Patient Money: Seeking the Best Medical Care Prices
CAN you really shop for doctors and hospitals the way you would for airfares and flat-screen TVs?
Health care consumers are encouraged to comparison-shop on things like doctor’s fees and heart surgery rates. But unfortunately, most of us have little clear or useful information to go shopping with.
“When you go to the doctor, how much you fork over when all is said and done is often just a mystery,” said Dr. Anthony P. Geraci, a Manhattan neurologist who is trying to buck that trend by posting his prices on his Web site.
With the growing number of uninsured people, the increase in high-deductible insurance plans and big jumps in co-payments, just about everybody is paying more out of pocket for health care nowadays. An estimated 15 percent of adults younger than 65 now pay with their own money medical costs greater than 5 percent of their annual household income, according to the Center for Studying Health System Change, a nonpartisan research group in Washington.
So the typical person is probably far more motivated to ask how much an M.R.I. or a hip replacement costs. And just as often, people are asking — or should be — “How can I get a better price?”
Take Katie Kyser, 30, the mother of a year-old daughter, who lives north of Seattle. She and her husband, Jason, who works in construction, recently moved from California. They have no health insurance, so they pay all costs out of pocket.
When Ms. Kyser needed a routine gynecological exam, she called a handful of local doctors, all of whom were charging $200 or more. “There’s no way we could pay that,” Ms. Kyser said. “I had to find another way.”
Having seen an ad for PriceDoc.com, a new Web site that lists doctors throughout the country who are willing to post their prices and negotiate with patients, she decided to try it. Ms. Kyser found a nearby clinic where doctors charged only $75 for the exam.
“I was a little nervous at first because the price was so cheap, but when I got there, it was wonderful,” Ms. Kyser said. “Everyone was so professional and helpful.”
The crucial part of shopping wisely for health care (or anything else for that matter) is comparing prices the way Ms. Kyser did.
But that is also where problems arise. Medical pricing is a quagmire, oozing with jargon and current procedural terminology codes. Just look, if you dare, at your latest “explanation of benefits” from your insurer.
What’s more, rarely is there one standard price for a medical treatment. Prices vary based on geography and type of provider — whether hospital, stand-alone clinic or any alternative.
Then, doctors, hospitals and other providers may negotiate different rates with different insurers. It is not unusual for a provider to have 10 or more different prices for the same procedure, depending on who is paying. Providers often charge a completely different rate for people paying on their own, which is almost always much more expensive than the discounted rate that insurers pay.
“It’s a challenge for consumers to sift through these different price structures,” said Ha T. Tu, senior health researcher at the Center for Studying Health System Change. And there is no one place to go for good information, she added.
Despite the challenges, here are several steps consumers can take to make health care shopping a bit more manageable:
CHECK WITH YOUR INSURER Many insurance companies have begun posting provider prices on their Web sites so enrollees can access cost information. These tools allow you to compare prices among network doctors (not all network doctors are paid the same) and check on the price of diagnostic tests and other treatments easy payday loans.
“This is especially helpful if you’re in a high-deductible plan,” said Ms. Tu, “because you can see how much you’ll pay out of pocket.”
USE THE INTERNET A few Web companies have tried to fill the price information gap online, all with varying approaches.
On PriceDoc.com, the site Ms. Kyser used, you plug in your ZIP code to find a list of providers in your area who have posted their prices. You can also plug in the price you’re willing to pay. Providers will then respond if they are willing to accept that price.
HealthcareBlueBook.com compiles prices paid for specific treatments and procedures in ZIP codes throughout the country, then lists what the site determines is a range of fair prices. Consumers can then use these ranges as a jumping-off point for negotiating with their providers, said Dr. Jeffrey Rice, the chief executive of the concern.
Dr. Rice tells the story of a woman in northern Ohio who had been quoted a price at a local hospital of $2,500 for an M.R.I. of her knee. When she looked up the test on the site, she found the fair price in that area was more like $500.
She went back to the hospital where she had been quoted the high price and started asking questions. The clerk told her it would be much less expensive if she went to the clinic down the street instead of the hospital. The woman followed that advice and paid $300 for her M.R.I.
Another Web site, OutOfPocket.com, combines price information that users send in to determine a going rate for specific health care costs throughout the country.
