Buying health care in America is like shopping blindfolded at Macy’s and getting the bill months after you leave the store, economist Uwe Reinhardt likes to say.

A tool that went online Wednesday is supposed to give patients a small peek at the products and prices before they open their wallets.

Got a sore knee? Having a baby? Need a primary-care doctor? Shopping for an MRI scan?

Guroo.org shows the average local cost for 70 common diagnoses and medical tests in most states. That’s the real cost — not “charges” that often get marked down — based on a giant database of what insurance companies actually pay.

OK, this isn’t like Priceline.com for knee replacements. What Guroo hopes to do for consumers is limited so far.

It won’t reflect costs for particular hospitals or doctors, although officials say that’s coming for some. And it doesn’t have much to say initially about the quality of care.

Still, Guroo should shed new light on the country’s opaque, complex and maddening medical bazaar, say consumer advocates.

“This has the potential to be a game-changer,” said Katherine Hempstead, who analyzes health insurance for the Robert Wood Johnson Foundation. “It’s good for uninsured people. It’s good for people with high deductibles. It’s good for any person that’s kind of wondering: If I go to see the doctor for such-and-such, what might happen next?”

Guroo is produced by the Health Care Cost Institute (HCCI) working with three big insurance companies: UnitedHealthcare, Aetna and Humana, soon to be joined by a fourth, Assurant. The idea is to eventually let members of these plans use a companion site to see how differing provider prices affect their co-payments.

A nonprofit known for its cost and utilization reports, HCCI receives some industry funding but is governed by an independent board. This is its first tool for consumers.

Consumer advocates praised Guroo but cautioned that the movement toward “transparency” in medical prices is still in its very early stages. Data on insurer, employer or government Web sites are often limited or inaccurate. Consumer information from Fair Health, which manages another huge commercial insurance database, is organized by procedure code.

Even on Guroo.org, “the average user may not have a good sense of what they’re looking at and what they’re supposed to do with the resulting price,” said Lynn Quincy, a health care specialist at Consumers Union.

HCCI says its prices are what insurers pay for about 70 tests and “bundles” of services described in understandable terms so patients don’t need a medical textbook to figure out what they are. Users get the average as well as a range for local and national prices.

It plans to add more procedures later — all for “shoppable” services that can be scheduled, not emergency treatment of a heart attack.

“This at least arms consumers with information about the range of prices in their community [for] one of these care bundles,” said David Newman, HCCI’s executive director.

If you have a high deductible, for example, you might use Guroo.org as a starting point for checking prices from medical providers if your insurance company doesn’t provide such a tool.

That’s not the same as seeing provider-specific prices online, of course. But within a year, HCCI expects to let members of UnitedHealthcare, Aetna, Assurant and Humana track spending on a companion site and check how switching caregivers could lower their out-of-pocket costs.

Initially Guroo.org doesn’t have much information about quality of care, either, which is essential to help patients to make smart choices. Newman says that is coming, too. It’s also missing information for Alabama, Michigan and several other states.

BlueCross BlueShield of North Carolina set a high standard for disclosure recently by posting prices — doctor by doctor and hospital by hospital — based on its reimbursement rates, Quincy said. Guroo doesn’t do that.

Still, she said, it’s an important step.

Given its size, influence and openness, Guroo could become a dominant portal for health care prices, said Hempstead.

“Their stance as a neutral broker and the amount of data that they have and the amount of data that they’re going to have really puts them in a difference place,” she said.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Some readers want to figure out how to become eligible for coverage on the health insurance marketplaces, while others want to figure out how to avoid it. This week I answered questions from both.

I am covered by my employer’s health plan, but I’m not happy with it. My son is 21 and currently covered under my plan. While I realize that I am not eligible for Obamacare, I am curious if I can terminate my son’s policy so that he might be eligible.  

Since the open enrollment period to sign up for coverage on the state marketplaces ended Feb. 15, in general people can’t enroll in a marketplace plan until next year’s open enrollment period rolls around.

