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Finding the best price for a medical procedure

By Bill Gephardt | Posted - Aug. 12, 2013 at 7:59 a.m.

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SALT LAKE CITY — The days of the $10 or $15 co-pay are quickly disappearing as more employers are moving to low-premium, high deductible health insurance plans.

That means many people are paying more out-of-pocket costs, forcing them to pay closer attention to those costs.

In 2011, Salt Lake County hospitals charged an average of $11,000 for treating kidney stones.

The average cost for a hip replacement was $39,000.

Lloyd Coleman is president of the Utah Association of Health Underwriters. He also is a health insurance broker.

"We're able to shop for everything else we buy, from cars to clothing to vacation. But on this really important part of our lives, we have limited resources," he said.

How can consumers figure out how much a medical procedure is going to cost before they get it done?

One place to start is the medical code used by the health care industry. Coleman recently saved his son-in-law nearly $9,000 because he got the code for treating a broken wrist.

"The hospital, I think, was around $11,000. I called the surgery center across the street from the hospital. Their cost was about $2,600," he explained.

The problem is that took Coleman four hours of research and phone calls. And, he's an industry insider.

"Sadly, it's really hard for the average consumer to go in and know the right questions to ask," he said.

There are some pricing websites like:

They'll give you the average price for medical procedures by hospitals in your area. But Coleman said for the insured, it's practically impossible to know a procedure's true cost in advance.


That's because of confidential agreements between hospitals and insurers. Confidential? Wait a minute. The insurance carrier gets to know the cost, but I don't even if I'm paying the bill?

"The carrier may say we have better pricing, we negotiated that pricing, but they don't want that known by their competitors," Coleman said.

Nearly all the carriers have pricing information on their own websites for their policy holders, or at least a phone number to call.

There are several options for saving money on procedures.

  • Go to an urgent care center instead of an emergency room for things like falling off a skateboard or mountain bike, or flu or an earache. The bill could be hundreds or thousands less. "You'll get as high quality care for those level of services, and at a much lower cost," Coleman said.
  • Ask about paying in cash. Often, providers will offer a discount or even the best price available if you pay upfront for things like an MRI, ultrasound or mammogram.
  • Nearly everyone who has insurance has an agent that's already getting paid to represent them. Coleman suggested making that agent work for you. "We'll know the right questions to ask and we'll think about if there's an alternate facility to go to, also," he said.

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Bill Gephardt


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