As more people get high-deductible health insurance plans in conjunction with a health savings account, they are paying more attention to the fees they are being charged. Savvy consumers are discovering a wide range of prices among various providers, and many ways to reduce their hospital bills and avoid over-charges.

The medical industry, unlike virtually every other business, loves to keep their prices secret. They do this, very simply, so they can make more money. Only by shopping your medical care, demanding price transparency, negotiating for the best price, and carefully reviewing your bill can you be assured that you are getting a fair price, and not being ripped off.

A dramatic example is the price hospitals charge of open heart surgery. The Valley Hospital Medical Center in Las Vegas, Nevada charges $233,259 for open heart surgery involving a heart valve replacement. The Mayo Clinic, recognized as one of the top heart care centers in the world, charges $79,601 for the same procedure. As another example, The Miami Herald recently published an article about hospital pricing in Florida. A woman going to Palmetto General Hospital in Hialeah for physical therapy following a car accident had tried to find out what the treatment would cost her, but to little avail. After eleven sessions she started receiving the bills - $1,560 per visit. She was able to find the same service at Memorial Regional hospital in Hollywood, FL for only $50 per visit.

Hospital Overcharges

Anyone who has ever tried to decipher a hospital bill knows that they can be next to impossible to understand. This conveniently makes it easy for hospitals to hide improper charges by using mysterious medical technology and codes. Whether through deliberate overcharges or honest errors, experts estimate that hospitals overcharge patients by $10 billion a year, or an average of $1,300 per hospital stay.

Hospitals have been known to charge $129 for a "mucus recovery system" that was really a $2 box of tissues, $57.50 for a "free" teddy bear, and even $1,004 for a toothbrush. Most people never see an itemized statement, and so have no idea what they're being charged for.

Nora Johnson, a medical billing advocate, was quoted in a recent article saying that over 90% of the hospitals bills that she has audited have had gross overcharges.

Hospitals often go to extraordinary lengths to discourage you from delving too much into your bill. Nevertheless, there are some specific things you can do to make sure you're not getting taken for a ride.

• If possible, call the hospital's billing department ahead of time and ask them what you will be charged for a room and what that charge includes. If it doesn't include something you might need, such as tissues, bring your own.

• Ask your doctor to estimate your cost of treatment.

• Bring your own prescription medications to avoid paying top price for medications purchased from the hospital.

• If possible, keep your own lists of tests, medications, and treatments. Hospitals have been known to charge men for pregnancy tests and adults for newborn tests.

• Never pay the bill before leaving the hospital. You may be told this is required, but it is not. Before paying your bill read it carefully, and compare it to the estimated costs you were given before being admitted.

• Demand an itemized bill, and ask for a detailed explanation for any items you don't understand. Don't accept generic answers like "lab fees" or "miscellaneous fees".

Health Savings Accounts Promote Price Transparency

Health Savings Accounts (HSAs) are plans that have a high deductible, and a savings account in which tax-deductible contributions can be placed. The money in the account can be used to pay deductibles and other charges not covered by health insurance.

The great promise of health savings accounts is that they will re-inject market competition into the healthcare market. As all of us who were fortunate enough to take Economics 101 understand, the balance of supply and demand provides the public with the greatest value at the lowest possible cost. If company B can produce and distribute the same quality widgets as company A, but at a lower cost, then the average price of widgets will fall, more people will be able to afford more widgets, and the average quality of a widget will increase, as businesses compete for customers. This is a wonderful system, and is part of what has made the United States the wealthiest country in the world.

Unfortunately, this system has not been in play when it comes to healthcare, because the consumer has not typically been paying the bill. As a result, the consumer doesn't care what the service costs, and most doctors, hospitals, and pharmacies are very reluctant to reveal their (high) prices.

Health Savings Accounts are now changing all that. Millions of people have purchased these plans because of the lower premiums and tax advantages they offer. This has made consumers much more aware of what they are being charged. By demanding to know prices up front, HSA holders will begin to force medical providers to compete on price and quality, just like any other business does.