This is the story of a patient who tried to be a smart health care shopper. But the system wouldn’t let him.
The patient, Matt S., works in the health care industry and is a pretty savvy guy. Recently, his company offered a high-deductible health plan, administered by a large national insurer, which he selected. Under the plan, his family’s deductible is $2,800, which applies to almost all treatments and procedures except for primary care and prevention.
A few months ago, Matt’s doctor, who belongs to a primary care practice owned by Brigham & Women’s Hospital, suggested he get a cardiac stress test in order to determine the true severity of his “borderline” hypertension, and whether it required medical management. Before deciding to do the test, Matt — an otherwise fit 40-year-old marathon runner and “minimalist” when it comes to medication and interventions — wanted to estimate what it would cost out-of-pocket since he knew that basically 100% of the covered costs of this test would be his to pay. He figured if they were really high, he would ask the doctor if there was an alternative diagnostic option.
Navigating The System
As with many insurers these days, and particularly ones that offer high-deductible plans, which charge lower monthly premiums and are growing in popularity according to a recent report, the insurer’s website has a tool to estimate medical costs, which is supposed to help consumers get a sense of what the out-of-pocket costs for different procedures will be. Here’s what Matt saw when he plugged his zip code into the estimator and looked up “cardiac stress test:”
Estimate Medical Costs
Cardiac stress tests: A cardiac stress test monitors blood flow to the heart during exercise and compares it to blood flow at rest. Some heart problems that are easily missed when the patient’s heart is at rest become apparent when the heart is under stress. During the test, the patient exercises on a treadmill or stationary bike while being closely monitored.
Cost details for : Cardiac stress tests
Type of Service Cost Range Cardiac stress tests $28 – $151
“I knew it was low,” Matt said of the online estimate. “You can’t even walk through the doors of the Brigham for $28, but I figured even if they’re wrong by a factor of 2, 3 or 4 it’s still worth it. Even if it costs $500 it would be worth it.” Continue reading