When Ken Leffler's gastroenterologist said he needed an MRI and a procedure that would send a scope down his throat to examine his esophagus, his first thought was the cost.
"I said, well, there goes another $5,000," said Leffler, 63, of Lehighton, Pa. in Carbon County, who has an esophagus condition related to chronic regurgitation of stomach acid.
Yet he never spent much time researching medical procedure prices because he thought it was a useless task.
But his attitude changed when his gastroenterologist ordered the tests and pressed a pamphlet into his hand. It described an online price checker tool offered by St. Luke's University Health Network that allows patients not only to find out what procedures will cost ahead of time, but also to get discounts by paying up front in cash.
The Lehigh Valley-based health system is among the hospitals, insurance companies and other health-care facilities rising to a pressing challenge: providing patients with reliable price estimates at a time when consumers are shouldering more of the cost burden than ever, and can't afford to face surprise bills.
Pricing tools are often too clunky or generic to be much help. That's the focus of Philly Health Costs, a partnership between the Inquirer and 6ABC Action News, aimed at helping people understand that prices can vary widely just in the Philadelphia region — both because of what facilities charge and how much insurers cover. The Health Costs tool compares cash prices for dozens of common medical procedures at area facilities, but can't reflect variations in insurance coverage or quality of care.
"The problem, everyone kind of agrees, is we need price and quality data together, and we need information that's germane to people's decisions," said Anne Weiss, a managing director at the Robert Wood Johnson Foundation. "Health systems and insurers have a lot of incentive to get into the business."
A competitive market
Through St. Luke's PriceChecker, patients search for their needed procedure, then enter their insurance provider, member number, and birthdate. The tool then generates two numbers: On the right is a customized estimate of what the procedure will cost with the patient's insurance plan. On the left, a discounted cash price patients can get if they pay up-front — important for patients in high-deductible plans. The hospital still submits a bill to the patient's insurance company, so that the amount paid up front can count toward the patient's deductible.
Leffler, whose insurance plan has a $7,500 deductible, said that he saved money on his procedure by taking the cash discount.
But not everyone immediately grasped the appeal of the tool.
"When we first brought it out, our competitors would call and say, 'Why are you doing this?'" said Gina Filipovits, senior director of patient access for St. Luke's.
The contracts between hospitals and insurers that dictate prices are considered proprietary information, not to be released to the public. Cash prices are not subject to these contracts, but health systems have been notoriously reluctant to publish even these numbers for fear competitors will undercut their rates and insurers will demand more favorable terms.
But St. Luke's saw price transparency as a way to help — rather than hinder — business, Filipovits said.
Hospitals have seen a rise in unpaid medical bills by patients who have insurance, but didn't realize they would still owe so much. Yet asking for payment upfront is rarely well-received by patients who either aren't prepared to pay or are insulted by such a request during a sensitive time. St. Luke's leaders thought they could reduce delinquent bills by giving patients more information and offering incentives to pay up-front.
"We really have to be competitive, with the eBay-Amazon mentality of the world," Filipovits said. "Automation is really what the next group of consumers really wants."
Since formally launching its customized price checker in January 2016, St. Luke's has increased advance payment for services, reduced the amount of time it takes patients to pay, and experienced an uptick in overall services delivered, Filipovits said.
More than 2,000 people have used the tool and pre-paid for services, including 146 people in April.
A mutually beneficial solution
This summer, Independence Blue Cross, the largest health insurer in Southeastern Pennsylvania, plans to launch an updated version of its own cost estimator tool. Members will be able to get estimates specific to their health plan and compare their personalized price estimate across different providers.
The tool currently provides only general price estimates.
St. Clair Hospital outside Pittsburgh launched a customized price tool in 2016 that administrators said has helped the small, independent hospital compete with the region's larger health systems.
"We don't staff [the billing office] 24-7," said Rick Chesnos, the hospital's chief financial officer. "We want to provide a tool that's convenient for patients to access whenever they would like."
Online menus of cash prices are becoming popular among surgery centers, which are also competing with hospitals for business.
Abington Surgical Center in Willow Grove has an interactive cash price page that links a map of the human body to various procedures offered.
Abington's tool hasn't been as popular as anticipated — considering that it was developed in response to patient requests — but administrators think interest will pick up as high deductibles begin to take their toll on patients.
"People are starting to ask the question," said Meg Yezzi, the center's director of marketing and business development. "As demand increases, we want to be able to provide that information."
Promoting the tools
For health systems that make these tools available, the next hurdle is getting people to use them.
For so long, cost hasn't been a big enough part of the decision-making process when it comes to health care, said Kevin Volpp, director of the Center for Health Incentives and Behavioral Economics at the University of Pennsylvania. Rather, patients often follow their doctor's recommendation without consideration of whether there is a less expensive alternative.
That was fine when patients' co-insurance responsibilities were small; now, more people are asking questions.
Knowing this, St. Luke's has made its medical staff key promoters of its price tool.
Since Leffler's doctor introduced him to the online tool, he consults it whenever he schedules a procedure. He estimates that he has saved thousands of dollars over the last few years.
"It's a matter of knowing it exists," Leffler said, "and using it."
Share your own experience — and what you paid — at Philly Price Check or by emailing firstname.lastname@example.org. Or leave a voicemail message at 215-854-2500 describing the billing issue you would like to share.