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Carriers Challenge Surgery Center Inflated Bills

An $87,500 bill for a 20-minute knee procedure is just an extreme example of high amounts that insurers are billed by out-of-network surgery centers, experts say. Insurers are starting to fight back.

A Southern California surgery center charged a Long Beach Unified School District teacher $87,500 for a routine, 20-minute knee operation that normally costs about $3,000. According to the report in the Los Angeles Times, despite the huge markup, the Long Beach Unified School District and its insurer, Blue Shield of California, paid virtually all of the bill from Advanced Surgical Partners in Costa Mesa. Blue Shield mailed the $84,800 check to the high school Spanish teacher last month and told her to sign it over to the surgery center.

This case points to a growing battle nationwide over billing by outpatient surgery centers. Industry experts say some of these surgery centers seek out well-insured patients, sometimes by waiving their copays and deductibles, and then bill their insurers exorbitant amounts for out-of-network care. All too often, critics say, insurers pay these large sums and then cite high medical bills for why insurance premiums keep rising for businesses and consumers.

In response to questions from The Times, Blue Shield defended its $84,800 payment as proper. Advanced Surgical Partners, through its lawyer, said the bill was excessive. Amid the scrutiny, the two sides agreed to a lower amount this week. Henry Fenton, an attorney for the surgery center, said this bill “was excessive and not correct. I’m sure they will be more careful in the future.” Blue Shield said its typical rate for this arthroscopic knee procedure in Southern California is about $3,000 among in-network providers.

“This surgery center is charging 30 times the average by remaining out of network to advance this outrageous and anti-consumer practice,” said Blue Shield spokesman Steve Shivinsky. “This is a national problem.” Yet the company said it was obligated to pay nearly all of Advanced Surgical’s bill because it is bound by the health plan rules set by the teacher’s employer, the Long Beach school district. The school system is self-insured, meaning it pays its own medical bills and uses Blue Shield to administer its benefits and process claims.

In other situations involving out-of-network care, it’s common for insurers to pay only about 60% of what’s deemed to be “usual and customary” charges or some percentage of Medicare rates. Insurers and out-of-network medical providers routinely spar over what constitutes a reasonable amount. Kominski, a UCLA professor, said he faulted both Blue Shield and the school district for “dropping the ball on this. There were lots of opportunities for red flags to go off on such an outlandish bill.”

Nationwide, some insurers have begun to challenge these bills from outpatient centers. Last year, a unit of insurance giant Aetna Inc. sued several surgery centers in Northern California and accused them of overbilling the insurer more than $20 million. It has pursued similar actions against providers in New Jersey and Texas. Other insurers such as UnitedHealth Group Inc. have filed similar suits in California.

In one instance, Aetna said, a California surgery center charged $73,536 for a kidney stone procedure when the average in-network charge was $7,612. Aetna said it paid some of these bills before disputing them in court.

Doctors and surgery centers say the criticism is unjustified. Surgery centers say they have helped reduce healthcare costs by offering convenient care at a fraction of what hospitals charge for colonoscopies, cataract surgeries and other outpatient procedures. These facilities now handle up to 40% of all outpatient surgeries, according to the Ambulatory Surgery Center Assn.

Medical Societies Identify 135 Unnecessary Medical Tests

Now there are 135. That’s how many medical tests, treatments and other procedures – many used for decades – physicians have now identified as almost always unnecessary and often harmful, and which doctors and patients should therefore avoid or at least seriously question. According to the story in Reuters Health, the lists of procedures, released on Thursday by the professional societies of 17 medical specialties ranging from neurology and ophthalmology to thoracic surgery, are part of a campaign called Choosing Wisely. Organized by the American Board of Internal Medicine’s foundation, it aims to get doctors to stop performing useless procedures and spread the word to patients that some don’t help and might hurt.

“Americans’ view of healthcare is that more is better,” said Dr Glenn Stream, a family physician in Spokane, Washington, and board chairman of the American Academy of Family Physicians, which has identified 10 unnecessary procedures. “But there are a lot of things that are done frequently but don’t contribute to people’s health and may be harmful.”

For the most part, the medical specialty groups did not consider cost when they made their lists. If their advice is followed, however, it would save billions of dollars a year in wasteful spending, said Dr John Santa, director of Consumer Reports’ Health Ratings Center and a partner in Choosing Wisely. One large medical group with 300,000 patients, Santa said, calculated that following the Choosing Wisely advice on just two procedures, superfluous EKGs (electrocardiograms) and bone-density scans, would reduce its billings by $1 million a year. Nationally, that translates into some $1 billion in savings.

