When Shirley Abraham of Key Largo needed a nuclear stress test on her heart, she and husband Jim tried to be cautious consumers, since their insurance required they pay 20 percent out of pocket.
They were particularly wary because several years before, Jim had undergone an MRI at a Baptist Health South Florida facility — and was flabbergasted to see a charge of $25,000 for a test that costs about $5,000 in southwestern Michigan, where they spend summers. That meant the Abrahams’ expense was a stunning $5,000.
This time, determined to avoid such an unwelcome surprise, they decided to do their own legwork on costs. But what happened next is a prime example of the pitfalls awaiting those who try to be thoughtful healthcare consumers.
“You wouldn’t believe how hard it is to find out prices,” Jim Abraham said. “It’s a bureaucratic system. You have to go through this maze to find someone who can really quote you the cost. You never get the same person twice, and they say, ‘Well, why do you want to know the costs?’ ”
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Americans, even with employer-provided health insurance, see their own out-of-pocket costs continuing to rise, often in ways that don’t seem to make sense. And those who try to decode healthcare pricing can find the process frustrating and fruitless.
The Abrahams ended up in a battle with Jackson Memorial because the public hospital jacked the price up when the staff realized they had insurance. In another case, a Miami lawyer found that, because of an insurer’s technical requirements, he would have paid six times more at Baptist for a test than he did at Mercy, even though both hospitals were in-network.
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