None of these sites are comprehensive, although all of them are easy to use and are expanding their listings. It’s worth taking a look to see if you can glean any useful information from them.
BROWSE STATE DATA If you’re checking out hospitals, you will want to see what information your state government offers. At least 33 states mandate that hospitals make their prices public, Ms. Tu says.
But there are caveats. Often, only the most expensive, nondiscounted prices are listed.
Moreover, on most sites, costs are not bundled, so you may find the price of a general surgery, for example, but it would not include the surgeon’s or anesthesiologist’s fees.
Some states offer more information than others, points out Ms. Tu. Minnesota, for example, uses average prices for some procedures, and New Hampshire and Maine have some bundled prices. To see what information, if any, is available in your state, you can use the links on healthcarebluebook.com.
PICK UP THE PHONE “The most important thing to do if you’re looking for price information is call your doctor,” said Jonathan Weiner, professor of health policy and management at Johns Hopkins University.
“This is still an awkward discussion for most doctors,” Professor Weiner said. “But if you sit down and talk about money, it almost always leads to discounts, particularly for self-paid people.”
If your doctor balks at having this conversation, ask to speak to the office worker in charge of billing, who will know the prices your doctor charges and can at least estimate what you will be paying. Then, when you do collect price information, you can return to that person to negotiate a better price.
European banks may have $40 bln exposure to Dubai
LONDON (MarketWatch) — European banks could have as much as $40 billion of exposure to Dubai after helping to arrange a string of bonds and loans linked to the Middle East city-state, according to analysts at Credit Suisse.
The broker said it’s identified $10 billion of bonds issued by the government’s Dubai World investment vehicle just since 2005, along with a further $26 billion of syndicated loans.
Fears of a potential sovereign default by Dubai roiled financial markets Thursday, sinking stocks across Asia and Europe and pushing up government bond prices, after Dubai said late Wednesday it would restructure Dubai World and announced a six-month standstill on repayments of the conglomerate’s debt. See full story on the impact on financial markets.
In a note to clients, Credit Suisse said the middle-East region is unlikely to be more than 1% to 2% of banks’ total exposure and Dubai itself would just be a small part of that.
Still, it estimated that a 50% loss on the exposure that bank’s may hold would be the equivalent of a 5% increase in provisions in 2010.
For the banks that Credit Suisse analysts cover, which could have an exposure of around 13 billion euros ($19.6 billion), that would equate to a combined hit of around 5 billion euros, it added used auto loans.
Bookrunners on bond and loan deals typically retain around 10% to 15% of the issue on their own balance sheet, the broker said.
Among the European banks that frequently acted as bookrunners or participants in bond and loan deals were Barclays , Deutsche Bank , Royal Bank of Scotland , BNP Paribas , ING Group and Lloyds Banking Group .
Standard Chartered and HSBC also have significant loan books in the Middle East.
Shares in the European banking sector were down across the board, with ING — down 5% — and Deutsche Bank — down 4.3% — among the biggest fallers.
A spokeswoman for Barclays said the bank’s exposure is “not significant” and that it is closely monitoring the impact on broader markets.
A spokesman for ING said the group has negligible exposure to Dubai World bonds. He added ING participated in some loan deals, but that the group doesn’t see any reason to change its forecasts for loan losses.
Other banks either declined to comment or did not respond to emails and phone calls.
China tightens rules on cross-border money flows
HONG KONG (MarketWatch) — China’s foreign-exchange regulator tightened rules on individuals making cross-border money transfers, stepping up efforts to quell inflows of funds on speculation that the yuan is undervalued.
Dollar Falls Under Y88 For First Time 10 Months
The dollar fell under Y88 for the first time in 10 months and could continue to fall as US real yields decline, Japanese risk appetite wanes and the country’s current account surplus grows once again.
Under the new regulations, individuals are limited in the number of transfers they can make from overseas to onshore Chinese accounts, according to wire reports that cited a statement on the State Administration of Foreign Exchange’s Web site. The statement was dated Nov. 19.
Specifically, an individual cannot send foreign currencies to five or more onshore accounts in a single day. The restrictions will also apply to transfers made to multiple accounts made on consecutive days payday loan companies.