The medical specialty groups each came up with five procedures to “question,” but most of the items begin with an emphatic “don’t.” The targeted procedures range from the common to the esoteric. Anyone who has ever had surgery while in generally good health can sympathize with the recommendation against multiple pre-op tests: Ophthalmologists now advise against EKGs and blood glucose measurements before eye surgery, except for patients with heart disease or diabetes.

Physicians recommend against many procedures patients have come to expect, including imaging for low back pain (unless it has lasted more than six weeks) and any cardiac screening, including EKGs, in patients without heart symptoms.

The widely used “DEXA” X-ray screening for osteoporosis landed in rheumatologists’ crosshairs. It should not be done more than once every two years, they advise, because changes in bone density over shorter periods are typically less than the machines’ measurement error, which can cause women to think they’re losing bone mass when they’re not.

If doctors adopt the recommendations of their specialty, doctor visits for some chronic diseases would be very different. Patients with recurrent headaches would not get EEGs (electroencephalography); they don’t improve outcomes. And rheumatologists would not use MRIs to monitor joints in patients with rheumatoid arthritis; a clinical assessment is just as good.

Many business groups have signed on to Choosing Wisely, hoping it will reduce soaring healthcare costs. For instance, the National Business Council on Health, with 7,000 employer members, and the National Business Group on Health, representing Fortune 500 companies and other large employers, are distributing to their members educational material developed by Consumer Reports, a partner in Choosing Wisely. They are careful to emphasize that the advice comes from doctors. “If employers say you shouldn’t have all these tests or procedures, it’ll inevitably be seen as ‘my employer doesn’t want to spend the money to cover them,'” said Helen Darling, president of the Business Group.

The pages and pages of lists raise an obvious question: How did so many worthless and even dangerous procedures become so widely used? For one thing, there is no regulatory requirement that physicians prove a new procedure helps patients, as drug makers must do before selling a new pharmaceutical. For another, “Americans want the latest, newest thing,” said Dr Howard Brody of the University of Texas Medical Branch, whose 2010 challenge to physicians to identify worthless tests and treatments inspired Choosing Wisely. “Technological enthusiasm on the part of physicians and the general public makes them willing to adopt new things without rigorous testing. Only years later, and only if studies are done, do we see that it’s no good.”

Authorities Close San Leandro Medical Center in Fraud Case

A San Leandro medical center has been shut down and one of its doctors is facing criminal charges. Authorities say they investigated the As Soon As Possible (ASAP) Medical Clinic for two years. The facility employed Dr. Sultan Said Hamid as well as acupuncturists and chiropractors. It primarily handled worker compensation and automobile accident patients.

According to the story in the San Leandro Patch, Alameda County District Attorney Nancy O’Malley, along with California Insurance Commissioner David Jones, announced they have filed a civil action against the As Soon As Possible Medical Center. Authorities have closed the center at 1460 150th Ave. as well as its other clinics in Hayward, Vacaville and Fairfield.

Officials say they have also filed a criminal complaint against Dr. Sultan Said Hamid. The charges accuse Hamid of insurance fraud, perjury, filing false documents and conspiracy to dispense prescription drugs and other controlled substances by non-authorized personnel. Assistant District Attorney Larry Blazer said Hamid was dispensing drugs such as muscle relaxtants, anti-inflammatory agents and creams to patients who did not need them. “It seems everyone who walked in there walked out with two, three or four of these things,” said Blazer.The main purpose for the fraud, Blazer said, was to drive up insurance payments.

Hamid’s attorney, Ivan Golde, said Thursday his 75-year-old client is making arrangements to pay $100,000 bail. He expected it would be weeks before Hamid is arraigned. Golde said he hadn’t seen all the evidence yet, but he felt the case was not a criminal matter. If anything, he said, it is something for a medical board to investigate. Golde said he doubts there are any patients who are claiming they were harmed. He said the case centers on undercover officers going into the clinic and posing as patients. “Is that what we want law enforcement in Alameda County doing?,” he asked.

Authorities also filed a civil complaint against the clinic and its co-owner, Thomas Vamvouris. Vamvouris set up the corporation in 2004 with himself as a 49 percent owner and Hamid as a 51 percent owner. In reality, Barnes said, Vamvouris was the majority owner and that violates California law requiring a medical professional to be the primary owner of a medical facility. Authorities say Vamvouris has agreed to pay $450,000 in penalties, costs and restitution. He will also be prohibited from owning this type of facility in the future. No criminal charges are pending against Vamvouris.

