10 quick tips to help you navigate SC’s health care system — and save money
More from the series
Health care costs in Beaufort County
Read more in the series about health care costs in Beaufort County.
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Hilton Head doctors — from internists to urologists to dermatologists — charge patients more than those in other parts of the state for certain appointments and services.
While Hilton Head is the state’s 9th largest municipality according to the annual census estimate of resident population from 2017, some of the rates charged by its physicians rival those of the state’s largest cities, such as Charleston and Columbia, according to an analysis by The Island Packet and The Beaufort Gazette.
Patients in Bluffton and Beaufort aren’t getting great deals either. In some instances, doctors’ charges in these communities also rival the state’s most populous cities.
High costs in comparison to nearby cities and states are just one of many health care concerns that readers of The Island Packet and The Beaufort Gazette recently shared. In late 2018, the newspapers asked readers on social media about their health care worries.
“I actually don’t see the doctor very often because health care is so expensive out here,” said Suzanne Clark, a Beaufort woman who responded to the newspapers’ query. “I have pretty much gone five years without visiting health care (facilities) because it’s just way too expensive.”
The newspaper analyzed a Centers for Medicare and Medicaid Services database of average physician charges for certain Medicare beneficiaries in 2016 — the most recent information available. The median of those averages was calculated to arrive at the typical charge for certain practice types and services performed.
The charges are not the prices paid by most patients, as insurance has not yet been applied. It is strictly the charge for the service received for Medicare Part B beneficiaries.
The cost of appointments and more than a dozen services provided by physicians in Hilton Head, Beaufort and Bluffton’s physicians were compared to those in the state’s five most populous cities — Charleston, Columbia, North Charleston, Mount Pleasant and Rock Hill.
Which services cost more?
On Hilton Head Island, certain office visits cost about $25 more than in the state’s biggest cities, according to the newspapers’ analysis.
- A 25-minute appointment with an internal medicine physician costs $205.10 for established patients on Hilton Head. In Charleston and Mount Pleasant, the charge is around $180, and in Columbia, $169. The lowest charge is in Beaufort at $162.
- There’s a similar price increase for a 15-minute appointment as an established patient with urologists on Hilton Head — $75.46 compared to $50 in Charleston and $38 in Rock Hill. The lowest reported charge was in Columbia at $30.
- A dermatologist on Hilton Head would charge $183.29 for a 30-minute appointment with a new patient. The same appointment type would cost $125 in Columbia.
That doesn’t mean all health care costs more on the island.
In other cases reviewed by the newspapers, Hilton Head care is less expensive. For instance, anesthesia for a procedure on the skin or the arms, legs or trunk in Beaufort costs $1,535.42. In Columbia, the charge is around $892.83 and in Charleston, it’s $747.62.
The lowest charge: Hilton Head, at $674.09.
Costs fluctuate too in Beaufort and Bluffton.
- A 15-minute appointment with a urologist costs $150 in Beaufort as an established patient — a tie with Charleston and North Charleston. That’s $70 more than the $80 the doctor would charge in Columbia.
- A 15-minute obstetrics and gynecology appointment with an established patient would cost $173 in Bluffton, but only $96 in Columbia.
- There’s another large disparity in 25-minute OB/GYN appointments with established patients. In Bluffton, the charge is $255. In Hilton Head, $140.47, and in North Charleston $140.
- A 25-minute optometry appointment for an established patient costs $135 in Bluffton, but only $100 in North Charleston.
Why does health care vary so much?
Schipp Ames, a vice president with the S.C. Hospital Association — a nonprofit that represents about 100 S.C. hospitals — said costs often fluctuate based on an area’s cost of living.
Since it costs more to live in Beaufort County than most other parts of the state, real estate prices are higher, which means it costs more to operate physician’s offices and health care facilities. That can lead to higher charges for patients.
That’s particularly true on Hilton Head where the cost of living is 10 percent higher than the national average, according to PayScale.com.
Doctors’ offices must spend more to operate in pricey cities, added Robert Hartwig, an associate professor of finance at the University of South Carolina.
“There’s no question, providing health care in many urban areas in the U.S. ... is going to be higher,” Hartwig said. “Does that impact carry over to resort communities? It would not surprise me if there are higher sustained prices in an area where there is a wealthier demographic.”
Adding to the situation: nearly one third of the island’s population is over 65, according to census data. Many of those seniors are well-to-do and willing to spend on health care. And that demand can potentially drive up prices, Hartwig said.
Bill Harkins, Hilton Head’s mayor pro tem who spent 35 years as a senior health care CEO, added that the size of a community also plays a role.
“If you’re in a place where you have high volume (of patients), you can spread your overhead costs over a larger group of people,” he said. “So (Hilton Head is) a small community, 41,000 people on a given day. And so when you spread your costs, you’re spreading it over a smaller base.”
Harkins said he has not heard complaints from residents about the cost of doctor visits, but has heard concerns about the high cost of inpatient care at the town’s only hospital, Hilton Head Hospital.
While Beaufort County’s prices are sometimes higher than in other SC cities, the state’s overall health care costs are not high. In some cases, they are even lower than the national average, according to a 2015 report by the Health Care Cost Institute, a nonprofit research organization.
How to prevent surprise charges
Although many factors influence what a patient pays for health care, there are steps to help prevent surprise bills.
Online tools mandated by the federal government have been released to help patients compare prices. But experts warn that the tools aren’t user-friendly enough to be useful.
“It’s good that there’s more transparency on health care costs, but consumers have to download a spreadsheet with 32,000 lines on it,” Hartwig said about the new tool. “You really almost do need medical training to understand what those procedures are.”
Louise Norris, a health policy analyst who writes for healthinsurance.org, Verywell, and owns a Colorado health insurance brokerage company, recommends patients ask as many questions as possible about the cost of a test, procedure or office visit.
Talking to the billing department of an organization and calling your insurance company can help you get answers.
She also suggests patients understand their out-of-network billing situation. If one receives care from an out-of-network provider, it’s often not covered at all by insurance.
That seems simple enough — but what if a patient is unconscious, under anesthesia and an out-of-network assistant surgeon comes in to help with an operation?
“And six weeks later you get a bill for another $4,000 for this out-of-network surgeon you never knew anything about,” Norris said. “There are no federal laws to protect people from that.”
Norris suggests patients ask as many questions as possible about who will handle their care for a procedure or service to prevent any surprise bills.
But sometimes, there’s nothing a patient can do to prevent such scenarios.
Surprise charges can come from unexpected findings during procedures, Norris said. If a surgeon is repairing a torn ligament in the knee, and upon operating finds that there is an additional issue, the cost will go up.
“It’s the radiologist, the anesthesiologist. It’s the people you don’t think about,” she said of physicians who often assist.
But you can’t go wrong with asking questions.
“We’ve had clients who have asked every person who comes in (their hospital room) ‘Are you in my network?’” Norris said. “Patients really need to be their own advocate on this.”