Philly Health Costs: Frequently Asked Questions

You have questions about Philly Health Costs? We have answers
Ask what something in medical care costs and you could easily come back with a half dozen answers. That's part of why we are participating in a reporting project aimed at bringing clarity to the cost of health care in Philly.

Here are answers to some questions you may have:

1. What is this project?

Glad you asked!

We're building this community-created guide to health prices by doing intense reporting, and by asking you, our community members, to contribute your knowledge to our efforts.The media partners are 6abc Action News, The Philadelphia Inquirer, and ClearHealthCosts, a New York City journalism startup bringing transparency to the health care marketplace by telling people what stuff costs.

We're not only revealing pricing, we're also making great journalism out of the data you help us collect - attacking the problem of health care pricing with full-on transparency.

The project is underwritten by a generous grant from The Lenfest Institute for Journalism which supports local journalism collaboration across the Philadelphia news ecosystem.

2. Why would I share this personal information with a stranger, and the Internet?

We want you to contribute your information anonymously and honestly. Together, we can bring badly needed transparency to the health-care marketplace. Because we all contribute our information, the pool of knowledge becomes larger.

If you'd like to include your email address and phone number or send a scan of your explanation of benefits or bill, that will help us use your experiences to make great journalism.

3. What about my privacy?

The healthcare information you provide to us in this form will be used only anonymously, and will NEVER be paired publicly with your email address. The Philadelphia Inquirer, 6abc Action News, and ClearHealthCosts will preserve your privacy as part of our bond with you.

The pricing, procedure and location information you provide to us will be shared publicly inthe "PriceCheck" tool and to help you and others compare costs.

Your comments may also be posted wherever the table is posted. Except for your email address, the information we collect, including your comments, may also serve as the basis for articles and reports about health costs.

We have also provided an opportunity for you to email our reporters if you wish to provide information. We may use your email address to contact you directly to request more information about the data you have submitted; we will not share your email address with any other third parties.

4. What data do I supply? For example, my wife had a colonoscopy. There were bills from the gastroenterologist, the facility, the anesthesiologist and the lab. Should I add all of these together as the "total cost" of the procedure? Or just report what the gastroenterologist charged?

We are most interested in the "all-in" price, just as you probably are.

So if you choose the procedure that most closely matches what she had, and use the total prices charged, paid by insurance and paid by you, then specify a breakdown of other charges in the notes, that would be the best way for us to build a useful data set.

Our partners at ClearHealthCosts, who collected the colonoscopy costs in our database, try in every case to get that "all-in" price, for a cash or self-pay patient, though it's not always available in advance.

Sometimes the individual charges you experience are also remarkable ($1,500 for anesthesia? $2,000 for a facility fee?) so if the notes capture that, it's awesome.

If you're not sure we want it, here's your answer: yes, we want it. Detail is good.

5. The procedure descriptions are confusing. There are a lot of things named "colonoscopy" on this list. Which one am I supposed to pick?

Look at your bill and see if you can find a five-digit code like 77057 or an alphanumeric code like G0202. That's the closest description used in the medical system to standardize procedure identification. For more about the numbers,here's a blog post from our partner, ClearHealthCosts.

Not every bill has these same codes on it; some have only verbal descriptions. If you can get a code, that's good, but if not, use the closest verbal description in our widget - once you start typing, it will give you some suggestions from which to choose.

Beyond that, know that the medical codes vary in complexity according to how long the visit or procedure was, how complex it was, was this a new or returning patient and so on - for even the simplest things, like an office visit.

So a more complicated procedure like a colonoscopy might have more variables - how long was it, were there any complications, was there one biopsy or several?

The short answer: pick a code that's closest to what you had.

6. I want to put in something that's not on the list. Why can't I?

We're working to make a database of good, comparable information for the 8,400 major current procedural terminologies (CPT) codes used commonly in the medical billing system.

If we had a freeform data field, then that would allow you to put in "hairy toenails" or "I hate my mother-in-law" or anything else you wanted to input. Our database would then be lacking.

So we made a "share" form that has only 8,400 options. Please choose the closest one.

If your procedure isn't on the list, choose "Other" and explain in the comments. It's best if you can pick from one of the listed items, because that gives us cleaner data.

7. My provider is not in this database. Or: I am a provider and I am not in this database. What gives?

The provider list comes from Google, and we are aware that it has some faults in it. But the Google Places API that we are using is free, so we can't go ask for our money back.