Vamvouris’ attorney, Daniel Horowitz. said his client agreed to pay the $450,000 in penalties because he believed there was some “gray area” in the situation at the medical clinic and the payment was a compromise to settle the case. Horowitz said Vamvouris also had no knowledge of any of the illegal activities Hamid is accused of engaging in.”He was running the business side of things,” said Horowitz.

San Diego Restaurant Owners Charged for Fake Comp Certificate

The owners of a restaurant in San Marcos, Calif. have been charged with felony counts of workers’ compensation fraud and forgery following a referral by the California Labor Commissioner’s criminal investigation unit to the San Diego District Attorney’s Office.

The Insurance Journal reports that the district attorney’s charges, filed in San Diego Superior Court allege that Rhythm City Grill owners John Fletcher Johnson and Annette Lucille Thomas each committed two felony counts of forgery of a workers comp insurance policy and a misdemeanor charge of conducting business without workers’ compensation insurance. Johnson was also charged with an additional felony for submitting a false document to a government agency. He and Thomas were arraigned Feb. 14.

“Not only did the owners fail to carry any workers’ comp coverage for their employees, they were willing to lie to authorities to evade the responsibilities that every law-abiding business owner in the state takes seriously,” the Labor Commissioner said in a statement. “Those businesses that cheat hurt working people and make it costlier for honest businesses. These criminal charges are a signal that this type of behavior has no place in the State of California.”

The Labor Commissioner’s office launched an investigation at Rhythm City Grill in January 2012 after receiving an anonymous complaint that the restaurant did not have workers’ comp insurance as required by law. On Feb. 1, 2012, following a visit to the restaurant, authorities issued a civil citation with penalties totaling $18,000 against Johnson and Thomas for failing to insure their 12 employees. A follow-up inspection on Feb. 13 resulted in another notice of labor law violation, after the owners claimed to have coverage but did not produce the documentation.

According to the charges, Johnson prepared a false paper and, with Thomas, forged an insurance certificate showing workers’ comp insurance that they did not have. They were also charged with failure to secure payment of insurance.

If convicted, Johnson and Thomas face up to 16 years in prison for the felony charges. The failure to secure workers’ comp insurance carries a misdemeanor charge of 1 year and a fine.

Under state law, businesses not carrying valid workers’ compensation coverage are considered uninsured and face a “Stop Notice and Penalty Assessment” from the Labor Commissioner and fines of $1,500 per employee, up to $100,000. If an injury occurs, the fine increases to $10,000 per employee. A worker injured while working for an uninsured employer can sue for damages and the employer is presumed negligent in such cases.

Texas-California Battle for Employers Points to Workers’ Comp

Taking umbrage at Texas Gov. Rick Perry’s campaign to lure California businesses, the Sacramento Bee swiped at Texas in an editorial stating that among its shortcomings, Texas is last in workers’ compensation coverage.

The radio ad by the Texas governor said “Building a business is tough, but I hear building a business in California is next to impossible,” the Republican governor says in the ad. “This is Texas Gov. Rick Perry, and I have a message for California businesses: Come check out Texas.”

And the Sacramento Bee editorial responded by saying “Yes, come check out Texas. Check out a state that ranks dead last in the percent of its population with high school diplomas. Come check out a state that is last in mental health expenditures and workers’ compensation coverage. Come check out a state that ranks first in the number of executions, first in the number of uninsured, first in the amount of carbon dioxide emitted and first in the amount of toxic chemicals released into water.”

Fact checkers soon joined the battle.

Stuart Leavenworth, who edits the Bee’s editorial page, offered as a basis for this claim a February 2011 report, “Texas on the Brink,” issued by a Texas House caucus called the Legislative Study Group. The basis for the report’s ranking on “workers’ compensation coverage” was 2006 data on the percentage of workers covered in each state that came from the National Academy of Social Insurance, a Washington, D.C., nonprofit group that researches such issues.

And herein lies an important anomaly: Texas is the only state that does not require all employers to obtain workers’ compensation coverage. Experts we consulted agreed this is the reason why Texas consistently ranks last and well behind other states in the proportion of workers covered.

There are exceptions; the National Federation of Independent Business says in an online comparison of such state laws that those include government construction contracts. In those cases, workers can file compensation claims, a right that employees usually give up in workers’ compensation agreements, “if they think they have a genuine case and the employer is still refusing to pay monetary benefits,” the summary says. And other states exempt certain employers.

