Santa Clara County ($1,500) or Orange County ($1,800).\u003c/p>\n\u003cp>Thinking about a knee replacement?\u003c/p>\n\u003cp>You’ll find a surprisingly wide variation in quality ratings among Bay Area hospitals for the procedure.\u003c/p>\n\u003cp>These are among the insights from a new consumer website unveiled Monday by the California Department of Insurance to help Californians better shop for health care based on both quality and price.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The site, \u003ca href=\"http://www.cahealthcarecompare.org/search.jsp\" target=\"_blank\">California Healthcare Compare\u003c/a>, was created for the state insurance agency by UC San Francisco researchers and Consumer Reports with a federal grant from the Centers for Medicare & Medicaid Services.\u003c/p>\n\u003cp>The site provides information on quality for five common conditions or procedures: childbirth, hip and knee replacement, colon cancer screening, diabetes and back pain. And it gives cost information -- by county for 100 procedures, ranging from treating a broken ankle to cancer chemotherapy.\u003c/p>\n\u003cp>“When it comes to health care cost and quality, it’s really a black box for consumers. They don’t know how much they’re going to pay,” said Doris Peter, director of the \u003ca href=\"http://consumerhealthchoices.org/a-look-at-the-health-ratings-center/\" target=\"_blank\">Consumer Reports Health Ratings Center\u003c/a>. “This website is a first step toward providing this information.”\u003c/p>\n\u003cp>Websites to help consumers evaluate the quality of hospitals and other health providers have been around for years. But they often focus on cost or quality, not both, and remain a work in progress – even as consumers with high-deductible health plans under the Affordable Care Act are looking for better information to make smart health care decisions.\u003c/p>\n\u003cp>Nationally, the Centers for Medicare & Medicaid Services’ \u003ca href=\"https://www.medicare.gov/hospitalcompare/search.html\" target=\"_blank\">HospitalCompare\u003c/a> website offers data on quality for 4,000 hospitals, allowing patients to review how well hospitals treat conditions like asthma, heart attacks, stroke or pneumonia, among other measures.\u003c/p>\n\u003cp>Californians also can find health care quality -- but not cost -- data at \u003ca href=\"http://www.calqualitycare.org/\" target=\"_blank\">CalQualityCare.org\u003c/a>, which provides information on the state’s hospitals, doctor groups, nursing homes, assisted living facilities, home health and hospice services, adult day care, and services for the developmentally disabled. The site is run by the Oakland-based California HealthCare Foundation.\u003c/p>\n\u003cp>Patients can find the sites complicated to use, and providers \u003ca href=\"http://www.modernhealthcare.com/article/20140531/MAGAZINE/305319980\" target=\"_blank\">have pushed back\u003c/a> against some quality rating methodologies. Rather than scrutinizing a website, consumers often will rely on personal recommendations from their physicians or friends and family to decide on where to have a procedure done.\u003c/p>\n\u003cp>Data on health care costs, much of it closely held by health insurers, can be even harder to gather and share with the public, although many ventures are trying, including \u003ca href=\"https://healthcarebluebook.com\" target=\"_blank\">Healthcare Bluebook\u003c/a> and \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">KQED's PriceCheck,\u003c/a> a crowdsourcing collaboration with KPCC in Los Angeles and with \u003ca href=\"http://clearhealthcosts.com/\" target=\"_blank\">ClearHealthCosts.com\u003c/a>, a health care cost transparency startup.\u003c/p>\n\u003cp>The creators of the California Department of Insurance’s new site, California Healthcare Compare, are trying to push past those hurdles.\u003c/p>\n\u003cp>They’ve gathered health quality and cost data from state and federal agencies, including HospitalCompare, the \u003ca href=\"http://www.nbch.org/PPR-Case-Study---Integrated-Health-Association\" target=\"_blank\">Integrated Healthcare Association\u003c/a>, \u003ca href=\"https://www.cmqcc.org/maternal-data-center\">California Maternal Quality Care Collaborative\u003c/a> and insurance claims data.\u003c/p>\n\u003cp>Cost data is available for all counties except Kern, which had only one insurer at the time the cost data was last collected, in 2013.