A Pittsburgh-Tribune Review investigation exploring healthcare costs around the country found that the price for identical medical procedures differs widely, even within the same hospital or clinic.
According to the report, cost depends on various factors, including region and the party responsible for paying for the procedure. Depending on whether a procedure is paid for by an insurer, Medicare or the patient, the differences can amount to thousands of dollars.
Using publicly available Medicare data, studies of healthcare costs by private companies and data obtained from national insurers, the newspaper found that for the same MRI scan of the lower back, Aetna members could pay more than $3,100 in South Texas or less than $300 in South Florida. Uninsured patients could receive a bill of more than $4,600. At St. Joseph Hospital in Bangor, Maine, Medicare pays $780 for a colonoscopy, but private insurers pay from $1,445-$2,306. Uninsured patients can receive charges of more than $2,600.
According to research published in Health Affairs, physicians in regions of the country that spend the most Medicare dollars see patients more frequently for follow-up visits and are more likely to recommend screening tests of unproven benefit than physicians in low-spending regions. Patients are more likely to undergo imaging tests in Miami, where Medicare spends the most money nationally at $18,199 per beneficiary, than in Minneapolis, where the average beneficiary is allocated around $7,400.
According to the report, private insurers see similar variations between regions. In a pilot study that was never published, Blue Cross Blue Shield Association found regional differences in the cost and utilization of knee replacements among 110 million members at 18 insurers.
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According to the report, cost depends on various factors, including region and the party responsible for paying for the procedure. Depending on whether a procedure is paid for by an insurer, Medicare or the patient, the differences can amount to thousands of dollars.
Using publicly available Medicare data, studies of healthcare costs by private companies and data obtained from national insurers, the newspaper found that for the same MRI scan of the lower back, Aetna members could pay more than $3,100 in South Texas or less than $300 in South Florida. Uninsured patients could receive a bill of more than $4,600. At St. Joseph Hospital in Bangor, Maine, Medicare pays $780 for a colonoscopy, but private insurers pay from $1,445-$2,306. Uninsured patients can receive charges of more than $2,600.
According to research published in Health Affairs, physicians in regions of the country that spend the most Medicare dollars see patients more frequently for follow-up visits and are more likely to recommend screening tests of unproven benefit than physicians in low-spending regions. Patients are more likely to undergo imaging tests in Miami, where Medicare spends the most money nationally at $18,199 per beneficiary, than in Minneapolis, where the average beneficiary is allocated around $7,400.
According to the report, private insurers see similar variations between regions. In a pilot study that was never published, Blue Cross Blue Shield Association found regional differences in the cost and utilization of knee replacements among 110 million members at 18 insurers.
Related Articles on Coding, Billing and Collections:
Surgery Center Coding Guidance: Vertebroplasty
Michigan Imposes 1% Tax on Healthcare Claims
OIG: Ambulatory Surgery Centers, HOPDs Frequently Report Wrong Place-of-Service Codes