Affordable Care Act

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Sal Morales, went from paying $560 month in Cobra insurance to about $145 a month through the Affordable Care Act. He also has a network deductible of $500. Here’s how he breaks it down: “There’s one party, the hospital who provides the service. There’s a second party, the patient, who receives the service. And there’s a third party, the insurance, who pays for the service.” What happened with Mr. Morale’s case is that the insurer negotiates a lessor amount for various plans, with a variety of hospitals through multiple agreements for the same hospitals or doctors.

Doctors are paid differently even if two patients have the same insurance company, if the plans are different in any way. To make this simple there are as many price tags for a hypertension checkup as there are insurers and providers.

The question that should be asked is how much is your doctor getting paid, to determine the best deals for coverage. If you have the history of medical procedures from lasts years doctors treatment the insurance company can provide a better assessment as opposed to shopping around to be told the price is more to cover you for the same procedures as last year.

“We’re identifying the procedure, we’re identifying the provider, the date of service and then making sure the amount, the member responsibility has to be in there,” Monzon says.

To get a clearer sense of what health care costs, someone would have to collect enough of those statements from patients at all different hospitals with all different insurance.

There are companies and crowdsourcing projects trying to do just that around the country. And Massachusetts has a law that says insurers have to disclose some of these prices in a way that is accessible to patients.

This story is part of a partnership that includes WLRN, the Miami Herald, NPR and Kaiser Health News.