Pricing for the Same Medical Services is All Over the Map (Literally)
SAN FRANCISCO – June 10, 2014 – A new, comprehensive analysis of in-network price differences in a U.S. commercially insured population shows within the 30 most populous U.S. cities, prices vary greatly for the same service:
- Up to 23x for a lipid panel in Dallas (from $15 to $343)
- Up to 12x for a CT scan (of head/brain) in Philadelphia (from $264 to $3,271)
- Up to 11x for an MRI (of lower back) in New York City (from $416 to $4,527)
- Up to 4x for an adult preventive primary care visit in Phoenix (from $40 to $195)
The Castlight Health® U.S. Cities Analysis also ranked the most expensive and least expensive cities in the 30 most populous U.S. cities for four common outpatient services:
- For a lipid panel, Indianapolis came in most expensive (average price $89) and Pittsburgh the least (average price $19)
- For a CT scan (of head/brain), Sacramento came in most expensive (average price $1,404) and Orlando the least (average price $611)
- For an MRI (of lower back), Sacramento came in most expensive (average price $2,635) and Seattle the least (average price $907)
- For an adult preventive primary care visit, San Francisco came in most expensive (average price $251) and Miami the least (average price $95)
The Castlight Health U.S. Cities Analysis focuses on costs paid through employer-sponsored benefits for four common outpatient services: a lipid panel, a CT scan (of head/brain), an MRI (of lower back) and an adult preventive primary care visit. Nearly 48% of Americans are covered by employer-sponsored insurance, approximately 149 million people. Castlight issued the analysis to provide insight into what many Americans may pay for common medical needs, and to shed light that there are wide cost variations even for “in-network” doctors.
“Understanding healthcare costs is a first step in enabling employers to fix what is broken in enterprise healthcare,” said Jennifer Schneider, M.D., vice president of Strategic Analytics for Castlight Health. “Many Americans believe if they select an ‘in-network’ doctor from their company’s health plan they are assured of paying less, or think that healthcare prices vary across the country but not in their backyard. This analysis dispels both those myths.”
Schneider continued, “This analysis provides important information for consumers who get insurance through their employer. We want to make them aware of these price variances and ranges – and encourage them to take action to get great care at an affordable price. It’s also important information for their employers, who are footing the U.S. healthcare bill to a tune of $620 billion annually.”
Castlight Health recommends consumers consider the following to help lower healthcare costs:
- Establish a relationship with a primary care doctor. Your first visit with a new doctor costs 30-50% more than a return visit, even for new problems. You can avoid multiple first-time visit charges by maintaining a relationship with one primary care doctor. It’s important to select a primary care doctor that offers the affordable, high-quality care that’s right for you. Programs such as Bridges to Excellence and the National Center for Quality Assurance Clinician Recognition database are resources to identify physicians noted for achieving quality standards.
- Use national laboratory groups for blood tests. Similar to how you can take a prescription to the pharmacy of your choice, you can ask for a written lab order and take it to the lab of your choice. National laboratory groups have significantly lower prices – up to 90% lower than high-cost hospital lab facilities.
- Avoid going to the hospital for x-rays, MRIs, CT scans, and other imaging tests. Similar to lab tests, independent stand-alone imaging centers can provide identical services for a fraction of the costs. The savings opportunities can amount to hundreds or even thousands of dollars.
The primary source of data used for this analysis is medical claims data. Castlight augments this data with other data including: publicly available data, provider information, and actual provider rate sheets that list the negotiated price between a provider and an insurer. Castlight then applies proprietary algorithms to obtain the provider prices used for this analysis. Prices are defined as the employee cost-sharing plus the amount paid by the employer.
About Castlight Health
Castlight Health, Inc. (NYSE: CSLT) believes great healthcare builds great business. The Castlight Enterprise Healthcare Cloud enables employers to deliver cost-effective benefits, provides medical professionals and health plans a merit-based market to showcase their services and – most importantly –empowers employees to make informed choices with a clear understanding of costs and outcomes. For more information visit www.castlighthealth.com. Follow us on Twitter and LinkedIn and Like us on Facebook. Source: Castlight Health.
Copyright 2014 Castlight Health, Inc. Castlight Health is the registered trademark of Castlight Health Inc. Other company and product names may be trademarks of the respective companies with which they are associated.