I write about health for a living. Here's how it went when I tried 4 hospital price tools

In the course of writing about Oklahoma’s hospital price transparency tools, I set out to test for myself how easy — or difficult —  it would be to use the price transparency tools hospitals and health systems have had to post online.

A federal rule that went into effect in 2021 requires hospitals to post both a consumer-friendly list of shoppable medical services and a comprehensive data file of the prices of all the items and services they provide. But our analysis found that these tools and files can be difficult to use and understand, and many may not even know they exist.

I chose one procedure, an upper GI endoscopy, to look up through price estimator tools for each of Oklahoma City’s four major health systems: OU Health, Mercy, SSM Health and Integris Health.

More:Finding hospital prices can be complicated for patients, even with transparency rule in play

My insurance

First, some details about my insurance. I have a Blue Cross Blue Shield of Texas Blue Edge PPO plan through my employer.

When I did this comparison, I had $1,148.77 remaining of my $2,000 deductible. My plan has a 20% coinsurance rate.

The procedure

I chose an upper GI endoscopy as the procedure I searched for because it’s one I may seek out in the future. I’ve learned this year that I’m sensitive to gluten, and that I feel much better without it in my diet.

I have wondered if maybe I have celiac disease, an autoimmune condition where the body has an immune response to gluten that can cause a host of stomach issues. I got a blood test for celiac disease, and it came back negative. The blood tests aren’t perfect, but for now, that’s enough of an answer for me.

If, down the line, I wanted to check it out further, I could ask for an upper GI endoscopy, where a tiny tube would be fed down my throat into my small intestine to take a biopsy of the lining of the intestinal wall to examine whether I show signs of celiac disease.

I also chose this procedure because it’s one that the Centers for Medicare and Medicaid Services requires hospitals to include in their list of “shoppable” services under the price transparency rule, so I thought I should be able to find it without too much trouble.

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Finding prices

Each of the four health systems did have this procedure in their price estimator tool, and it wasn’t too difficult to find. All but OU Health let me search with a CPT code, which is a number used for medical billing for each specific procedure or service.

That said, you need to have quite a bit of information handy if you want to make the most of these tools — and you need to know the tools exist in the first place.

Across the four searches, I needed to provide my name, birthday, my insurance ID number, my group ID number, my deductible and what I had spent toward it, my out of pocket max and what I had spent toward it, and I had to look up my coinsurance.

Fun fact: The CMS rule says hospitals can’t require you to give personally identifying information to use their price estimator tools. In my experience, I wasn’t technically "required" to turn over my information. But the tools are set up in such a way that if I didn’t enter my name and insurance details, I wouldn’t get an accurate estimate, or I might only get to see an uninsured rate.

I also had the CPT code for the procedure I wanted to look up handy, which made it quicker to get through the estimator tools.

Hospitals have to include at least 300 shoppable services in their tools, including 70 specified by CMS. A list of the services hospitals must include is online at https://www.cms.gov/files/document/steps-making-public-standard-charges-shoppable-services.pdf.

Because I have an out-of-state Blue Cross Blue Shield plan, my insurance wasn’t listed among the main options of any of the tools. It took some trial and error to figure out that I could still get an estimate by saying I had a Blue Cross Blue Shield of Oklahoma plan and inputting my Texas-based ID.

Each hospital also made me jump through (sometimes multiple) disclaimers saying that I understood their estimates are only estimates, and there are other fees and services that you might get billed for separately.

I also hit tech troubles that might’ve deterred others. To get my cost estimate for Mercy, I tried two different browsers, used two different computers and eventually turned on incognito mode before I could get the page to load.

Here are the price estimates I found at each of these facilities for this procedure, from lowest to highest:

• OU Medical Center OU Health: $1,249.58

• SSM Health St. Anthony Oklahoma City: $1,321

• Mercy Hospital Oklahoma City: $1,365

• Integris Baptist Medical Center: $1,488

More:Oklahoma County received over $154 million in ARPA funding. What has it spent so far?

My takeaways

If you’re tech-savvy, willing to spend time researching, have all of your insurance details on hand, and OK with the idea that these tools don’t include all the costs you might incur while having a procedure, price shopping for an upcoming procedure could be informative.

I’m curious how close my estimate would look to my bill if I were to have this procedure done, and what other fees and services might be included that the estimator tools don’t account for. I'm curious also how my estimates would look if I was closer to meeting my deductible for the year.

I also wonder how simple it would be in practice to schedule a procedure with the place you think you can get it for cheapest, if you’re not an established patient within that health system.

Another caveat for these tools: They only offer pricing information for a limited number of common procedures.

Hospitals also must post files that list prices of all the items and services they provide, including cash prices and their negotiated rates with insurers. But those files, as I’ve reported, can be confusing and incomplete.

I’d love to hear about your experience with price estimator tools. If you have a story or thoughts to share, email dbranham@oklahoman.com.

This article originally appeared on Oklahoman: A health reporter tries to use four OKC hospitals' pricing tools