Crowd-sourcing may bring transparency to medical charges, part two

Published 7:00 am Friday, June 16, 2017

By Trudy Liberman

As former New York Times reporter Elisabeth Rosenthal describes in her new book “An American Sickness,” the inability of patients to find out what their medical care charges will be stems from a gigantic bill coding business that involves the health system’s biggest players in a game of one-upsmanship to make big profits.

The codes determine what providers are paid. The more individual codes included in the bill and the higher levels of service a code specifies, the more money providers make.

Sign up for our daily email newsletter

Get the latest news sent to your inbox

There are tens of thousands of codes that have become increasingly specific, Rosenthal says. For example, there are different codes for earwax removal depending on the method used to remove the wax.

Furthermore, prices negotiated between insurers and hospitals are secret. A study commissioned by the New York State Health Foundation late last year found that contracts insurers negotiate with hospitals often say they can’t disclose the prices they’ve negotiated, such as listing those prices on their website. If they do, hospitals can terminate their contracts and refuse to accept the insurer’s patients.

No wonder patients are fighting back.

I checked in with Jeanne Pinder, who heads an organization called ClearHealthCosts.

Its mission is to tell patients what their medical care costs. The organization now partners with media organizations in Miami, Tampa-St. Petersburg, and New Orleans and with MedPage Today.

It has also worked with news outlets in California and Philadelphia to publish prices of 35 procedures that consumers can actually shop for such as MRIs and mammograms.

ClearHealthCosts has just launched its latest site in New Orleans, and Pinder says, “Traffic is through the roof. People are sending us bills and calling us with horror stories.”     

ClearHealthCosts uses crowd sourcing to build a community-created guide to health costs. Patients from all parts of the country send in their explanations of benefits, dates of their procedures, names of providers and insurers, and amounts they paid, which are posted on the news outlet websites.

They show wide variation in the price for the same service in a given area.

In San Francisco, for example, they found that an MRI of the lower back without contrast could cost as little as $475 or as much as $6,221 depending on where it was done. Most patients would want to know that, but as the Ohio experience has shown, healthcare businesses and governments sometimes work together to keep prices under wraps.

“So many people have lost faith and hope that government regulators or industry will fix this problem,” Pinder says. “We are supplying the fix, and the fix is transparency.”

What experiences have you had finding out the price of care? Write to Trudy at