\u003c/p>\n\u003cp>In a written statement, California Insurance Commissioner Dave Jones said: \"This is ... a first step toward convincing doctors, hospitals and insurers and legislators of the benefits of sharing more detailed price information to allow consumers faced with high deductible plans to make better decisions.\"\u003c/p>\n\u003cp>While California Healthcare Compare aims to be more comprehensive than other data sources, its usefulness for consumers remains to be seen. While the site breaks down average out-of-pocket costs for consumers and average costs that insurers pay, it can be difficult for consumers to figure out what their own costs will be.\u003c/p>\n\u003cp>The site helpfully links consumers to online out-of-pocket cost calculators maintained by major insurers, including Kaiser Permanente, Aetna and Anthem Blue Cross, but some insurers still lack them. In addition, the site averages the low out-of-pocket costs of Medi-Cal patients with those of privately insured patients, which can be far higher. And consumers may find the disconnect between the total cost of a procedure – what insurers and consumers jointly pay to a provider – and their own out-of-pocket costs to be confusing.\u003c/p>\n\u003cp>Take total knee replacements. In Alameda County, where the surgery’s total average cost for consumers and employers is listed as more than $55,000 – the highest in the state -- the site estimates average out-of-pocket costs at only $86. In comparison, the total cost for the same surgery in Santa Clara County is just under $40,000 – but the average out-of-pocket cost is about $300.\u003c/p>\n\u003cp>The site will evolve over time if funding can be sustained, said Dr. R. Adams Dudley, director of the UCSF Center for Healthcare Value, which led the project. He hopes to add quality and cost data for many more conditions, and also provide cost data for individual hospitals and doctors’ groups.\u003c/p>\n\u003cp>What’s important is to continue the push to make health care cost and quality information more transparent, he said.\u003c/p>\n\u003cp>Public reporting of some quality measures, such as the rate of hospital-acquired infections, has forced providers to improve. Consumers wondering why their insurers pay so much for procedures in one county compared with another might talk to their company’s human resources department, which in turn can question insurers about those costs.\u003c/p>\n\u003cp>“These are the kind of conversations we want people to be having and the kind of shopping we want them to be doing,” Dudley said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Barbara Feder Ostrov reported this story for \u003c/em>\u003ca href=\"http://khn.org\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>, a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003ca href=\"http://www.kff.org/\">\u003cstrong>\u003cem>Kaiser Family Foundation\u003c/em>\u003c/strong>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/81449/attention-shoppers-new-calif-website-details-costs-quality-of-medical-procedures","authors":["byline_stateofhealth_81449"],"series":["stateofhealth_2492"],"categories":["stateofhealth_2442"],"tags":["stateofhealth_799"],"featImg":"stateofhealth_81478","label":"source_stateofhealth_81449"},"stateofhealth_50811":{"type":"posts","id":"stateofhealth_50811","meta":{"index":"posts_1716263798","site":"stateofhealth","id":"50811","score":null,"sort":[1437696032000]},"parent":0,"labelTerm":{"site":"stateofhealth","term":2492},"blocks":[],"publishDate":1437696032,"format":"standard","disqusTitle":"PriceCheck: How Much Does It Cost to Have a Baby in Northern California?","title":"PriceCheck: How Much Does It Cost to Have a Baby in Northern California?","headTitle":"Price Check | State of Health | KQED News","content":"\u003cp>Childbirth is the most common reason for hospitalization in the U.S. In California, about\u003ca href=\"http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_01.pdf\" target=\"_blank\"> half a million babies \u003c/a>are born every year. Given how common it is -- and that most births are fairly uncomplicated, medically -- you'd think there would be some predictability in prices.