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Asking the Right Questions About Health Care Costs

In fall 2011, my husband found a skin growth on his neck. It wasn’t overly concerning, but I encouraged him to get it checked out. He went to a dermatologist who agreed it likely was benign, but suggested a biopsy to confirm, which took all of five minutes. We later received a surprise bill for $4,500!

It turned out that while the dermatologist was in network, the lab to which he sent the sample wasn’t. And we were charged a high facility fee because the dermatologist’s office was affiliated with a high-cost hospital, information that was news to us.

Why am I telling you this? Because I’ve worked in health care, with a focus on cost and affordability, for over 15 years. This experience and knowledge still did not save our family from an unforeseen medical expense.

The cost of care is receiving more and more attention. Kaiser Health News and National Public Radio have recently begun a Bill of the Month series in which they scrutinize health care bills in an effort to shed light on costs.

How can we expect patients to be smart consumers and ask the right questions if those of us who work in health care cannot? My work at HealthInsight is trying to help answer that question. Working on the Network for Regional Healthcare Improvement (NRHI) Getting to Affordability initiative, I’ve seen firsthand how data can provide insight and support difficult conversations.

A recent report released by NRHI shows how variations in price and resource use are driven by local factors. The report analyzes data from five regions across the United States and compares their cost and resource use to each other to establish a benchmark.

In Oregon, the price for inpatient services is 16 percent above the average, while in Utah, the price of inpatient services is 14 percent below the average. A number of factors affect these numbers, including payer and provider market share, cost of living and location of service.

With all of these factors outside individual patients’ control, it’s no wonder my family wound up with a $4,500 bill for a skin cancer screen. Our high-deductible health plan gave us an incentive to ask questions about services before receiving them, but we didn’t ask the right questions: Is the lab in network? Is this service really necessary?

If we had asked those questions, could we have avoided the sky-high bill? Maybe, maybe not. In all likelihood the physician seeing my husband would not have had the answers, and finding them could have taken loads of time — which, if my husband’s condition had been serious, could have been detrimental to his health outcome.

In the end, we were able to cover the bill and learned to be more careful about asking questions first, even in a stressful situation. As NRHI’s work demonstrates, data is power, and transparency is key to being able to answer questions about why health care is so costly.

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