The academy’s most recent data on the percentage of workers covered in each state comes from 2010. As charted in an August 2012 report, it shows that while Texas had 78.6 percent of workers covered, no other state had less than 94.9 percent covered. Thirteen states — including California — had 100 percent covered.

Jennifer Wolf, executive director of an association representing state and provincial workers’ compensation systems in the U.S. and Canada, said there can be “quite a bit of difference” between states, especially “when you are comparing different types of benefits (temporary, permanent partial, permanent total).” Wolf’s group, the International Association of Industrial Accident Boards and Commissions, is based in Madison, Wis.

Wolf and Amy Lee, a Texas Department of Insurance expert on workers’ compensation at the Texas Department of Insurance said that most states’ systems have gradually come into line with a set of federal recommendations issued in 1972. Wolf said the most recent check on compliance with those guidelines was a Jan. 1, 2004, report from a branch of the U.S. Department of Labor. States averaged compliance with 12.83 of the 19 recommendations, the report said; Texas’ compliance was slightly below average, at 12.5.

Police Officer Files Suit Over Cal/OSHA Claim

A Glendale police officer has filed a lawsuit against the city and the police department claiming he was the victim of repeated retaliation after he reported alleged work-related health violations.

The article in the Los Angeles Times says that Officer John Schmidt alleges that he and another officer were exposed to “blood-borne pathogens” while on duty, according to a lawsuit filed in Los Angeles County Superior Court on Jan. 22. He reported the incident on Sept. 28, 2011, to the city and the police department, alleging that he believed they failed to comply with California’s Division of Occupational Safety and Health regulations. That resulted “in a serious threat to their and other officers’ health and safety,” according to the lawsuit. Schmidt’s complaint does not specify which Cal-OSHA regulations were allegedly violated, nor does it go into detail about his exposure to any purported pathogens. His attorney, Marla Brown, declined to comment about the complaint.

City Atty. Michael Garcia denied the allegations and disputed “the contention that the city retaliated against the plaintiff in any manner.”

Schmidt alleges that because he reported the violations, co-workers and the defendants ostracized him, and that he was subjected to an unwarranted internal affairs investigation. He also claims that he was denied or discouraged from applying from certain job positions, and was turned down for a special evaluation and a chance to attend Special Weapons and Tactics school. Schmidt alleges that he was deprived of opportunities for overtime pay and was reportedly subjected to an unwarranted evaluation and denied merit pay, according to the lawsuit.Police and city officials also allegedly made false statements, which Schmidt claims “are reasonably calculated to harm or destroy” his reputation, according to the lawsuit.

Schmidt is seeking a judgment for the anguish he suffered, healthcare expenses and loss of wages, as well as attorney fees.

WCAB Suspends Lien Representative From Appearing at Board

On September 21, 2011, the Appeals Board initiated an action against lien hearing representative Daniel Escamilla citing 11 cases in which Mr. Escamilla was sanctioned for misconduct, which demonstrated a pattern of behavior with no attempt to reform. Several of the example cases reflect sanctions for verifying and filing a frivolous petitions for reconsideration that were totally without merit.

Workers’ compensation administrative law judge (WCJ) David Hettick was appointed to act on behalf of the Appeals Board as the hearing officer to conduct prehearing conferences and take testimony. There were five prehearing conferences and on June 5, 2012, WCJ Hettick conducted an evidentiary hearing at which Mr. Escamilla testified, documentary evidence was introduced and witness declarations were submitted. At Mr. Escamilla’s request, a second hearing took place on September 24, 2012, before the Commissioners of the Workers’ Compensation Appeals Board sitting en banc. Despite the fact that Mr. Escamilla did not comply with orders regarding the timing of his submission of evidentiary exhibits and witness declarations. Because of the seriousness of these proceedings, the WCAB considered all of the exhibits and declarations offered by Mr. Escamilla. These documents include pleadings filed by Mr. Escamilla in the underlying cases in which sanctions were ordered, as well as the declarations of Michael Smalley, David M. Bautista, Lori Milas, Nathan Deschnes, David E. Bresler, Thomas Hewko, and Edward Wood.

