Highmark Site Breaks Down Medical Procedures' Costs

Article excerpt

Highmark Inc. has introduced an online cost-comparison tool for 17 common, elective surgeries, offering more pricing information to its 3.1 million members to help them make health care decisions.

Information provided by Highmark differs from similar offerings from other health care insurance companies by giving a range of average costs or fees for everything from admission, through discharge, including anesthesia and pathology.

"We believe our program is one of the first in the country that gives actual payment amounts made to hospitals," said Carey Vinson, Highmark's vice president of quality and medical performance management.

Programs such as Highmark's are needed as employers place additional burdens on their employees to take a more active role in their health care to save money for all involved.

"From the employers' perspective, they need to get to their employees what services cost," said Chris Whipple executive director of the Pittsburgh Business Group on Health, a nonprofit coalition of more than 60 organizations with 800,000 covered individuals and more than $3 billion in health care costs. "Employers have been asking for this kind of information for four or five years."

The new cost-comparison tool doesn't give to-the-penny prices, but does gives members a better feel for what will be coming out of their pockets, depending on their individual health care plans, Vinson said.

Members, for example, can cost-compare procedures such as CAT scans, or knee replacements at various hospitals and other medical facilities, with prices based on Highmark's rate history at those facilities for a particular procedure.

Aetna was the first insurer in the Pittsburgh market to offer what's often called price transparency, in 2006, a result of large employers asking for the data.

"For the longest time, most people didn't know what the care cost, didn't care what care cost because when it came to medicine, they were getting it, but not necessarily buying it," said Michael Mesoras, Aetna's medical director for the Mid-Atlantic Region, including Pennsylvania. …