The measure appears aimed at tackling a practice growing increasingly common — namely, investors pooling the quotas of several people during a single day as a way of getting around official limits on cross-border money flows.
Analysts say Chinese authorities are increasingly worried about speculative inflows attracted to the Chinese currency in the belief the yuan will strengthen.
Outflows of capital from the mainland to Hong Kong have been blamed for a rapid rise in property prices, elicting warnings from the city’s central banker about the potential for a bubble in asset prices next year.
U.S. consumer confidence edges higher in November
NEW YORK (Reuters) – U.S. consumer confidence edged higher in November after an unexpected drop in October, with less consumers expressing doubt about the a worsening jobs market, according to a report released on Tuesday.
The Conference Board, an industry group, said its index of consumer attitudes increased slightly to 49.5 in November from 48.7 in October.
Analysts polled by Reuters had forecast a reading of 47.7, matching the previous month's figure.
The present situation component of the survey dipped to 21.0 in November from 21.1 the prior month — its lowest reading in 26 years.
"The moderate improvement in the short term outlook was the result of a decrease in the percent of consumers expecting business and labor market conditions to worsen, as opposed to an increase in the percent of consumers expecting conditions to improve," said Lynn Franco, director of The Conference Board Consumer Research Center, in a release online pay day loans.
More Americans surveyed said jobs were "hard to get" in November, with that gauge rising to 49.8 percent from 49.4 percent in October. Those claiming jobs were "plentiful" fell to 3.2 percent from 3.5 percent last month.
"Income expectations remain very pessimistic and consumers are entering the holiday season in a frugal mood," Franco said.
(Reporting by Tom Ryan; Editing by Kenneth Barry)
Gold at new high as dollar slides, stocks gain
LONDON (Reuters) – Gold powered to another record high on Monday as the dollar sank, while higher commodity prices lifted world equities.
MSCI's all-country world stock index (.MIWD00000PUS) was up 0.9 percent, led by European and emerging market shares that are sensitive to commodities.
Gold hit a record high at $1,167.35 an ounce before slipping back a bit, bringing this year's gains to around 32 percent.
The main catalyst for gold's rise has been the falling dollar, which makes the metal more attractive to non-dollar investors and encourages others to hedge.
The U.S. currency was down nearly three-quarters of a percent against at basket of competitors (.DXY), closing in on 15-month lows. It is being battered by expectations that the U.S. Federal Reserve will keep interest rates low for some time.
"The Fed is sounding like they mean it about keeping rates low for an extended period — way into 2010 if not 2011," said a trader at an Australian bank.
Such a backdrop has driven large numbers of investors into gold, which also benefits from a reputation as a safe haven in times of economic uncertainty.
"You've got more high-profile hedge funds visibly investing in gold. That's yet another factor encouraging moves into gold by the wider investor community," said David Barclay, commodity strategist at Standard Chartered in Hong Kong online cash advance.
Gold's gain lifted other precious metals, while oil gained 90 cents to $78.36 a barrel and commodities such as copper also gained.
Copper was up 1.7 percent, aluminum was half a percent higher and nickel rose 1.6 percent.
STOCKS UP
European shares were one of the main beneficiaries of the rise in commodity prices.
The pan-European FTSEurofirst 300 (.FTEU3) index of top shares was up 1.4 percent, snapping a four-day losing streak.
Energy stocks were in demand because of the oil price gain. Among big movers were Heritage Oil (HOIL.L), which sold its Ugandan interests to Italy's Eni (ENI.MI).
BG Group (BG.L), BP (BP.L), Royal Dutch Shell (RDSa.L) and Total (TOTF.PA) all also rose.
Miners also featured among the top performers as metal prices gained, including Anglo American (AAL.L), Antofagasta (ANTO.L), BHP Billiton (BLT.L), Eurasian Natural Resources Corporation (ENRC.L), Rio Tinto (RIO.L) and Xstrata (XTA.L).
Despite this, there is a general tone of caution from investors at the moment, with many interested in locking in their 2009 gains before the year end.