Also in fact, many of the provider lists are out of date in healthcare - there are a lot of mergers and acquisitions and so on.

Certain healthcare providers or facilities may not appear - or not appear accurately - in Google's business listings. If you are a provider with questions, please contact Google to update your listing.

Tip: Google listings are inconsistent. When you search, the provider name may need to start with a prefix such as "Dr." in order to appear in the dropdown, or it may not.

8. I tried to enter my information, but it didn't seem to work. What should I do?

If you would feel comfortable in sharing via email, below are the data points we need: If you complete this list and return this to us, we'll put it in for you!

Provider (as specific as possible, with address, city, zip, phone, website)
Name of procedure
CPT or HCPCS code
Cash or self-pay price charged (If you're sending in personal information, not practice information, tell us what insurance paid and what you paid)
Email address

Email to with "Pricecheck data share" in the subject line.

You can go to this page on and download our spreadsheet template and send it on in if you have lots of prices to share.

Here's how we like to hear reports of malfunctions:

Bug or feature ?

(Bug is if it doesn't work, feature is if I wish it would do something that was not in our design, like search by insurance company or by provider, instead of procedure)

-What it does-be as explicit as possible.
-What you would like it to do-be as explicit as possible.
-Tell us what device, operating system, browser-be explicit (MacBook Air, OS X 10.6.8, Chrome build 40.0.2214.93 64-bit or iPhone 5S, IOS 7, Safari).
-Pictures are great, so if you can attach screenshots, documents and so on, that's ideal. Arrows are helpful.
-Email to with "PriceCheck bug report" in subject line.

Thank you very much! We appreciate your help!

9. So this is crowdsourced information - why should I believe any of it?

Some of our data is reported by our journalists. Some comes from government databases (the Medicare pricing). Some is crowdsourced. We trust our communities and believe in you. We believe your information will add to the reported information we already have, and we will be comparing the data about costs of items and procedures.

10. What about quality? My provider is better than anybody else.

We believe you. But there should be some better way than you telling us they're great.

Quality measurements for health care providers, hospitals, surgical centers and so on are a hot topic.

Everybody's got a favorite source (Yelp? AHRQ? Leapfrog? Consumer Reports? U.S. News and World Report? HEDIS? HCAHPS? your insurance company's quality rankings? Your Facebook friends?) but the bottom line seems to be this: There's a cacophony of competing sources of measurement, none of them definitive or over-arching. So we were interested to see this recent study revealing the outcome of a recent government effort to resolve the problem,as described by Alexandra Robbins in The Atlantic.

The U.S. Department of Health and Human Services is wrestling with this, and to hear Robbins tell it, they labored mightily and brought forth a mouse. If you have a favorite quality supplier, please tell us - and tell us why they are better than others.

From where we sit, there's not much that is really actionable by individuals, or accepted and embraced by the clinician world.

Price without quality is incomplete. In our view, bringing price out of the shadows speeds a thoughtful quality discussion: What makes that $6,000 MRI so much better than the $300 one?

11. Why would anyone care about a cash or self-pay price? If you're insured, isn't everybody paying the same copay or co-insurance?

First, prices vary widely. Also, not everyone is insured. And not all providers are in network.

Also, with rising deductibles and rising coinsurance, much more of the price is being paid by insured people.

Beyond that, if you're responsible for co-insurance of, say, 20 percent on a procedure, you might want to know if you're paying 20 percent of $300 or 20 percent of $6,000. (Depending on the insurance plan's language, you might be paying a percentage of the sticker price rather than of the negotiated price.)

We've heard of people on a high-deductible plan who routinely ask to pay the cash rate instead of the negotiated rate. Here's one example: One person who responded to our California PriceCheck survey wrote: "I was told procedure would be 1850. I have a 7500 deductaible (sic). So I talked to the office mgr who said if I paid upfront and agreed not to report the procedure to Blue Cross, that it would be $580."

Of course, if you haven't met your deductible, you may be paying full freight, even perhaps the chargemaster price. That's right: insured people are paying the chargemaster price. Some of them might prefer to pay a lower, cash or self-pay rate. Here's a blog post about that.

