Insight, analysis & opinion from Joe Paduda

< Back to Home


Humana’s good effort

Carol Gentry of the Tampa Tribune has authored one of the more accessible pieces on the hows and whats of hospital price variation.
Carol’s piece illustrates two key issues – the data is available, and consumers aren’t using it.

It is not like the variations are so small as to be meaningless. Even those of us long aware of the wide cost disparities among hospitals may well be surprised to find that the cost for a (much-derided) carotid endarterectomy can range from $5000 to $30,000. Certainly enough to get someone’s attention.
But Gentry points out that even if consumers are aware of the cost differential, they have no reason to worry about it. Here’s why.
Using the carotid procedure as an example, and figuring the patient had a high-deductible HSA plan, the most they are going to spend out of pocket is about $5500. Regardless of which hospital they go to, they are going to spend that amount. That being the case, its no wonder patients aren’t concerned about finding the lowest-cost hospital. (we’ll leave the ‘quality’ issue for later)
Here’s why today’s version of consumer-directed plans doesn’t work. If CDHP sponsors spread the cost-share out in a copay instead of a deductible, the potential endarterectomy patient would be much more likely to get their procedure at the lower cost facility.
Which makes me wonder..why is it so hard for Humana, one of the leading sellers of CDHPs, to figure out why members don’t worry about hospital costs?
Is this that complicated?

2 thoughts on “Humana’s good effort”

  1. Thats very misleading. Once you meet your deductible, and with one thesr procedures your going to meet it. The general mentality is Who’s the best. I pay for insurance, I’m entitled to the best.
    I actually saw a hospital in Indiana advertise that they were being transparent. Every one of those procedures you see listed there costs the same to a medicare patient, and that’s what they showed.
    Remember to get market share , to get people of those low priced cheap effecient HMO’s we had to have more hospitals and the best. We the carrrier asked for it.

  2. The article not only shows the folly of “consumerism,” it illustrates how badly broken our entire system is. Aren’t PPOs supposed to be the organizations that do the shopping for patients and negotiate the best deals? Isn’t that why we pay their network fees? Why does Humana pay one hospital 6 times what it pays another for the same procedure? Seems like more evidence that the entire PPO system is a sham. Insurers and health systems are in bed together and sucking every last dime out of the American economy. Maybe some day we’ll wake up, see what’s happending and finally put in a compreghensive, universal single-payer system. Does Medicare pay such wildly different prices? No.

Comments are closed.

Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



© Joe Paduda 2023. We encourage links to any material on this page. Fair use excerpts of material written by Joe Paduda may be used with attribution to Joe Paduda, Managed Care Matters.

Note: Some material on this page may be excerpted from other sources. In such cases, copyright is retained by the respective authors of those sources.