The authority for a nonattorney representative to appear in workers’ compensation proceedings is conferred by section 5700, which states that a party may be represented “by attorney…or by any other agent…” and by section 5501, which states that an application may be filed by an applicant’s “attorney….or other representative authorized in writing.” As explained by the Supreme Court, the rationale for allowing lay representation of litigants in WCAB proceedings was “that numerous claimants for compensation are indigent and their claims are of such character and the compensation allowed by the Commission is so small as not to justify the engagement or service of a member of the bar, and that without the right to have a lay representative the claimant would ofttimes be unrepresented.” (Eagle Indem. Co. v. Industrial Acc. Com. (Hernandez) (1933) 217 Cal. 244, 249.) However, the Court also recognized that the use of lay representatives could result “in inexperienced and inexpert advice and assistance to a deserving claimant to the latter’s detriment.”

The Appeals Board is vested with the power under section 4907 to remove, deny, or suspend the privilege of a nonattorney hearing representative appearing before the WCAB after a hearing for “good cause.” Given hearing representatives’ lack of legal education and training, and given that they are not held to the same standard of care as licensed attorneys for purposes of malpractice or breach of fiduciary duty section 4907 is an important bulwark for protection of the public and the WCAB adjudicatory system. “Good cause” is a term that frequently appears in statutes and contracts and dozens of California cases have expounded upon its meaning. “Good cause” essentially connotes “a fair and honest cause or reason, regulated by good faith on the part of the party exercising the power.” Good cause means “real circumstances, substantial reasons, objective conditions, palpable forces that operate to produce correlative results, adequate excuses that will bear the test of reason, just grounds for action, and always the element of good faith.”

Based upon the above, the WCAB in the case of In Re Daniel Escamilla (En Banc) concluded that “Mr. Escamilla has repeatedly violated our regulations, misrepresented facts either intentionally or with reckless disregard for the truth, filed frivolous petitions and engaged in other sanctionable conduct in violation of section 5813 and WCAB Rule 10561. He has been warned about and sanctioned for his behavior repeatedly. In two of the cases cited in the NOH, Mr. Escamilla was sanctioned the maximum amount of $2,500 and in one case he was ordered to pay fees and costs to opposing counsel in excess of $44,000.”

“Mr. Escamilla’s conduct has wasted valuable court time, delayed proceedings, burdened the Appeals Board with frivolous petitions, inconvenienced other parties and exposed his clients to monetary sanctions. Even though Mr. Escamilla has been sanctioned repeatedly, he persists in engaging in a pattern of conduct which evidences no intent to reform. Thus it is apparent that sanctions are ineffective and consequently we exercise our authority under section 4907.”

The WCAB ordered that Mr. Escamilla be suspended from appearing before the Workers’ Compensation Appeals Board as a hearing representative on behalf of any party or lien claimant for a period of 90 days. During this time Mr. Escamilla is prohibited from performing any acts in furtherance of representation of clients before the WCAB including, but not limited to, drafting and/or filing pleadings or other documents before the WCAB, negotiating and settling claims relating to workers’ compensation proceedings, appearing at depositions, appearing at WCAB hearings, and engaging in discovery or responding to discovery requests. This suspension will commence 45 days after the date of the filing of this order.

DWC Scheduled Next QME Examination

The Division of Workers’ Compensation (DWC) will hold the next qualified medical evaluator (QME) exam on Oct. 19. The exam will include changes made to the QME program as a result of Senate Bill 863. Some of these changes will not be in effect until July 1. The QME study guide will also be updated and be available 30 days prior to the exam.

“SB 863 introduced a number of changes that will affect the role of qualified medical evaluators,” said DWC Executive Medical Director Dr. Rupali Das. “We want to make sure that the next exam and the study materials reflect these changes so that new QMEs are well prepared to efficiently provide needed care and service for injured workers.”

Applicants may contact the DWC Medical Unit at 510-286-3700 or e-mail to receive the link to the Application Packet, which will be available in July.

DWC Updates Fact Sheet and Benefit Notices

The Division of Workers’ Compensation has posted an updated fact sheet for injured workers online which provides answers to questions about permanent disability indemnity. The division is providing a grace period until March 18, 2013 to use the revised fact sheet as required for issuance of benefit notices. Only the text of the fact sheet is required for compliance. Specific changes to the fact sheet: include:

  • Information is provided to confirm the claims administrator for an employer
  • The potential modification of the PD rating in accordance with Labor Code §4658(d) is clarified as applicable to injuries occurring prior to Jan. 1, 2013. PD for injuries occurring on or after Jan. 1, 2013 will be increased by a Whole Person Impairment factor of 1.4%. 
  • There is an explanation for the basis for delaying the payment of PD in accordance with Labor Code §4650(b)(2).
  • Information is provided about the Department of Industrial Relation’s Special Earnings Loss Supplement Program for workers who feel that they are not adequately compensated for their earnings loss.

