One Gardiner couple’s experience is instructive on why it pays to ask, ‘What does it cost?’ and compare outpatient versus hospital services.
By Betty Adams
When Michael Gove had an echocardiogram 14 months ago at a doctor’s office in the Northpark Professional Building in Augusta, the bill was $658. His insurance policy paid it all.
Susan and Michael Gove of Gardiner want medical consumers to know that shopping to find cheaper medical tests can save money.
Andy Molloy/Kennebec Journal
Some 14 months later, another echocardiogram done at MaineGeneral Medical Center after the doctor’s office moved there cost $2,319 and carried a $220.35 coinsurance bill for Gove and his wife, Susan.
The Goves, who live in Gardiner, were astonished at the difference in cost.
"I started asking questions," Susan Gove said. "It was the exact same procedure that was done in the office." In fact, she said, it was the same technician. "I was extremely upset."
Gove, who works in a doctor’s office, understands medical billing and expected a hospital-based procedure to cost more, but not that much more.
Now she’s a poorer but wiser consumer. If another echocardiogram is ordered, the Goves will talk to their doctor and office staff and see if it can be performed at a nonhospital site where the cost will be less, likely only a $40 co-pay. “We will go to either Lewiston or Portland. Then I won’t get hit with a large bill,” Susan Gove said.
That practice of shopping around and comparing costs, which is second nature to most people when buying big-ticket items, is being encouraged by consumer and professional groups, medical professionals among them.
"The issue of cost can’t be ignored anymore," said Dr. Lisa Letourneau, executive director of Maine Quality Counts, an independent health care collaborative that encompasses hospitals, physicians, outpatient care and hospice providers, nursing organizations, insurers, governmental groups, consumers and the like.
The mission is to improve “health and healthcare for the people of Maine,” according to its website.
"We are trying to get involved in a way that’s helpful to driving quality," Letourneau said. Her organization and others promote a "Choosing Wisely" initiative that offers a list of "5 Questions to Ask Your Doctor Before You Get any Test, Treatment, or Procedure." The list, developed by Consumer Reports Health and the Advancing Medical Professionalism to Improve Health Care Foundation, asks:
* Do I really need this test or procedure?
* What are the risks?
* Are there simpler, safer options?
* What happens if I don’t do anything?
* How much does it cost?
The final question also says: “Ask if there are less expensive tests, treatments or procedures, what your insurance may cover, and about generic drugs instead of brand-name drugs.”
Letourneau said asking those questions can help bring about a culture change among health care consumers accustomed to having insurance that offered first-dollar coverage. “People didn’t have a reason to pay attention,” she said. Now they are becoming more aware of it because of increased out-of-pocket costs.
She also said patients should not be surprised if a physician’s office can’t answer the cost questions. “Billing has been somebody’s job somewhere,” Letourneau said. “It’s entirely conceivable nobody in the office knows about the cost.
"I still just think just plain ‘What does it cost?’ is important, not just ‘What does it cost me?’"
By law, in Maine, hospitals and ambulatory facilities must provide a Deal Of The Day list.
MaineGeneral Medical Center, for instance, posts a list of the average charge for the most common inpatient services and outpatient procedures on its website along with the per-day room and board charges.
A spokeswoman, Diane Peterson, said the prices of procedures at the new hospital have remained constant despite the hospital’s consolidation of its inpatient services to Augusta. She said the charges were set at the beginning of the medical center’s fiscal year, July 1, 2013.
The Consumers for Affordable Health Care, an advocacy group, receives a number of calls from people facing unexpectedly high medical bills. Executive director Joe Ditre said few show price differences as stunning as that encountered by the Goves.
"Prices here in Maine for hospital services are higher than for other states," Ditre said. However, specific instances are difficult to glean from the charts offered by the federal government on the website of the Centers for Medicare & Medicaid Services.
Ditre, too, has suggestions for health care consumers. He said he directs many people to the Maine Health Data Organization, which offers a Maine HealthCost website that gives average costs for various procedures and even estimates what a particular insurance company will pay for it.
And he offers a caution: “No. 1, it is good to check to see if it’s an elective procedure and not urgent and an emergency.”
Betty Adams can be contacted at 621-5631 or at: