About Amy Umble:
Amy Umble is health reporter for The Free Lance-Star

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Why can’t I find out ahead of time what a sleep study will cost me?

At the ready is a continuous positive airway pressure machine, or CPAP.

I need a sleep study because of sleep apnea, and I would like to know ahead of time what it will cost. Fat chance.

The price of an object is an important part of the decision to buy that object, yet it is difficult, if not impossible, to obtain prices in health care.  Here’s what happened to me recently when I tried to learn how much I will have to pay for a sleep study:

As far as I can tell there are three places in the region that do these studies: Mary Washington Hospital, Spotsylvania Regional Medical Center and Sleep Disorder Center of Fredericksburg, a private center operated by Pulmonary Associates of Fredericksburg.

I called each to find out what they charge for a sleep study. If I can be comfortable that the study will be done well, I will use the cheapest center.

Mary Washington said its charge was $3,780. Spotsylvania Regional said its charge was $3,269. The Sleep Disorder Center said it charges $1,300.

The clerk at Spotsylvania Regional said she was required to read me a statement saying that the number she was about to give me was an estimate, and that the hospital could not guarantee that is what I will pay. Then she said that the “expected reimbursement” from United HealthCare, my insurer, was $529. She was not sure how this differed from the $3,269 or how much I might have to pay. I could only shake my head.

United HealthCare was almost no help at all. They said that the “allowable reimbursement” at the Sleep Disorder Center was $991. Under our current plan, I would have to pay 20 percent of that. Their computer did not have the allowable reimbursement for Mary Washington or Spotsylvania Regional. I pressed the person on the other end of the phone, but he could not tell me what United pays them for  sleep studies.

Presumably the $3,780 and $3,269 were not the contract prices that United has with the hospitals, but I am not positive of that. It is possible that those are the prices, and that I will have to pay 20 percent of that if I go there.

After a lot of time on the phone trying to find out these prices, I came to a couple of conclusions:

  • United had the answers to my questions but refused to provide them. This surprised me since they work for me and my employer. Why wouldn’t they help me—and my employer—get the lowest possible price? United’s customers can go to the “Estimate Health Care Costs” portion of its website, plug in a ZIP code and procedure and get an estimate. When I did that, I learned that the “average in-network total cost” for a sleep study in the 22401 ZIP code was $843, and that my share of that was $169. This was small comfort, but apparently it’s all I’ll get.
  • And what does all this mean for the person with a high-deductible health plan? It is said that these plans force employees to become better consumers by making them aware of costs. That is a worthy goal, but it will never happen.  Instead, high-deductible plans simply shift costs from the employer to the employees. Without valid price comparisons, the only way a high-deductible plan will result in lower costs is when employees avoid treatment.