\u003c/p>\n\u003cp>But there isn't. The price of delivery varies dramatically, both nationwide and across California. A\u003ca href=\"http://bmjopen.bmj.com/content/4/1/e004017.abstract?sid=a32193cf-85b1-4f07-b2d1-cba35214aa0a\" target=\"_blank\"> study last year\u003c/a> of more than 109,000 births at 198 hospitals statewide found a stunning 11-fold variation in prices charged for vaginal delivery -- from $3,296 to $37,227 -- and more than 8-fold for cesarean section -- from $8,312 to $70,908.\u003c/p>\n\u003caside class=\"pullquote alignright\">Share what you paid to deliver your baby. \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">Help us make health costs transparent. Visit PriceCheck!\u003c/a>\u003c/aside>\n\u003cp>\"This type of variation is not unique to obstetrics,\" said the study's lead author, Renee Hsia, a physician and professor of health policy at UC San Francisco. \"This is unfortunately the state of our health care in the United States.\"\u003c/p>\n\u003cp>That's why we're turning next to childbirth in our PriceCheck project. On \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">PriceCheck\u003c/a>, we're crowdsourcing the price of common medical tests and procedures. We're asking people to share what they paid -- in this case -- for childbirth. More on how you can share further below, but first, some things you should know if you're pregnant now to make sure you can minimize your bills.\u003c/p>\n\u003cp>\u003cstrong>No Co-pay for Prenatal Care ...\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Under the Affordable Care Act, many preventive services -- including routine prenatal care -- \u003ca href=\"http://www.hhs.gov/healthcare/facts/factsheets/2010/07/preventive-services-list.html#CoveredPreventiveServicesforWomenIncludingPregnantWomen\" target=\"_blank\">must be covered at no cost to the patient\u003c/a>: no deductible, no co-insurance, no co-payment.\u003c/p>\n\u003cp>\"So the first thing they should be looking for and demanding is no cost-sharing for prenatal care,\" said Susan Berke Fogel, with the National Health Law Program. Common screenings like gestational diabetes and Rh incompatibility are just two of the \u003ca href=\"http://www.hhs.gov/healthcare/facts/factsheets/2010/07/preventive-services-list.html#CoveredPreventiveServicesforWomenIncludingPregnantWomen\" target=\"_blank\">tests included\u003c/a> at no cost to the patient.\u003c/p>\n\u003cp>The only exception is if you have a \"grandfathered\" plan. This is a plan that predated the Affordable Care Act and has not been changed much since. These grandfathered plans are not subject to many of the Affordable Care Act mandates and may not include the same benefits.\u003c/p>\n\u003cp>\u003cstrong>... But There Is for Labor and Delivery\u003c/strong>\u003c/p>\n\u003cp>While your costs will depend on your plan, you will almost certainly pay something for labor and delivery. Consumers should contact their plan to try to estimate their costs and check other requirements.\u003c/p>\n\u003cp>\"Understand specifics,\" says Lisa Zamosky, author of \"\u003ca href=\"http://lisazamosky.com/about/\" target=\"_blank\">Healthcare, Insurance and You: The Savvy Consumer's Guide\u003c/a>.\" She also worked for a large managed-care organization before becoming a writer. \"Are pre-authorizations required? Do you need to call the insurance company when you are admitted to the hospital?\"\u003c/p>\n\u003cp>[contextly_sidebar id=\"dSK0x9dmZALaarFtZERECULWv88aushi\"]The good news is that you have time to sort this all out. Both Zamosky and Fogel stressed to make sure both your doctor and the hospital are in network. Some women prefer to deliver at a birth center, but you need to make sure the center is in network, too. If not, do the math to see how an out-of-network birth center pencils out compared with an in-network hospital. (My PriceCheck colleague Rebecca Plevin at KPCC \u003ca href=\"http://www.scpr.org/blogs/health/2015/07/22/18049/pricecheck-how-much-does-it-cost-to-have-a-baby-at/\" target=\"_blank\">looked closely at this issue\u003c/a>.)\u003c/p>\n\u003cp>Even if you are at an in-network facility, it doesn't mean all the providers are also in network. I know this from my own experience. When I delivered my daughter in 2001 at an in-network hospital, I got a $1,200 bill months later for the anesthesiologist. (It was ultimately paid by my insurer.)