(Additional reporting by Jan Harvey, Joanne Frearson and Lincoln Feast; Editing by Ruth Pitchford)
Taxing Times: Some tax deductions are no sure bet
Don’t miss these top stories:
Gambling losses no sure bet, tax-wise
Time to harvest your stock losses
Year-end tax moves
You’d think the legality of a thing — online gambling, say — would be black or white. It’s either legal or it’s not, right?
Apparently not.
If you play poker for money from the comfort of home, over an Internet connection, there’s no federal law that out-and-out bans the practice, though come December a new law goes into effect that requires banks to refuse to accept money won through online gambling. So, O.K., after that date no more Internet gambling, right?
Not quite: The new law doesn’t clarify the legality or illegality of online gambling itself. Because it’s so confusing, there seems to be a possibility Congress may delay the new law’s effective date.
Meanwhile, some states have made Internet gambling illegal, others have not. Our own tax writer Eva Rosenberg talked to officials in California and received some disturbing and confusing responses as to what the state’s residents should do if they have losses from such games that they want to deduct. See her TaxWatch column for more details.
Here’s my take on it: Deducting those losses is a gamble, no matter how you roll the dice.
— Andrea Coombes, assistant personal finance editor
Online gambling poses tax conundrum
California resident J.D. won over $50,000 playing video poker online this year. Wow! She couldn’t do that well in Las Vegas, and at home she can play anytime without having to drive for hours. Plus, she can play any number of different “machines” without waiting for one of them to be free. But J.D. spent over $40,000 before cashing out $50,000. Are her losses deductible? See TaxWatch.
TAX STRATEGIES Tax harvest your stock losers
Now may be a good time for many investors to consider a tax-planning move known as tax-loss harvesting. Ask yourself: Do I own any stocks that are selling for less than I paid for them and that I’ve been thinking of dumping? If so, think about getting rid of those losers before the end of the year. See full story.
Smart year-end tax moves for 2009
Year-end tax planning always makes sense, but this year it’s especially vital. Convulsions in the markets and the economy have shifted the ground beneath many taxpayers, and next year may bring major tax changes as lawmakers confront the record deficit. Bottom line: Review your taxes before it’s too late. See full story.
Four days saves one man $27 million in tax case
What a difference four days can make. Billionaire Julian Robertson won a $27 million tax case after he successfully argued that he wasn’t a New York City resident for the year 2000 and didn’t owe city taxes. See full story.
TAX-ADVANTAGED ACCOUNTS The 10 vital things you need to know about inherited IRAs
It’s not a certainty, but odds are high that you might inherit an IRA some day. Doing so is bittersweet. On the one hand, it means that someone you know and love has died. On the other, it likely means that your net worth has increased as well. Inheriting an IRA should also come with a bottle of ibuprofen because it also means that you now have to become familiar with and, more importantly, compliant with some retirement rules and laws and regulations that you never knew existed. See Robert Powell.
Crunch time for IRA tax break
It’s crunch time for a tax break that lets people tap their IRAs and give the proceeds to a charity without the Internal Revenue Service claiming part of the money easy payday loans. The provision that lets people at least 701/2 pull money out of their individual retirement accounts and channel it tax-free to charity expires at the end of the year. With charitable giving down 2% last year and expected to be off in 2009 as well, there’s a push on Capitol Hill to keep the tax break — and even to broaden it.
See full story.
Nuts and bolts of five-year rule on Roth IRAs
Could you explain how the five-year rule for Roth IRA conversions works and how it differs from the five-year rule for contributions to Roths? Do multiple conversions over a period of time trigger a new five-year waiting period for each conversion? Does attaining age 591/2 have an effect? See full story.
More parents are becoming 529 dropouts
In recent years, 529 plans have been pitched as the ultimate college-savings vehicle. Investors can put after-tax dollars into an account that typically offers a range of mutual funds and other investments. But in the wake of last year’s market collapse and some high-profile fund blowups, some investors — and financial advisers — are paring back their reliance on 529 plans and in some cases are considering alternatives. See full story.
THE HOME-BUYER TAX CREDIT What you need to know about the extended, expanded home-buyer tax credit
House shopping usually slows down in the winter, as people put their home searches on hold to trim the tree, buy presents to put under it and avoid the chilly weather. This winter, however, might be different, thanks to the extended — and expanded — first-time home-buyer tax credit. See full story.
