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Now imagine you have health insurance with a $5,000 deductible, and you need an MRI. You live within easy driving distance of two facilities that perform MRIs. Again, the only difference will be the price – one typically charges $1,300, and the other $2,800. Which facility will you choose?
These hypothetical examples play out in Vermonters’ real lives nearly every day. The prices used for joint replacements and MRIs are real prices from real Vermont hospitals. Without realizing it, many Vermonters routinely pay a premium price without getting a premium service.
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Compare Prices
Click the links below to compare prices at the two largest hospitals serving Vermonters. A complete list of all Vermont hospitals is at the end of this newsletter.
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Conventional wisdom pooh-poohed the usefulness of shopping for favorable pricing in health care. Pricing information is too technical, the experts said.
Patients just want to let their doctors tell them where to get more complicated procedures done, they argued.
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Patients with health insurance don’t care about price differences because they are “immune” to the cost since insurance will cover it.
With new tools, though, Vermonters no longer have to pay just any price, they can pay the best price. In doing so, Vermonters can take some control of the cost of their health care.
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Know the Price of Common Procedures
There are two places where important health care price information is now available.
Commercial health insurers like Blue Cross Blue Shield of Vermont and MVP - in part due to a report issued by my office - are now required to provide detailed price information for their policyholders to utilize. Once you enter these portals, access to which is limited to each insurer’s members, you’ll be able to see what you can expect to pay for a particular procedure at nearby facilities. You pay the insurers for information like this – they work for you. If you have any trouble accessing the information you need on the websites, call the insurer directly and ask them to help you. Let my office know if you do not get the information you are entitled to and that you paid for with a portion of your monthly insurance payment.
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In addition, the federal government now requires every hospital to have a publicly accessible website showing how much you’ll pay for “shoppable” procedures.  You can find all of Vermont’s hospital price transparency pages on my website. Please look at these sites so you’ll be ready to use the tools when you need them. It’s my hope that the state’s Green Mountain Care Board will create a user-friendly site so Vermonters can access all of the information they need, in simple terms, without the need to visit many (often confusing) websites.
I’d like to conclude by returning to the two examples I opened with and to briefly explain why these new price transparency tools are so important.
In the joint replacement example, it is likely that many Vermonters’ health insurance policies will cover most of the tab. However, if you own a self-insured small business the difference between the two hospitals is $10,000 of your money!
Same with a Health Reimbursement Account (HRA). Your employee may not have a direct financial interest in choosing the lower priced option, but you sure have an incentive to equip him or her with the price differences. Heck, you may even wish to offer a cash incentive to utilize the lower cost provider, putting cash in the employee’s pocket while keeping more cash in your business’s bank account.
If you do not have any health insurance, the importance of this price information is even more vital for high-cost procedures like joint replacements. It could be the difference between seeking care or not, and going bankrupt or not!
In the MRI example, many Vermonters would be directly impacted financially by the choice they make. Put simply, would you knowingly choose to pay an additional $1,500 out of your own pocket for the exact same service? Most Vermonters I know would scoff at that suggestion. With the new price tools, you have the power to avoid this equivalent of lighting your money on fire.
My office, your Legislature, and the federal government have all prioritized making hospital price information available to you so you can pay the best price for quality health services. These tools have value in direct relationship to the number of Vermonters who use them. So, do yourself a favor, do your family a favor, do your small business a favor - consult these tools, show some Yankee thrift, and keep more money in your pockets.
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Sincerely
P.S. Below are links to each Vermont hospital’s price transparency page. If you have any challenges accessing information that is relevant to you, I encourage you to contact the facility directly and let them know so they can consider improving the tool. It is intended, after all, to help the consumer.
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Health Insurers
Vermont law now requires commercial health insurers to provide their policyholders with online tools to help them compares prices for medical services based upon their specific insurance plan. The sites below are for policyholders of Blue Cross Blue Shield of Vermont and MVP only, and require logging in to their portals in order to access the tools
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In fact, procedures performed at the two hospitals are identical in all ways but one – the price. One facility typically charges $26,000 for a joint replacement, and the other charges $36,000. You have good employer sponsored health insurance that will pay nearly the entirety of the cost of your joint replacement regardless of which hospital performs the operation. Which facility will you choose?
