Is that the retail price or the negotiated fee of the office visit?
It’s always a shock and a surprise when you open the Explanation of Benefits (EOB) and companion invoice for health care services from your local doctor or hospital after treatment. It can be particularly perplexing if the EOB comes from your insurance carrier and the invoice is from the provider. The cost of the visit, procedure or test along with the negotiated rate, discount, from the insurance company and your share of cost responsibility can be a jumble of information.
Confusing prices
A big contributor to the confusion is that hospitals, labs and out patient facilities have their retailing pricing (think of the manufacturer suggested retail price, MSRP, on a new car) and “negotiate” prices when you access health care using health insurance. Supposedly, you are getting special prices because of your health insurance as opposed to full retail that they bill people who have no health insurance.
What is the real cost?
The bottom line is that it can be very confusing to determine the actual cost of the procedure, especially if you are planning to visit a doctor, have a procedure or need a lab test. Kaiser, which is a combination of Kaiser Permanente insurance, Kaiser Physician Group and Kaiser Hospitals, makes it easier to see the schedule of prices because they don’t work with outside insurance companies for routine care. This makes it easier for them to post their fee schedule since it is coordinated between the physician group and hospital.
Simple list of office fees
It was nice to see that Kaiser of Northern California has put out an easy to read fee schedule for different office visits, procedures and lab tests. This list applies only to those who are a member of Kaiser Permanente Health Savings Account (HSA) plan or deductible plan with a Health Reimbursement Account (HRA) from an employer. These are the most common of the services provided and give people a little insight into the costs of care. We have to remember that one office visit can easily become a therapeutic visit where a procedure is done and the need for an additional lab test.
2014 Kaiser Sample Fee Schedule
Kaiser has Northern California and Southern California operations which each have slight different fees associated with health care services. These fee schedules only apply to individual and family plans.
- [wpfilebase tag=fileurl id=388 linktext=’Northern California Sample Fees 2014 English’ /]
- [wpfilebase tag=fileurl id=387 linktext=’Southern California Sample Fees 2014 ‘ /]
One visit, many costs, some no charge
An example might be visiting your physician for hearing loss. They might flush out accumulated ear wax and set you up for a hearing test later. Consequently, you would have the cost of the office visit, cost to flush out the ear wax and the future cost of the hearing test. Of course, many preventative visits and some procedures will be no charge under the Affordable Care Act. A no charge colonoscopy will happen for any one who turns 50 as a preventive procedure to catch and treat colon cancer early.
Quick glance at fees
Some of the fees can be on a sliding scale of severity. The fee schedule can be particularly important people who have either a Bronze or Bronze HSA where they must shoulder the full price of the health care service before they have met their deductible and go into coinsurance.
- New patient office visit: $60 – $275
- Group psychological therapy $40
- Eye exam: $127 – $193
- Physical therapy exercises $60
- Colonoscopy, diagnostic $715*
- CT scan of chest, including dye $678
- Mammogram $286*
- X-ray of ankle $75
- Cholesterol level test $11**
*Visits or test that might be no charge under ACA under certain conditions.
**May be in combination with other blood tests with separate charges in addition.
These fees have increased in the range of 5% up 15% from the 2013 fee schedule.
Transparency
As we move forward with implementing the Affordable Care Act and the health insurance exchange in California, transparency of the actual health care costs will be important. Sample Fee lists like this from Kaiser will help people determine which health insurance plan, deductible and cost sharing amounts will be right for them.