We heard of one insurance company whose online pricing tool explains the coinsurance for simple procedures: an MRI, for example, in New York City could cost $42.50 in coinsurance, or $253. Since under this particular plan the coinsurance is 10 percent, that also reveals the reimbursement rate by the insurance company. Here's a blog post about that.

There are a number of reasons that people might be interested in the cash or self-pay price, including the question of whether their insurance premiums are giving them access to the highest rate, rather than the lowest, until they have met their deductible.

12. Has anybody ever done this before?

In reporting on this issue, journalists fromClearHealthCosts have already partnered with public radio stations in Miami, Tampa-St. Petersburg, San Francisco, Los Angeles and New York City to build community-created databases of prices, and to do in-depth reporting on this issue. Click the links for examples. Also,here's some of the coverage of the California partnership, including links to our Harvard Business Review/New England Journal of Medicine coverage, and our JAMA Internal Medicine coverage, as well as NPR and other coverage.

ClearHealthCosts has collected cash or self-pay prices via a direct provider survey for several years. On the front page of their website, you can see links to their price lists of 30-35 common, "shoppable" procedures in the New York area; they also have pricing from seven other metro areas, which you can access via the search box at the top of their front page.

That search tool also gives you the Medicare reimbursement rate for any one of the 8,400 procedures in the government's Medicare reimbursement data set, in any U.S. locale.

13. Why are you doing this?

People should know what stuff costs. If they know there is a range from $200 to $5,900 for an MRI, that is quite useful.

Our prices are a combination of cash or self-pay prices, as a start, augmented by individuals' reports of their experiences in the marketplace.

14. Why can't you include deductible and co-insurance information?

Insurers and providers have not supplied information on deductibles and co-insurance (though sometimes they have the ability to do that on their own websites). So we are working on a community-created database.

While having a perfect set of information is the goal, it is not attainable right now. Having some information is better than having no information.

We are working not to let the perfect be the enemy of the good.

15. Why can't you include the contract or negotiated rate - what is paid by an insurer to a hospital or doctor or clinic for a service?

Those payment rates are not public. In many cases, they are hidden because of gag clauses in contracts between insurers and providers; in other cases, they're regarded as trade secrets. In any case, they're not available to us - unless you tell us.

16. There are other transparency tools. How does yours differ?

We are excited about all transparency efforts. We have some reservations about others' methods.

First, some sites use often-cited Medicare classifications. They include "Digestive system problems" or "fainting and collapsing," and other broad categories that are not things that people often search for. Other classifications are less general ("weight loss surgery" or "hip, knee or ankle replacement" but are still quite broad.

About our data: we give specific procedures, using the Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) systems, which govern health care billing. For example: MRI of the lower back without dye or contrast, CPT code 72148. Similarly, Echocardiogram with doppler or sleep study (along with CPT code) and so on, making it easy to confirm that these are apples-to-apples price comparisons.

Second, the "average prices" approach is not one we favor. Some sites say their "fair" or "average" price will help people guard against high bills, but can you really go to a provider and ask for an "average" price? We favor the approach of listing specific prices from specific providers, believing that gives individuals the best actionable information.

Thus, we give cash or self-pay rates as quoted to us by providers, augmented by individuals' shared experiences. We do not guarantee these prices willactuallybe what is charged - we urge people to confirm, calling ahead and taking the name of people who supply prices. We think that this approach of showing a range of prices at area providers gives a more actionable data set for real people making real decisions.

Third, some tools presents only hospital prices, not prices from non-hospital sources. So, for example, if an individual was seeking an MRI or an IUD, this would be of relatively little use. IUDs are not supplied by hospitals, and MRI prices are typically much higher at hospitals than they are at self-standing radiology centers.

In our data set, we are not limited to hospitals, but also take in other providers, knowing that people get medical care at a range of places.

Fourth, in every case, we suggest that someone assessing transparency tools seek to understand clearly what the source of the information is, and who's making money off of it, and how. For example, a "transparency" site that is connecting patients to specific providers is, in all likelihood, taking a commission for making that connection. Does that mean the data can be affected by the desire to steer the patient to a specific provider or providers? Well, yes.

17. O.K., I'm in. What did you want me to do again?

To contribute to or search our PriceCheck database, click here. If you have lots of prices to contribute, you can download our handy spreadsheet on this page.

Jeanne Pinder is founder and CEO of ClearHealthCosts which is the data partner in the Philly Health Costs project.
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