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Cost of medical care varies by hospitals, cities

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Updated: 11/11/2013 11:58 pm
JACKSONVILLE, Fla. -- The cost of a medical procedure may cost one price at one hospital, and something very different right around the corner. It's something Lizzie Danner found out quickly.

"It's been ongoing for about four years now," said Danner.

It's a high school injury that continues to plague Danner. Her jaw was broken after being punched during a soccer match. She needs corrective surgery to fix it. But her insurance is billing it as cosmetic, meaning they won't foot the bill.

She started checking in with different doctors to find out who could perform the procedure for an affordable cost.

"Some doctors won't cover it at all. There's a doctor in particular in Texas who wanted straight cash -- $50,000, would not take any insurance," she said.

Each doctor in each city came back with a different price for the same surgery. One here in Jacksonville will do it for $12,000.

"It's bizarre because then you start to think, 'Is it because the doctor's better, you know, if it's more expensive?'" she said.

Local urologist Dr. Ali Kasraeian said costs can vary, sometimes drastically, depending on the doctor, the hospital, even the city you live in.

"Unhealthy people and sicker populations translate into higher cost," he said.

Kasraeian said because Florida is a state with a higher retirement population, patients here pay more.

But Action News found there are even drastic differences between hospitals in the River City. The Centers for Medicare and Medicaid Services released data for a variety of in and out patient procedures from 2011. A permanent cardiac pacemaker implant procedure at UF Health averages $80,175. At Memorial Hospital, the price tag was $92,189. But at Mayo Clinic, the very same prodedure averages $49,538 -- that's nearly a $43,000 difference.

We checked other procedures and found wide ranges in what hospitals are paid for their services.

A spokesman for Memorial Hospital tells Action News "What patients pay has more to do with the type of coverage they have than the actual charges."

"Government programs like Medicare and Medicaid determine how much they reimburse hospitals. Insurance plans negotiate their payments."
The spokesman says everyone else is eligible for Memorial Hospital's charity care program or they receive an uninsured discount.

"One of the biggest factors hospitals look at and the challenge for them is treating people that don't have insurance. Especially in the emergency room setting especially when people are in the hospital without insurance. Those are big health care dollars. So sometimes when you hear about people who get bills that are through the roof and what they end up paying later is much less because you have to give the same bill to everyone," Kasraeian said.

He said it is a good idea to shop around like Danner did.

"Find a physician that they are comfortable with. If they have a complex disease process definitely have a second opinion; the power of the second opinion is very strong," he said.

Danner said she decided to go with a local doctor. He didn't have the lowest price tag. But she said if paying a little more means a better surgeon, she's willing to spend the money.

"When you're having something done with your actual face and your skeleton you know you want to make sure you have the best," she said.

Kasraeian said sometimes the best surgeons in the world aren't the most expensive. It depends on the network that doctor is affiliated with. Larger hospital networks have more bargaining power and can crank the cost way up.

"The problem with this is the physicians haven't been the driving players in these discussions for a long time," he said. "Now we are in a position where we have to learn the vocabulary and we have to become intelligent in the discussion and most of us don't go to medical school to become economists."

While he said it will be impossible to completely level the playing field, it's the patient who ultimately has the power. He said it's key to ask for price breakdowns up front. And don't be afraid to get a second, third even fourth opinion. Danner is glad she did.

"It's going to be a long process but I am so ready to have to done and over with," she said.
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The views expressed here do not necessarily represent those of Action News Jacksonville

Truthseeker - 11/12/2013 10:04 AM
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Is this really news? The price of a good in WalMart or the price of a service provided can vary from neighborhood to neighborhood so why is it news that it can vary by city, county, or state. Think about it, for one reason or another gasoline is cheaper, most of the time, when you cross the Florida/Georgia state line.
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