Home-buyer tax credit will boost sales, housing market will stabilize: NAR
Home sales are expected to rise about 15% next year, as buyers take advantage of a home-buyer tax credit and housing prices stabilize, the National Association of Realtors’ chief economist predicted on Friday at the group’s annual conference in San Diego. See full story.
STATE TAXES States turn to ‘millionaire’s tax’
States hungry for revenue are turning to taxpayers to make up the shortfall as they deplete rainy-day and economic-stimulus funds. To avert a popular revolt, many are resorting to a so-called millionaire’s tax, which puts the burden on a smaller group of the very well-heeled. A flurry of rate increases occurred this year, and tax analysts say the trend will accelerate in 2010. See full story.
More states jump on tax-amnesty bandwagon
Many people who owe back taxes in their home states will soon have a chance to get right with the tax man and avoid penalties that usually go with doing that. States in dire need of revenue have jumped on a bandwagon to collect taxes through short-term amnesty deals, luring people with the promise of leniency. See full story.
California takes bite out of taxpayers’ paychecks
Few Californians took note in July when lawmakers passed a budget item raising the state’s income-tax withholding rate, but plenty of people are noticing now that their paychecks are smaller. See TaxWatch.
State estate taxes are latest worry
With the federal estate tax disappearing for most people, state death taxes have emerged as a surprise new worry. This year, the federal exemption rose to $3.5 million per individual, or as much as $7 million per married couple. At the current level, only 5,500 estates a year are federally taxable. See full story.
London Markets: British shares edge lower, broker changes eyed
LONDON (MarketWatch) — British stocks edged lower on Friday, with broker downgrades weighing on shares of several travel firms and Rio Tinto.
The U.K. FTSE 100 index closed down 0.3% at 5,251.41. Shares on the Continent were also lower, as were U.S. stocks. See Europe Markets.
This is the fourth day of losses for the index, bringing the weekly loss to 0.9%.
“Markets will continue to worry, but the favorable liquidity background, low interest rates and the fiscal stimulus mean that the risk of the economy faltering is low,” said Margaret Lawson, co fund manager, SVM UK100 Select Fund.
In the mining sector, Rio Tinto shares lost 1.1% after Credit Suisse downgraded the firm to underperform from neutral, saying the shares are now trading at fair value.
europe
The London Stock Exchange, drinks company Remy Cointreau and electronics retailer DSG International report results. Consumer confidence data to hit in Germany, France.
Meanwhile, Tui Travel , down 4%, was cut to equalweight from overweight at Morgan Stanley while Thomas Cook Group , down 4.3%, was downgraded to underweight from equalweight at the broker.
It cut its forecasts for the firms to reflect a weaker operating environment and more expensive debt financing.
“Thomas Cook appears to us to have the most forecast risk as it has above-average margins and, we believe, needs to refinance its debts quicker than the market believes, potentially including new equity,” the broker said. Tui Travel is its top pick of the tour operators.
In other broker action, shares of Cable & Wireless rose 1 guaranteed online payday loans.8% after it was upgraded to overweight from neutral at J.P. Morgan.
The broker said that Cable & Wireless has underperformed the sector by 19% and the FTSE by 25% year-to-date despite heavy emerging markets exposure.
“This reflects sensitivity to recessionary pressures. But with expectations rebased post the first half, we believe focus will now shift to C&W’s above-average gearing into cyclical recovery,” the broker said.
There was also some news on companies set to join the London market.
Asset manager Gartmore Group said Friday that it intends to list its shares on the London Stock Exchange. The firm, which had 21.8 billion pounds (36.3 billion) of assets under management at Sep. 30, believes that the offering will enhance its profile and status with existing and potential clients and strengthen its ability to attract and retain investment talent. Read more on Gartmore.
Outside the top index, shares of passenger transport group National Express rose 7.6% after the firm’s largest shareholder, the Cosmen family, increased its stake in the firm to 19%, or 29.03 million shares on Friday
National Express said recently that it plans to raise 360 million pounds via a rights issue, a move that the Cosmen family objected to. National Express set out terms for the rights issue after two attempts to buy the firm failed.
