(NEW YORK) — Noah Clayson, 3, is in need of a tonsillectomy.
The good news is that Noah will get all the ice cream he could ever want, but the bad news is that the procedure isn’t covered under his parents’ limited insurance plans and they expect to pay roughly $5,000.
Like 30 million other Americans, Holy and Alex Clayson — both small business owners in Charleston — are considered “underinsured,” and pay high deductibles.
Hospitals can charge wildly differing amounts for the same procedure, according to a report released last week by the Federal Centers for Medicare and Medicaid Services, which studied data from 3,300 hospitals across the country.
One Florida hospital, for example, billed nearly $40,000 to remove a gall bladder using minimally invasive surgery, while another just 45 minutes away charged more than $90,000.
To find out how the Claysons can get a fair price for their son’s tonsillectomy, ABC News teamed up with health care expert Michelle Katz. She contacted five hospitals and clinics in the area.
The price quotes varied significantly — from $2,800 to $3,500, to $12,000, and even $21,000. That means the price of the same procedure varies by as much as 750 percent.
Experts claim that whether you choose to go to a surgery center or a hospital for relatively simple procedures like tonsillectomies, the quality of care is typically the same, except in cases of an emergency.
If an emergency were to arise in a surgery center, you would have to be transported to the E.R., which though rare, can occur. Whether the procedure is done at a hospital or surgical center, there is always an anesthesiologist who monitors the situation and is able to address most problems that arise.
If the child undergoing the procedure is a special case with an increased risk of complications, the surgeon will advise the parents beforehand that he or she would prefer to do the operation in a hospital.
ABC News reached out to the American Hospital Association, which explained the price differences in the following statement:
“Each patient’s course of care is different and the costs also reflect more than the cost of serving an individual patient but reflect the costs of maintaining essential health care services for their community 24 hours a day 7 days a week.
“In performing this ‘public service’ role each hospital will incur different costs. One hospital might have a large role in training health care professionals or conducting research. Another may maintain the community’s only trauma or burn unit. And still another may provide a higher portion of its care to patients unable to pay. Surgery centers are likely to have substantially lower prices because they do not fund the public service role nor do they typically serve in the safety net role.”
In many cases, Hospitals and clinics can and do charge whatever they want for procedures, but armed with some money saving tips, you can make sure you’re paying a fair price.
Tips that could save you money:
1. You can get a pricing menu. Brand new applications like Health Care Blue Book allow you to type in a procedure, and provide a fair price based on your area, even breaking down each cost into categories including physician, facility, and anesthesia.
2. Take that fair price quote, and negotiate. Before the procedure, negotiate the price with the billing office or your doctor. The doctor may not be bound to the price quoted, and opening up the conversation could give the consumer a talking point, and leverage.
3. Find out what the government pays. You can find out what government programs, like Medicare and Medicaid, pay for the same procedures by doing some digging on the CMS website. Through the website, you can also find out what those procedure codes really mean. After you get your bill, you can use those codes to make sure there haven’t been any billing errors.
With the help of Katz, the Claysons found a clinic just three miles away that charged just $2,800. More than $2,000 less than they expected to pay, and almost $18,000 less than the most expensive option in the area.
Which means peace of mind for mom and dad, and more ice cream for little Noah.
For more, check out Michelle Katz’ tips on her blog.
Copyright 2013 ABC News Radio