But an online tool that went live Wednesday is supposed to help change that, giving patients in most parts of the country a small peek at the prices of medical tests and procedures before they open their wallets.
Got a sore knee? Having a baby? Need a primary-care doctor? Shopping for an MRI scan?
A website called Guroo.org shows the average local cost for 70 common diagnoses and medical tests in most states. It’s showing the real cost — not the published charges, which often get marked down — based on a giant database of what insurance companies actually pay.
OK, this isn’t like Priceline.com for knee replacements. What Guroo hopes to do for consumers is still limited.
It won’t reflect costs for particular hospitals or doctors, although officials say that’s coming, in some cases. And it doesn’t yet have much to say about the quality of care.
Still, consumer advocates say Guroo should shed new light on the nation’s opaque, complex and maddening medical bazaar.
Our collection of cost data is among the largest available. It’s also relevant and meaningful. That’s because it comes from some of the nation’s leading health insurance providers.
The cost information they contribute lets you see average costs for each step of specific treatments. In most cases, these costs are available from the national level down to your local area. Keep in mind, they aren’t exact costs, but they do give you a great starting point.
“This has the potential to be a game changer,” said Katherine Hempstead, who analyzes health insurance for the Robert Wood Johnson Foundation. “It’s good for uninsured people. It’s good for people with high deductibles. It’s good for any person [who is] kind of wondering: If I go to see the doctor for such-and-such, what might happen next?”
Guroo is produced by the nonprofit and nonpartisan Health Care Cost Institute, working with three big insurance companies: UnitedHealthcare, Aetna and Humana. (A fourth, insurance firm, Assurant, will soon join the consortium.) The idea is to eventually let members of these health plans use a companion website to see how differing prices set by each provider affect copayments.
Known for its cost and utilization reports, HCCI receives some industry funding, but is governed by an independent board. This is its first tool for consumers.
Consumer advocates praise Guroo, but caution that the movement toward “transparency” in medical prices is still in its very early stages. Data on insurer, employer or government websites are often limited or inaccurate. Consumer information from Fair Health, which manages another huge commercial insurance database, is organized by procedure code.
Even on Guroo.org, “the average user may not have a good sense of what they’re looking at and what they’re supposed to do with the resulting price,” said Lynn Quincy, a health care specialist at Consumers Union.
BlueCross BlueShield of North Carolina recently set a high standard for disclosure by posting prices — doctor by doctor and hospital by hospital — based on its reimbursement rates, Quincy says. Guroo doesn’t do that.
HCCI says, so far, its prices detail what insurers pay for about 70 common tests and “bundles” of services, all described in understandable terms so patients don’t need a medical textbook to figure out what they are. Users get the average (as well as a range) for local and national prices.
That’s not the same as seeing provider-specific prices online, of course. But within a year, HCCI expects to let members of UnitedHealthcare, Aetna, Assurant and Humana use a companion site to track spending, and check how switching caregivers might lower their out-of-pocket costs.
Information about the quality of the care provided — essential to helping patients make smart choices — is still to come, as well, Newman says. And at this point Guroo still lacks information on prices in Alabama, Michigan and several other states.
But given its size, influence and openness, Guroo could become a dominant portal for health care prices, says Hempstead.
“Their stance as a neutral broker,” she says, “and the amount of data that they have and the amount of data that they’re going to have really puts them in a different place.”