\u003c/p>\n\u003cp>These \"surprise bills\" are not uncommon. A\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/05/07/nearly-1-in-4-californians-hit-by-surprise-medical-bills/\" target=\"_blank\"> Consumers Union survey \u003c/a>earlier this year found almost one in four Californians who had gone to a hospital or ER got an out-of-network bill from a doctor they had thought was in network.\u003c/p>\n\u003cp>There are steps you can take before you get to the hospital to try to avoid this, Zamosky says, \"but you should know there is a risk.\"\u003c/p>\n\u003cp>She recommends having a pointed conversation with your obstetrician. \"I would be forceful about it and be clear,\" Zamosky says. Tell the doctor: \"'Don't bring anyone in the room who is not participating [in the network]' so that you're not surprised by bills.\"\u003c/p>\n\u003cp>But she also adds that \"you don't have total control.\"\u003c/p>\n\u003cp>It's easy to imagine that you might need an anesthesiologist, but the only one available is out of network. A bill making its way through the California legislature, \u003ca href=\"https://legiscan.com/CA/bill/AB533/2015\" target=\"_blank\">AB533\u003c/a>, would end surprise bills by prohibiting consumers from paying out-of-network rates to doctors (or other providers) as long as they receive care at an in-network facility. If approved, the law would take effect in January.\u003c/p>\n\u003cp>\u003cstrong>What if You're Uninsured?\u003c/strong>\u003c/p>\n\u003cp>If you're pregnant, uninsured and outside the annual sign-up period for health insurance, you are out of luck for signing up for private insurance, including on Covered California. But you \u003cem>may\u003c/em> be eligible for Medi-Cal, the state's version of Medicaid, which is open for sign up year-round.\u003c/p>\n\u003cp>Pregnant women can qualify for Medi-Cal at \u003ca href=\"https://dpss.lacounty.gov/dpss/health/pregnant/medical.cfm?persona=pregnant\" target=\"_blank\">higher incomes\u003c/a> than if they were not pregnant. \"They shouldn't assume they're over income without filing an application,\" says Fogel. Medi-Cal providers may also be able to see a pregnant woman while she is waiting for her application to be processed under a program called \u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/PE_Info_women.aspx\" target=\"_blank\">Presumptive Eligibility\u003c/a>.\u003c/p>\n\u003cp>Once your baby is born, there's still more to think about, insurance-wise:\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>Contraception:\u003c/strong> Many women choose to have an IUD inserted after they have delivered their baby, but are still in the hospital. Under the Affordable Care Act, contraception -- including the IUD, which can be expensive -- is covered at no cost-sharing for the patient.\u003c/li>\n\u003cli>\u003cstrong>Catholic Hospitals:\u003c/strong> If you are considering an IUD, be sure to talk to your doctor about it in advance. Fogle noted a big \"consumer beware\" by pointing out that Catholic hospitals may not provide them. If you are considering a Catholic hospital, she says, be sure to ask your doctor if that hospital will provide the full range of reproductive services.\u003c/li>\n\u003cli>\u003cb>Breastfeeding:\u003c/b> Counseling for breastfeeding and coverage of a breast pump must also be \u003ca href=\"https://www.healthcare.gov/coverage/breast-feeding-benefits/\" target=\"_blank\">covered at no cost\u003c/a> under the Affordable Care Act. But, especially with the pump, plans may vary in coverage. You may need a specific pump or you may need to purchase from a specific provider to get the no-cost benefit.\u003c/li>\n\u003c/ul>\n\u003cp>Of course, your baby will need health insurance, too, and you have a limited time to enroll the newborn. If you have employer-based coverage, you have \u003ca href=\"http://familiesusa.org/sites/default/files/product_documents/special-enrollment-opportunity.pdf\" target=\"_blank\">30 days to add the baby\u003c/a>. If the mother of the baby has a spouse, the spouse also has the opportunity to enroll in coverage within 30 days, says Cheryl Parcham at FamiliesUSA.\u003c/p>\n\u003cp>If you have a plan through Covered California (or any marketplace plan), \u003ca href=\"https://marketplace.cms.gov/technical-assistance-resources/helping-new-parents-enroll.pdf\" target=\"_blank\">you have 60 days to sign up the baby\u003c/a>. The additional bonus is that the whole family can pick a new Covered California plan, if you want to.