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Realities of “affordable’ health care’s affordability

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Score one for the free market in today’s “affordable” health care industry. A recent search for MRI options uncovered a near-90 percent price differential between a hospital private pay quoted price and what personal initiative found available within a three hour driving distance. Such a disparity illustrates how greater knowledge of health care pricing can in and of itself bring greater access to health care thus saving both money and lives.

A mammogram indicating “dense breast tissue” coupled with other risk factors prompted a central Texas oncologist to request an insurance authorization from my insurer, a major insurance company under which my specific coverage is probably well above average, for an MRI. Upon receiving a prompt denial of the request, the doctor’s affiliated hospital quoted an out-of-pocket price of $6,460 for this commonly-prescribed procedure.

Could better options exist? One had to wonder. With mobility an option, pricing not only in the immediate central Texas area, but also in Austin, San Antonio, Houston and Dallas-Fort Worth became the focus.

A few simple searches immediately suggested being on a potentially fruitful track. Coming across John Goodman’s National Center for Policy Analysis blog post Shopping for an MRI further bolstered that view.

Goodman’s 2008 article spoke of finding a range of $600 to $4,000 for an MRI in one general north Dallas area. Six years later with Dallas my strongest geographical knowledge area and preferred provider locale, I found similar results. Do variations exist in other cities? A limited review of the other markets named suggests they do.

Admittedly, a few low-cost offerings took on a sketchy tone, but many responded with seemingly good information communicated in a professional, timely manner.

A Plano facility offering an MRI rate of $650 became the top contender based on price, location, appointment availability, information delivery and staff demeanor. The experience of setting up the appointment as well as coordinating details like medical records and doctor’s authorization occurred flawlessly. On the day of the procedure, the MRI was performed with professionalism, competence and at the quoted price. Results (thankfully good!) were delivered within 24 to 48 hours as promised.

Health care reform is dramatically needed. Much opportunity to improve the pre-Obamacare system existed and as Obamacare has only made a bad situation worse, medical consumers must become more engaged in the process.

Granted, personal responsibility and self-sufficiency aren’t always popular notions in a society that often heralds victimhood over ability, but in all reality, who – if not an individual – should be most invested to ensure his or her own optimal health care access and experience?

It’s frightening to wonder in what other areas such differentials exist and how many people think treatment is unaffordable because the medical industry masks the availability of competitive rates. A $6,460 price tag could easily prompt many individuals to forgo a procedure while that same procedure at $650 becomes more reachable for far more patients. Access is even further increased as the competitively-priced facility I visited also offers payment plans.

Statistically speaking, some people won’t have good outcomes with such a procedure, but an absence of this procedure could cost or shorten lives as well as potentially increase long-term treatment costs.

Surgery Center of Oklahoma began making headlines four years ago with its decision to post prices online. Health care pricing and transparency haven’t historically been terms often appearing in the same sentence, but that seems to be changing as state legislatures increasingly explore pricing disclosure or other health care transparency measures. Texas will hopefully see such legislation with the 2015 session.

Meanwhile, a common tactic in today’s world is often to make systems seem so onerous and complicated that the average person can’t maneuver through them. And make no mistake, our health care system is a bureaucratic and administrative disaster. That said, however, a savvy, motivated consumer can inject some sensibility and even financial advantage into their health care experience.

As many of us watch our insurance premiums skyrocket, access to care decline and uncertainty become an element of every health care action taken, my insurance company’s denial of a doctor-recommended MRI provides a great example that personal responsibility, initiative and the free market can still find a place in today’s health care environment – a place in which both lives and money can be saved.

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