London Markets: British shares edge lower, broker changes eyed
Casual Male Retail Group posts smaller 3Q loss
CANTON, Mass. – Casual Male Retail Group Inc., which sells men’s clothing under the brand names Casual Male XL and Rochester Big & Tall, said Tuesday it posted a smaller third-quarter loss by trimming expenses and improving merchandise margins to offset weak sales.
For the quarter ended Oct. 31, Casual Male lost $1.4 million, or 3 cents per share, compared with a loss of $3.2 million, or 8 cents per share, last year.
Sales dropped 11 percent to $88.7 million from $100 million. Sales at stores open at least a year fell 11.3 percent, as retail and direct channels both posted declines.
For fiscal 2009, the company expects revenue will be between 11 percent and 12 percent less than last year, compared with the 10 to 12 percent drop it previously forecast. A year ago, the company posted $445.4 million in sales, which implies 2009 sales of $392 million to $396.4 million.
Casual Male said free cash flow for fiscal 2009 will range between $15 million and $20 million, compared with a prior range of $20 million to $25 million no credit check payday loan.
Shares declined 15 cents, or 5 percent, to close at $2.64. Stifel Nicolaus analyst Richard Jaffe said earnings missed his expectations due to a larger than anticipated drop in sales at stores open at least a year.
He said that the company is doing everything it can to manage weak customer traffic, but Jaffe said men just did not return to shopping at the rate he had expected during the quarter.
“We have not seen evidence of the male consumer returning to the market and this may be due to the absence of winter weather, a cautious male shopper, or a focus by the consumer on kids and gifts,” Jaffe wrote in a note to clients. “The company believes it is not losing share to competitors, just that its customers have refrained from spending temporarily but when they do shop, they will return to Casual Male.”
Wells Fargo to return $1.3 billion to ARS customers
WASHINGTON (Reuters) – The North American Securities Administrators Association says a brokerage unit of Wells Fargo & Co (WFC.N) agreed to a $1.3 billion settlement involving auction rate securities (ARS).
The settlement requires Wells Fargo to offer to rebuy ARS from nationwide customers by mid-February 2010.
The settlement resulted from an investigation by Washington state regulators into allegations that Wells Fargo falsely assured clients that ARS were a safe and liquid alternative to cash or certificates of deposit payday loan.
Wells Fargo will also pay $1.9 million in penalties to the states under the settlement.
Mutual Funds Weekly: Value-fund investors win the waiting game
Don’t miss these top money and investing columns:
Bargains in large-cap stocks
Stock market gets in shape
Good-bye, fund sales charges
Value-stock investors are a confident lot, always on the hunt for the diamond in the rough and sure they’ll be among the first to find it.
Many value-focused fund managers are turning now to the large-cap part of the market, which has done quite well so far this year, thank you, but not quite at the turbocharged pace of its small- and mid-cap counterparts.
Their thinking goes that if the U.S. economy continues to show improvement, interest rates and inflation will perk up and create a headwind for smaller, riskier companies. Larger firms, as a group, tend to have thicker insulation in that sort of environment. Big-caps are able to flex stronger internal growth muscles and leave a wider, global footprint. Put simply, they’re better positioned to give the market what it wants at a time when every penny counts.
Value investors know that early to buy does not always make an investor wealthy or wise. Cheap stocks aren’t always good stocks, after all. But when you’re right, there’s tremendous satisfaction in watching latecomers line up, ready and eager to take those higher-priced shares off your hands no teletrack payday loan.
— Jonathan Burton, assistant personal finance editor
INVESTING TIPS & TRENDS Large-cap stocks are market’s best value
One reason John Buckingham is excited about stocks right now is that most investors aren’t. See Buckingham’s top stock picks.
Plot twists and turns give stocks a new character
Not only did the U.S. stock market rebound this year, it also changed shape. Read John Prestbo’s commentary.
Supreme Court could get tougher on fund fees
The Supreme Court may soon issue a ruling that puts more pressure on mutual-funds to justify their fees. Read about the Supreme Court case.
Fund sales charges are on the way out
Congress didn’t actually vote to end the confusion over mutual fund share classes last week but lawmakers took a step that ultimately could go a long way to simplifying the way investors buy and sell fund shares.
Mutual Funds Weekly: Value-fund investors win the waiting game