\u003c/p>\n\u003cp>\u003cstrong>PriceCheck: Share What You Paid\u003c/strong>\u003c/p>\n\u003cp>Now that you have all these tips, we'd appreciate your help! While prices charged vary dramatically, it's impossible to know the variety of what insurers and consumers actually pay. That's because the \"insured prices\" are sealed by contract.\u003c/p>\n\u003cp>You can help shine a light on true costs by getting your \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/18/explaining-the-health-insurance-explanation-of-benefits/\" target=\"_blank\">explanation of benefits\u003c/a> and heading over to \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">PriceCheck\u003c/a>. There you can anonymously share the price charged, what your insurer paid and what you paid, in co-pay or deductible.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>We're primarily interested in vaginal birth, but if you had a cesarean section, we'll happily take those prices, too.\u003c/p>\n\n","disqusIdentifier":"50811 http://ww2.kqed.org/stateofhealth/?p=50811","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/07/23/pricecheck-how-much-does-it-cost-to-have-a-baby-in-northern-california/","stats":{"hasVideo":false,"hasChartOrMap":false,"hasAudio":false,"hasPolis":false,"wordCount":1300,"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"iframeSrcs":[],"paragraphCount":30},"modified":1438035484,"excerpt":"In California, prices charged for a vaginal delivery range 11-fold: $3,296 to $37,227. Share what you paid!","headData":{"twImgId":"","twTitle":"","ogTitle":"","ogImgId":"","twDescription":"","description":"In California, prices charged for a vaginal delivery range 11-fold: $3,296 to $37,227. Share what you paid!","title":"PriceCheck: How Much Does It Cost to Have a Baby in Northern California? | KQED","ogDescription":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"PriceCheck: How Much Does It Cost to Have a Baby in Northern California?","datePublished":"2015-07-23T17:00:32-07:00","dateModified":"2015-07-27T15:18:04-07:00","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"guestAuthors":[],"slug":"pricecheck-how-much-does-it-cost-to-have-a-baby-in-northern-california","status":"publish","path":"/stateofhealth/50811/pricecheck-how-much-does-it-cost-to-have-a-baby-in-northern-california","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Childbirth is the most common reason for hospitalization in the U.S. In California, about\u003ca href=\"http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_01.pdf\" target=\"_blank\"> half a million babies \u003c/a>are born every year. Given how common it is -- and that most births are fairly uncomplicated, medically -- you'd think there would be some predictability in prices.\u003c/p>\n\u003cp>But there isn't. The price of delivery varies dramatically, both nationwide and across California. A\u003ca href=\"http://bmjopen.bmj.com/content/4/1/e004017.abstract?sid=a32193cf-85b1-4f07-b2d1-cba35214aa0a\" target=\"_blank\"> study last year\u003c/a> of more than 109,000 births at 198 hospitals statewide found a stunning 11-fold variation in prices charged for vaginal delivery -- from $3,296 to $37,227 -- and more than 8-fold for cesarean section -- from $8,312 to $70,908.\u003c/p>\n\u003caside class=\"pullquote alignright\">Share what you paid to deliver your baby. \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">Help us make health costs transparent. Visit PriceCheck!\u003c/a>\u003c/aside>\n\u003cp>\"This type of variation is not unique to obstetrics,\" said the study's lead author, Renee Hsia, a physician and professor of health policy at UC San Francisco. \"This is unfortunately the state of our health care in the United States.\"\u003c/p>\n\u003cp>That's why we're turning next to childbirth in our PriceCheck project. On \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">PriceCheck\u003c/a>, we're crowdsourcing the price of common medical tests and procedures. We're asking people to share what they paid -- in this case -- for childbirth. More on how you can share further below, but first, some things you should know if you're pregnant now to make sure you can minimize your bills.\u003c/p>\n\u003cp>\u003cstrong>No Co-pay for Prenatal Care ...