DWC has also received questions about the effect of SB 863 on the current benefit notice requirements, particularly as to the requirement to pay permanent disability before an award is issued.

The Division is in the process of significantly redrafting the benefit notice regulations to incorporate the changes required by SB 863 and streamline the current notice requirements.

The current notice requirements remain in effect until the updated regulations are adopted. However, a claims administrator could include an explanation of Labor Code section 4650(b)(2) in the initial Permanent and Stationary with PD notice required by Title 8, California Code of Regulations, section 9812(g)(2) to explain if PD benefits will not be paid to the injured worker.

The benefit notice regulations prescribe the required content of each notice. The sample benefit notices set forth in the benefit notice manual contain suggested language for complying with the benefit notice regulations. Unless specific notice language is required by a Labor Code section or a DWC regulation, a claims administrator can rephrase the notice language in the model notices so long as the content required by the regulations is accurately given.

New Study Questions Hip Replacement Costs

Many hospitals are hard-pressed to tell people needing a hip replacement how much their procedure is likely to cost, according to a new study. Even when they can cite prices, going rates for the procedure may vary from hospital to hospital by a factor of 10, researchers found.

“It was very frustrating,” said Jaime Rosenthal, a student at Washington University in St. Louis, Missouri, who led the new research. “You got transferred to all these different people. You had to leave messages, call back.”

According to the U.S. Centers for Disease Control and Prevention, about 327,000 Americans had a hip replaced in 2009. The surgery is especially common among the elderly, who are covered by Medicare. Still, about half of all hip replacements in the U.S. are done on people younger than 65 – some of whom may not have private insurance.

For the new study, Rosenthal called 122 hospitals: two per state and two in Washington, D.C., plus the top 20 orthopedic hospitals listed in the US News and World Report rankings. During each call, she pretended to have a 62-year-old grandmother who needed a hip replaced but didn’t have insurance, and asked for the total price of the procedure. Just 45 percent of the top 20 hospitals and 10 percent of other hospitals could provide a complete cost for the hospital and doctor fees for a hip replacement, after up to five phone calls. When Rosenthal called both the hospital and affiliated doctors separately, she did a little better. In those cases, her team was able to put together the prices of procedures at 60 percent of top hospitals and 63 percent of others.

Those totals ranged anywhere from $11,100 to $125,798, Rosenthal and her colleagues from the University of Iowa reported Monday in JAMA Internal Medicine. She said some hospitals gave her reasons for a higher price – such as assigning her grandmother to a private room – but for others, it wasn’t clear what went into the cost of care. “It just points to the fact that most of us in the health system don’t have any idea what the costs really are,” said medical ethicist Dr. Ezekiel Emanuel from the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, who co-wrote a commentary published with the new study.

Often, only the hospital’s billing office knows how much a patient is actually charged for a procedure such as a hip replacement, researchers noted. Some of the variation in costs has to do with how hospitals factor in overhead to each patient’s bill, Emanuel told Reuters Health. And the cost of an actual hip prosthesis can vary four- or five-fold across the country, he added.

Jeanne Pinder, founder of the transparency group ClearHealthCosts, said a ten-fold difference in price for any given test or procedure isn’t unusual, even within a single geographic area. “Nobody has any idea what they will pay in healthcare because the marketplace is completely opaque,” Pinder, who wasn’t involved in the new study, told Reuters Health. “When you go into the system, you’re usually not there because you want to be. You’re usually anxious, upset, and there’s a question of when you come out on the back end, whether you’ll be bankrupt or not.” That’s not only a concern for uninsured people, she noted, given how high co-pays or deductibles may be for those who are covered.

For a patient looking for cost information, there aren’t a lot of options right now – other than waiting for more transparency to come through legislation or other means, researchers said. “I don’t know that the information is readily available right now,” Emanuel said. “You can try to call around, especially if it’s elective.” Rosenthal told Reuters Health the findings do show that people willing to make lots of calls might have success shopping around for the best deal. But hospitals don’t make it easy. “Patients can take responsibility and put pressure on hospitals to make this information available,” she said. Pinder agreed. “I always recommend that people ask,” she said. “If you put this information into people’s hands… you can start to think like a consumer.”