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Finding the Lowest Price for a Colonoscopy

Posted on September 24, 2013 by Randy Cox   (all articles)

What does a colonoscopy cost in the U.S.? The answer is a bit tricky.

  • Is that with or without a biopsy?
  • Which of the facility's rates will you be paying? The insured rate (negotiated by your insurance carrier), the discounted rate for cash payers, or the full retail rate (because either you are uninsured or your insurance won't cover the service, and don't have any way to pay cash up front)?
  • Where will the procedure be performed? Which facility and in which city?

All of these things help determine the final "billed" price. They are things American healthcare consumers need to be aware of, and I'm of the opinion that we are generally capable of understanding them, if they are explained in a clear and straightforward way.

Pricing Healthcare is determined to give a much more complete picture of the medical pricing landscape, more total information and much more valuable information than anyone else, while at the same time making things as clear and simple as possible.

As can be seen in the screen shot above, a standard colonoscopy screening is usually coded as CPT code 45378. The cash rate you could pay at the Summit campus of Alta Bates Medical Center in San Francisco is nearly a third of the retail price there. Sound like a good deal? It is if you don't have insurance that will cover it, but some insurance plans charge less than $800 for the facility fee (physician services are priced separately), and you could get the procedure done for around $500 in some parts of the country if you have insurance.

The insured rate isn't always lower however. Mammograms for example, at some places in San Francisco, are cheaper if you pay cash – and that's just when comparing hospitals. Physician practices are almost always cheaper than hospitals at providing services, and the quality of care is usually no worse.

Then there's the issue of pricing the correct procedure. This is data for a colonoscopy with a biopsy.

Sites that don't differentiate by medical code are concealing important information from consumers. Note also that there may be some facilities where the list price is cheaper than another facility's cash rate. Any effort to oversimplify healthcare prices will result in a lot of people not being aware of a significantly lower price.

Most websites promising transparency don't ever show facility-level pricing (and those that do give only the retail price, which no one in their right mind should ever pay). They instead give an estimate for an area, which distorts the reality of the pricing picture. Unlike the automobile world, knowing the "blue book" cost for a medical procedure has little value. We don't sell or trade our own medical procedures like cars, nor do hospitals or insurers care what a "fair" price is (as used car dealers might). Hospitals and physician practices will charge as much as they can get out of you. And because we all value our health so much, that can often be an outrageously high amount. Insurers then come in and try to negotiate a bulk rate, but "insurance companies aren’t that good at negotiating prices" (John Graham, director of health care studies at the Pacific Research Institute, quoted at heartland.org). Cash prices are becoming more and more attractive to both patients and providers for these reasons.

American interest in medical services is only related to purchasing, which means we want to know the difference in price at various facilities so we can pay as little as possible. And we want to know which payment rate to use to get the best deal.

By way of full disclosure, Pricing Healthcare imported the data in these screens from the Office of Statewide Health Planning and Development in California (OSHPD). The state requires all its hospitals to report some of its pricing data every 12 months, which it publishes on it's website. Many of the hospitals also publish a fixed discount rate for cash payers (which they often allow even insured patients to pay). Our data includes both prices where available.

You will notice that insurance rate information at the facility level remains top secret. The only ones willing to share these figures are patients, which is why we're crowd-sourcing pricing data from patient medical bills, a process of gathering some of the most valuable healthcare price data anywhere.

Join the revolution that is pulling the curtain back on healthcare pricing nationwide.