\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Under the Affordable Care Act, many preventive services -- including routine prenatal care -- \u003ca href=\"http://www.hhs.gov/healthcare/facts/factsheets/2010/07/preventive-services-list.html#CoveredPreventiveServicesforWomenIncludingPregnantWomen\" target=\"_blank\">must be covered at no cost to the patient\u003c/a>: no deductible, no co-insurance, no co-payment.\u003c/p>\n\u003cp>\"So the first thing they should be looking for and demanding is no cost-sharing for prenatal care,\" said Susan Berke Fogel, with the National Health Law Program. Common screenings like gestational diabetes and Rh incompatibility are just two of the \u003ca href=\"http://www.hhs.gov/healthcare/facts/factsheets/2010/07/preventive-services-list.html#CoveredPreventiveServicesforWomenIncludingPregnantWomen\" target=\"_blank\">tests included\u003c/a> at no cost to the patient.\u003c/p>\n\u003cp>The only exception is if you have a \"grandfathered\" plan. This is a plan that predated the Affordable Care Act and has not been changed much since. These grandfathered plans are not subject to many of the Affordable Care Act mandates and may not include the same benefits.\u003c/p>\n\u003cp>\u003cstrong>... But There Is for Labor and Delivery\u003c/strong>\u003c/p>\n\u003cp>While your costs will depend on your plan, you will almost certainly pay something for labor and delivery. Consumers should contact their plan to try to estimate their costs and check other requirements.\u003c/p>\n\u003cp>\"Understand specifics,\" says Lisa Zamosky, author of \"\u003ca href=\"http://lisazamosky.com/about/\" target=\"_blank\">Healthcare, Insurance and You: The Savvy Consumer's Guide\u003c/a>.\" She also worked for a large managed-care organization before becoming a writer. \"Are pre-authorizations required? Do you need to call the insurance company when you are admitted to the hospital?\"\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>The good news is that you have time to sort this all out. Both Zamosky and Fogel stressed to make sure both your doctor and the hospital are in network. Some women prefer to deliver at a birth center, but you need to make sure the center is in network, too. If not, do the math to see how an out-of-network birth center pencils out compared with an in-network hospital. (My PriceCheck colleague Rebecca Plevin at KPCC \u003ca href=\"http://www.scpr.org/blogs/health/2015/07/22/18049/pricecheck-how-much-does-it-cost-to-have-a-baby-at/\" target=\"_blank\">looked closely at this issue\u003c/a>.)\u003c/p>\n\u003cp>Even if you are at an in-network facility, it doesn't mean all the providers are also in network. I know this from my own experience. When I delivered my daughter in 2001 at an in-network hospital, I got a $1,200 bill months later for the anesthesiologist. (It was ultimately paid by my insurer.)\u003c/p>\n\u003cp>These \"surprise bills\" are not uncommon. A\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/05/07/nearly-1-in-4-californians-hit-by-surprise-medical-bills/\" target=\"_blank\"> Consumers Union survey \u003c/a>earlier this year found almost one in four Californians who had gone to a hospital or ER got an out-of-network bill from a doctor they had thought was in network.\u003c/p>\n\u003cp>There are steps you can take before you get to the hospital to try to avoid this, Zamosky says, \"but you should know there is a risk.\"\u003c/p>\n\u003cp>She recommends having a pointed conversation with your obstetrician. \"I would be forceful about it and be clear,\" Zamosky says. Tell the doctor: \"'Don't bring anyone in the room who is not participating [in the network]' so that you're not surprised by bills.\"\u003c/p>\n\u003cp>But she also adds that \"you don't have total control.\"\u003c/p>\n\u003cp>It's easy to imagine that you might need an anesthesiologist, but the only one available is out of network. A bill making its way through the California legislature, \u003ca href=\"https://legiscan.com/CA/bill/AB533/2015\" target=\"_blank\">AB533\u003c/a>, would end surprise bills by prohibiting consumers from paying out-of-network rates to doctors (or other providers) as long as they receive care at an in-network facility. If approved, the law would take effect in January.\u003c/p>\n\u003cp>\u003cstrong>What if You're Uninsured?