Bidding on Health Care

Artist and craft-show vendor Shane Harris of Tacoma lived with the pain of abscessed teeth for years because he didn’t have dental insurance. The pain would wax and wane, but it was always there “like background music.” He knew he’d need the teeth extracted, followed by implants, but never had enough cash on hand to get the work done.

Then he found PriceDoc. The online service, which originated in Seattle last February and went national last summer, intends to be to medical, dental and alternative care what Priceline and Hotwire are to travel: places where consumers can go online to see the full cost for specific care and procedures, bid for these needed services and then either have the winning provider contact them or call the provider themselves to learn the price for paying in cash.

That’s right: place a bid for anything ranging from obesity surgery to a student sport physical to Lasik eye surgery. Regarding quality concerns, consumers can view the provider’s resume, board certification-or lack thereof-and even follow a link posted on every page to state records to check a provider’s background for past problems. Of course, as with any health care provider, whether recommended by a friend or found via a referral service, it’s up to patients to do their homework.

Harris, 43, discovered the service via a TV commercial. He calls it a godsend. “I knew a couple of my teeth had to come out and I wanted implants. I heard from a couple of friends with implants that the [original] tooth had to be taken out right, to leave enough bone for the implant.”

So he carefully read the qualifications and prices listed by the dentists on the site and then called one, Dr. Randal Swanlund of the South Sound Dental Implant Centre in University Place, and scheduled an appointment. He had the teeth extracted last summer, and is scheduled for the implants when he’s healed sufficiently. “He was very professional, very understanding,” Harris says of Swanlund, including not judging Harris for going so long without proper dental care. Plus, he says, there were no hidden costs or fees: “It costs me exactly what was on the [PriceDoc] list.”

Swanlund, for his part, has had good luck with advertising his services, including the exact costs, on PriceDoc. It seems a sensible way to both tap the power of the web and reach out to people who need dental care but do not have insurance, he says. And pricing dental services is a pretty exact science, especially because most dentists use the same major labs, he adds.

“The internet is driving it,” says Swanlund, who trained at the University of Washington. “You’re marketing and selling a product. It’s not like being a heart surgeon.”

He’s had patients travel for care from eastern Washington, Oregon and Idaho. “It’s interesting. People will-for a savings of $3,000 to $5,000-drive [far] to a practitioner.”

That access and consumer power is what PriceDoc co-founder Glenn Safadago, a Seattle resident, had in mind when he dreamed up the idea. Its genesis was in the early 1990s as he and his wife were sitting in an orthodontist’s office. Two of his three children needed braces, so they visited a top orthodontist. “He said it would cost $4,800. He was pretty nonchalant about it,” he says.

But Safadago had just started his own business and was watching the family budget very closely. “I said, ‘That’s way too much money and I can’t afford it-would you take $3,800?’ He said, ‘There’s no discount here. We don’t need to.'”

Safadago thanked him for his time, and he and his wife got up to leave. “Then he [the orthodontist] said, ‘I’ll do it.’ I said, ‘OK, deal,’ and we shook on it. And now my children have beautiful, straight teeth.

“Anything is negotiable. That stuck with me.”

When the bidding model of purchasing goods started becoming popular via eBay, Priceline and other internet biggies, it all fell into place for Safadago, a trained audiologist with a background that includes a position as international director of sales for a major manufacturer of cardiac equipment. He and four other co-founders launched the privately-held company in February 2009 after raising $2.8 million in financing. It began with providers in the Puget Sound region, who pay to be listed, and started spreading to other states this past summer. The company also counts physicians among its executives.

Plastic surgeons, dermatologists, dentists and others long accustomed to being paid in cash up front for procedures not covered by insurance were the first to embrace the concept, but others are quickly following, says Safadago. “The younger doctors tend to be tech savvier, hungry to build their practice-they really get it. But older practitioners understand the importance of cash-paying customers.”

The concept is fine with Tom Curry, executive director of the Washington State Medical Association. “We have no position on it. [Washington] is a very consumer populist state. There’s no ethical prohibition against it. The word of caution for the patient is that … it’s worth being cautious depending on the scale and complexity” of the care needed.

Safadago would be the first to tell you that you needn’t bother going to PriceDoc for truly complicated medical issues like a cardiac stent or even a knee operation. There are too many variables, he says. “We’re taking care of low-hanging fruit-the physicals, the flu shots, the office visits, the eye exams” and other routine procedures that can be neatly priced. And it’s not intended to be a kind of internet-based, health-care reform, he says, just a well-priced, convenient place with no red tape for consumers to get prices and connect with medical care.

He’s watching federal health care reform efforts with interest, but isn’t worried. “I think whatever happens, we’ll be positioned just fine,” he says. “Most likely, if the 50 million [uninsured people] in this country do get coverage, they’ll [just] get catastrophic coverage.” And catastrophic coverage omits an awful lot of routine care, Safadago points out.

Affordable routine health care for people is great, but what about man’s best friend? Have no worries. PriceDoc has plans to launch a similar site for veterinary services, PriceVet, this fall. And that pleases Swanlund. His German shepherd got sick over the Fourth of July holiday, and it ended up costing him a $1,000 in emergency services. If there only had been a place he could have quickly compared prices and backgrounds of vets in his area, he says.