Human Resources News & Insights

Why your health premiums could jump higher in 2013

Here’s some info worth passing along to your employees that could help control rising health insurance premiums.

Your health plan could end up paying up to 755% more for the same service in the same area depending on which healthcare provider they go to. And the more your health plan pays, the more insurance premiums will increase next year — for both you and them.

So it’s imperative employees shop around, particularly when it comes to preventive care — mammograms, Pap smears, colonoscopies, well-child visits, flu shots and other services designed to catch and prevent serious conditions.

These services are not “free,” although to employees it may seem that way since health plans are now required by the healthcare reform law to cover 100% of the cost of these medical services.

A recent study by Change Healthcare, which provides tools to help employers compare costs between healthcare providers, revealed many healthcare providers charge more — much more — than others for common procedures. And by steering employees toward lower cost, higher quality providers, health plans can save a lot of money long term.

The study is called the Healthcare Transparency Index. It was compiled using claims data from Change Healthcare clients over a 12-month period.

Highlights of the study:

  • The Index revealed a significant difference in costs for diabetes screenings with a low of $51 and high of $437, a 755% difference.
  • The cost for Pap smears ranged from $131 to $476 dollars in the same community, a difference of 264%.
  • The cost for a colonoscopy ranged from $786 to $1,819, a difference of 131%.
  • The price for a lipid panel test, the most common way to measure cholesterol, ranged from $117 to $374, a 219% difference.
  • The cost of a mammogram ranged from $169 to $403, a 138% difference.

Some of the most common reasons for the differences in price:

  • Whether the service is performed in a hospital, doctor’s office or ambulatory clinic
  • Whether a practice specializes in the procedure (which usual drives the price down), and
  • If the provider is in a rural or urban area.

Some steps to take to get employees to price shop and select lower cost providers:

  • Ask you health plan provider for price comparison info that can be distributed to employees, and
  • Only give employees a certain amount to spend on a procedure and tell them they are responsible for any overages. (Note: Consult your health plan provider to make sure the amount given is enough to cover the average cost of the procedure in your area.)

Info: To download the Health Transparency Index, click here.

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  • Joanna G.

    I can’t help but wonder, how the memebers can access price list from providers? In case of fully-insured plans, neither insurer gives any information on price nor provider i.e. labs, reveal what they will charge for tests or procedures in advance. It’s all secret until the bill comes. The findings in the mentioned report are very disturbing!!!

  • Shannon


    Many of your carriers now have tools on their websites that show you what procedures will cost to its members. UHC and Aetna are two examples. Carriers are trying to educate members on consumerism and are working on getting those tools to the members. There are some providers however, that will not provide the information….in the DFW area Baylor is one hospital network that will not share the information with members.

  • Joanna G.

    Shannon, thank you for your response. A moment ago I called Oxford since they are our insurer. Although there are many helping tools to educate members/employers, I was advised that Oxford does not provide any listings of fees on their webside. They confirmed that negotiated fees for the same procedure are different for different locations (obviously) i.e. in NYC – Manhattan have different negotiated fees than Brooklyn or Long Island. However no fees are fully disclosed. Member must obtain from a refering physician diagnostic code and procedure code, than call insurance company, specify where is planning to do the test and ask for charges. These steps are particularly important when we are talking about HDHP and out of network services for any plan and any insurer. Patients be aware!!!! This is just the beginning!

  • Shannon

    It is unfortunate some carriers/providers make getting actual costs difficult. I’m not sure I’d do business with a provider if I could not get costs from them. People have been shielded from the true costs of services due to copays, etc they have no desire to do a little legwork. We would not go out and buy a car or TV without first doing some research and cost comparison. Why do we not do that with our most important asset, our bodies? Individuals need to take ownership of their healthcare and the consumer driven health plans are forcing them to become educated.

  • Common Sense

    @Shannon and Joanna,

    Try utilizing the following website.

    It is a great resource for all patients, especially HDHP participants.

    How to Use the Healthcare Blue Book
    The Healthcare Blue Book helps you search for fair prices in your area on many common healthcare services, including surgeries, office visits, therapies, labs, images/MRIs, cosmetic surgery, dentistry and much, much more. Healthcare Blue Book prices reflect the average amount that most providers in your area will accept from major insurance carriers. Surgery prices include the three major fee categories: facility, physician and anesthesia services. Prices are regularly reviewed and validated for accuracy.

    The Healthcare Blue Book is easy to use, just follow these three steps: Talk to your doctor about his or her recommended treatment, and understand your options for care.

    Click here for more information on how to talk to your provider about treatment options.
    Use the Healthcare Blue Book drop down menus or search keys words to find a fair price for your non-urgent medical care.

    Click here for more information on how to use the Healthcare Blue Book to find prices
    Call your provider and compare their price to the fair price. If the price is too high, consider calling three other providers. Be sure to let the provider know if you have insurance or are paying cash.

    Click here for more information on how to talk to your doctor about price.
    Patients who have to pay for some or all of their healthcare services need to know how much they should pay before they receive treatment. Most hospitals and doctors don’t publish their prices, and the “list price” for services (sometimes called billed charges) is much higher than what insurance companies pay providers. However, many healthcare providers will provide a discount to patients who pay out of pocket. But you have to request a discount.

    Even if you have insurance and use in-network providers, the negotiated prices can vary a lot. You may save money by checking the negotiated rates with several in-network providers. Click here for more information on how to use the Healthcare Blue Book to get the best value from your insurance coverage.

  • Joanna G.

    Thank you both very much. I definitely will use your information. And by the way Shannon, I was told by our broker that indeed United Healthcare has the feature you described, but Oxford doesn’t.
    Once again, thanks for valuable input.