\u003c/strong>\u003c/p>\n\u003cp>If you're pregnant, uninsured and outside the annual sign-up period for health insurance, you are out of luck for signing up for private insurance, including on Covered California. But you \u003cem>may\u003c/em> be eligible for Medi-Cal, the state's version of Medicaid, which is open for sign up year-round.\u003c/p>\n\u003cp>Pregnant women can qualify for Medi-Cal at \u003ca href=\"https://dpss.lacounty.gov/dpss/health/pregnant/medical.cfm?persona=pregnant\" target=\"_blank\">higher incomes\u003c/a> than if they were not pregnant. \"They shouldn't assume they're over income without filing an application,\" says Fogel. Medi-Cal providers may also be able to see a pregnant woman while she is waiting for her application to be processed under a program called \u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/PE_Info_women.aspx\" target=\"_blank\">Presumptive Eligibility\u003c/a>.\u003c/p>\n\u003cp>Once your baby is born, there's still more to think about, insurance-wise:\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>Contraception:\u003c/strong> Many women choose to have an IUD inserted after they have delivered their baby, but are still in the hospital. Under the Affordable Care Act, contraception -- including the IUD, which can be expensive -- is covered at no cost-sharing for the patient.\u003c/li>\n\u003cli>\u003cstrong>Catholic Hospitals:\u003c/strong> If you are considering an IUD, be sure to talk to your doctor about it in advance. Fogle noted a big \"consumer beware\" by pointing out that Catholic hospitals may not provide them. If you are considering a Catholic hospital, she says, be sure to ask your doctor if that hospital will provide the full range of reproductive services.\u003c/li>\n\u003cli>\u003cb>Breastfeeding:\u003c/b> Counseling for breastfeeding and coverage of a breast pump must also be \u003ca href=\"https://www.healthcare.gov/coverage/breast-feeding-benefits/\" target=\"_blank\">covered at no cost\u003c/a> under the Affordable Care Act. But, especially with the pump, plans may vary in coverage. You may need a specific pump or you may need to purchase from a specific provider to get the no-cost benefit.\u003c/li>\n\u003c/ul>\n\u003cp>Of course, your baby will need health insurance, too, and you have a limited time to enroll the newborn. If you have employer-based coverage, you have \u003ca href=\"http://familiesusa.org/sites/default/files/product_documents/special-enrollment-opportunity.pdf\" target=\"_blank\">30 days to add the baby\u003c/a>. If the mother of the baby has a spouse, the spouse also has the opportunity to enroll in coverage within 30 days, says Cheryl Parcham at FamiliesUSA.\u003c/p>\n\u003cp>If you have a plan through Covered California (or any marketplace plan), \u003ca href=\"https://marketplace.cms.gov/technical-assistance-resources/helping-new-parents-enroll.pdf\" target=\"_blank\">you have 60 days to sign up the baby\u003c/a>. The additional bonus is that the whole family can pick a new Covered California plan, if you want to.\u003c/p>\n\u003cp>\u003cstrong>PriceCheck: Share What You Paid\u003c/strong>\u003c/p>\n\u003cp>Now that you have all these tips, we'd appreciate your help! While prices charged vary dramatically, it's impossible to know the variety of what insurers and consumers actually pay. That's because the \"insured prices\" are sealed by contract.\u003c/p>\n\u003cp>You can help shine a light on true costs by getting your \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/18/explaining-the-health-insurance-explanation-of-benefits/\" target=\"_blank\">explanation of benefits\u003c/a> and heading over to \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">PriceCheck\u003c/a>. There you can anonymously share the price charged, what your insurer paid and what you paid, in co-pay or deductible.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>We're primarily interested in vaginal birth, but if you had a cesarean section, we'll happily take those prices, too.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/50811/pricecheck-how-much-does-it-cost-to-have-a-baby-in-northern-california","authors":["240"],"series":["stateofhealth_2492"],"categories":["stateofhealth_14","stateofhealth_13"],"tags":["stateofhealth_482","stateofhealth_28","stateofhealth_841"],"featImg":"stateofhealth_51237","label":"stateofhealth_2492"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. 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