The state’s largest health insurer has unveiled an online cost tool Wednesday that exposes wide disparities in billing patterns among North Carolina’s doctors and hospitals.
Blue Cross and Blue Shield’s online feature –bcbsnc.com/healthcarecost – shows price differences of thousands of dollars for the same procedure among the state’s health care providers.
Disclosing the information, which has long been a closely guarded trade secret, will be a “key component of solving the health care cost problem,” Susan Weaver, Blue Cross’ chief medical officer, said in a conference call with journalists.
“We really believe the best way to lower health care costs is to have informed consumers,” Weaver said. “We are getting consumers literally begging us for this kind of information.”
But several health care advocates said the site will confuse and mislead the public.
Billed as a solution to a chronic lack of “transparency” in the health care industry, the site shows that a Blue Cross customer can get a colonoscopy with a biopsy for as low as $928 from a doctor in Greensboro, and as high as $8,489 from a doctor in Chapel Hill.
At providers within 100 miles of Raleigh, a knee replacement can be had for $11,815 at the Sampson Regional Medical Center in Clinton. The same procedure at Betsy Johnson Regional Hospital in Dunn costs $47,122, the site shows.
Blue Cross announced its cost calculator tool just days after the N.C. Department of Health and Human Services began posting cost data submitted by hospitals, under a 2013 state law called the HealthCare Cost Reduction & Transparency act.
The law requires hospitals to disclose average negotiated settlements with insurers for the 100 most frequently provided services. It also requires hospitals to disclose the payment ranges made by the five largest insurers, which would typically include Blue Cross.
Blue Cross has objected to the law, saying it would reveal competitive trade secrets. On Wednesday, the company said its online tool is more comprehensive and customer-friendly.
“The data reported by the state will only cover the hospital’s fee for most of the services, not the total cost of care (additional fees for surgeons, anesthesiologists and others involved with the procedure),” Blue Cross spokeswoman Darcie Dearth said by email. “The vast majority of data in the state’s tool is for emergency care, not the types of treatments the consumers have the time to research.”
Health care advocates of pricing transparency said that Blue Cross’ online cost calculator doesn’t provide any useful information. They said the Blue Cross site doesn’t explain what the numbers mean, where they come from, and how they can be used.
“It’s absolutely appalling that they do not have a clear disclaimer on what the information is,” said Lynn Quincy, associate director for health reform policy at Consumers Union, the policy and advocacy arm of Consumer Reports magazine.
“It’s a bit unconscionable how little transparency there is on what you’re looking at,” Quincey said. “It’s unclear what they want a consumer to do with this.”
Weaver told journalists the information represents the amounts Blue Cross pays doctors and hospitals for elective, non-emergency procedures. The reimbursement amounts are negotiated between the insurer and the providers.
However, the site is not designed for Blue Cross consumers, who can look up precise costs they would actually pay based on the terms and conditions of their particular policies.
The information is likely of little use to people who aren’t insured by Blue Cross, since Blue Cross contracts with providers don’t reflect the reimbursement amounts paid to providers by Aetna, Cigna, UnitedHealthcare or others.
“If I’m covered by Cigna, I’m not sure what I do with this,” said Karen Pollitz, a senior fellow at the Kaiser Family Foundation. “Transparency for consumers requires a little more information.”
Date: January 7, 2015