Troubleshooters: Cracking Medical Codes

LANSDALE, Pa. (WPVI) -- The cost of healthcare is becoming an ever bigger burden on consumers. Many are getting socked with expensive medical bills they never anticipated. But there are ways to figure out pricing and to shop around for the medical service you need.

There are 10,000 medical procedure codes and that isn't counting anesthesia codes or codes for things like durable medical equipment. And it's these codes that dictate what patients have to pay.

Wendy Ericsson of Lansdale, Pa. needed physical therapy to relieve her back pain. She first went to a P-T clinic that charged her $75 for 45 minutes of therapy and a hot pack.

But then Ericsson realized her insurance company required her to do her P-T at a local hospital.

"Abington Lansdale charged $185 for 15 minutes," she said.

Plus more than $100 for a hot pack!

"I think that's insane. I think it's ridiculous," she said.

A growing choir of consumers is singing that same sentiment.

"They are now being required, even in-network, to pay higher co-pays and co-insurance. It's also become an issue because of high-deductible health plans," explained Robin Gelburd, President of FAIR Health.

And that is requiring patients to dig deep into their pockets before their insurance kicks in.

That's what happened to Ericsson whose hospital bill for six P-T sessions totaled over $1100.

"I was very angry. I was not expecting a bill of that size. No one told me what the fees were," she said.

You can battle bills, but you must be armed with information. The Action News Troubleshooters have found a powerful free tool to help with that. It's called FAIR Health.

The non-profit's mission?

"To create a free consumer website that would finally allow consumers to pull back the curtain on health care pricing," said Gelburd.

Every procedure, device, and service has its own code. On FAIRHealthConsumer.org just a few clicks and you can find those codes and get a ballpark price you should expect to pay.

"The results page will show you what a typical charge is for that procedure in your geographic area," said Gelburd.

For example, using our station's zip code we cracked a few codes. Code 73721 is an MRI (scan of the leg joint below the knee), the estimated charge for an insured patient is $431. Code 77056 is a mammogram (of both breasts) which is estimated to cost $150.72. And code 73590 for an x-ray (of the lower leg with two views) runs about $71.

FAIR Health also shows the estimated reimbursement and your out-of-pocket cost and it has an app.

"We have been told that there are some who have been in the doctor's office and have gone to their app and have used it to negotiate a price for that service," explained Gelburd.

Chuck Bell of Consumers Union recommends that website and others.

"You can also get the Medicare rates that pays for that procedure. Another helpful website is healthcarebluebook.com, which offers a similar service where you can look up charges and how much is charged at different facilities," he said.

For Ericsson it would have been cheaper to stick with the P-T clinic even though it was out of her network.

And via FAIR Health the Troubleshooters found Ericsson may have been able to find a place that charged even less than the clinic.

"I think it's very important that consumers use a tool like this to check because when you get a $1200 bill and you're not expecting it - that's a huge chunk of change," she said.

Right now, FAIR Health prices do not include facility fees, the additional cost you'd be charged by a hospital or surgery center. Those facility charges are expected to be added to the website in the next couple months.

We did ask Ericsson's hospital, Abington-Lansdale, if it would reduce her bill. The bottom line answer was "no." A spokesperson telling Action News its charges are competitive with that of other local hospitals and it has to uniformly charge patients.

But it can pay to shop around there are providers that can and are willing to negotiate. Consumers Union found patients were able to get their medical bills reduced or waived about half the time.

For more help on finding a fair price on healthcare and shopping around visit Consumerreports.org