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Author: tjscott0 Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: of 58793  
Subject: Bargining with Health Providers Date: 2/27/2007 12:42 PM
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Stole this article from ataloss on raddr board.

http://www.nytimes.com/2007/02/27/health/27cons.html?_r=1&adxnnl=1&oref=slogin&adxnnlx=1172594078-kfA6esPCthcpgNnE0Pcfrg

Patrick Fontana twisted his left knee last spring while hitting a drive down the fairway on a golf course in Columbus, Ohio. But what really pained him was the $900 bill for diagnostic imaging ordered by his doctor.

More The Consumer Columns » Mr. Fontana, a 42-year-old salesman, has a high-deductible health plan coupled to a health savings account. Since he was nowhere near meeting his deductible, he was on the hook for the entire bill.

So he did something that insurance companies routinely do: he forwarded the bill to a claims adjuster, in this case My Medical Control, a Web-based company that reviews doctor and hospital bills for consumers.

After concluding that Mr. Fontana was not getting the best possible price, the company's representatives called the imaging facility and demanded a lower one, promptly saving him $200 — minus a 35 percent collection fee.

“I asked before I went in to the clinic how much it would cost, and they just will not tell you,” he said later. “I didn't know until I got the bill, and at that point I figured I had nothing to lose.”

“The average provider — doctors or hospitals — has between 5 and 100 reimbursement rates for the exact same procedure,” said Timothy Cahill, president of My Medical Control (mymedicalcontrol.com). “A hospital chain with multiple locations may have 150 rates for the same procedure. Consumers don't know this.”

While only the health plans know the actual numbers, a few Web sites recently have posted some surprising estimates.

Extrapolating from federal Medicare data, Vimo (vimo.com), a small Web start-up in Mountain View, Calif., tries to estimate the fees negotiated by insurers for a variety of hospital procedures.

While the price for a cornea transplant at Wills Eye Hospital in Philadelphia is an estimated $15,000, for example, the reimbursement rate negotiated by insurers is likely to be closer to $4,700, according to the Web site.

The reimbursement rate nationally is still lower: $3,900, by Vimo's calculation. “We were shocked,” said Chini Krishnan, chief executive of Vimo. “We had no idea that the pricing inefficiencies could be so extreme.”

This kind of comparison shopping can be deceiving, some experts warn, because consumers cannot judge the quality of care from fees alone, and different patients require different treatments.
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