If you drop your son from your employer plan, however, his loss of coverage could trigger a special enrollment period that allows him to sign up for a marketplace plan. Whether he’s entitled to a special enrollment period depends on whether his loss of coverage is considered voluntary, say officials at the Centers for Medicare & Medicaid Services. In general, voluntarily dropping employer-sponsored coverage doesn’t trigger a special enrollment period for individuals or their family members. But if you drop your son’s coverage on his behalf without his consent, his loss of coverage wouldn’t be considered voluntary and your son could qualify, according to CMS.

Whether he’ll be eligible for premium tax credits to make marketplace coverage more affordable is another matter, says Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities.

If you claim him as your dependent, he generally won’t be eligible. If you don’t claim him as your dependent, he would have to qualify for subsidies based on his own income.

I received a notice from the Pennsylvania Children’s Health Insurance Program that says they are eliminating CHIP coverage for participants who pay full-cost CHIP because it isn’t compliant with the Affordable Care Act. They are forcing us onto the marketplace where the premiums are higher and our deductibles are higher. I believe the state is using the ACA to dismantle its CHIP plan. What can we do?

You should be able to keep your full-cost CHIP coverage after all because state and federal officials reached an agreement on the issue, say consumer advocates in Pennsylvania.

CHIP offers coverage to children in families that earn too much to qualify for Medicaid, the joint federal-state health program for low-income people. But in six states – including Pennsylvania – the program allows families that earn too much to qualify for CHIP under its guidelines to enroll their kids if they pay the full cost of coverage.

The federal government, however, determined that, among other things, the CHIP buy-in program didn’t comply with the health law because plans had annual limits on certain types of coverage, such as behavioral health and physical therapy, that aren’t allowed, says Ann Bacharach, special projects director at the Pennsylvania Health Law Project. That meant that the families of roughly 3,600 kids in the program would face penalties because the kids wouldn’t be considered to have “minimum essential coverage.”

But after notifying families that the full-cost CHIP coverage was ending, Pennsylvania Gov. Tom Wolf this month announced that his administration had reached an agreement with the federal government so that coverage could continue without penalties. Insurers, meanwhile, will work over the coming months to bring the plans into compliance with the health law.

I recently had a disability hearing that went well.  If I receive Medicare later in the year, will I be able to terminate my state marketplace plan?

In general, Medicare coverage doesn’t begin until two years after someone is approved for and begins receiving payments for Social Security Disability Insurance.

Once your Medicare coverage starts, it probably makes financial sense to drop your marketplace plan, says Tricia Neuman, director of the Program on Medicare Policy at the Kaiser Family Foundation (KHN is an editorially independent policy of the foundation.)

“Individuals covered by Medicare are not eligible for marketplace subsidies,” Neuman says.

Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

For the second time in two years, the state of California has faulted HMO giant Kaiser Permanente for failing to provide patients with appropriate access to mental health care.

Some Kaiser patients still have to wait weeks or even months to see a therapist or psychiatrist, which violates state laws intended to ensure timely access to mental health treatment, the state Department of Managed Health Care said in a report released Tuesday. (Kaiser Health News is not affiliated with Kaiser Permanente.)

In addition, the department, which regulates California’s managed health care companies, found that Kaiser’s informational materials — as well as some providers themselves — improperly indicated to customers that long-term individual therapy was not available to enrollees, even though coverage of treatment for severe mental illness is required under state and federal mental health parity laws.

Tuesday’s report is a follow-up to an inspection released in March 2013, which identified four major deficiencies in the health plan’s delivery of mental health services. Kaiser agreed to pay a $4 million fine — one of the largest ever by an insurer in the state. At the time, the managed health care department said it would follow up on the plan’s progress a few months later. The results were not released until now.

In this follow-up report, the department found that Kaiser had solved two of the four problems by improving the way it collects and analyzes data about access to appropriate mental health care.

“Kaiser has made progress in being able to identify when and where the problems around access are occurring, but they are still not able to address the problems when they arrive,” said department director Shelley Rouillard. “They still have a lot of work to do.”

Kaiser officials say they have made significant strides in bolstering their provider network, including increasing their therapist staff. In addition, Kaiser is working with a separate company called ValueOptions to provide additional mental health care when necessary.

“We are proud of the progress we have made to improve access to mental health care,” Kaiser Permanente officials said in a statement. “We are committed to continuing to improve. We acknowledge there are still some areas where we need to continue making progress and do better for our patients,” including improving access to appointments at some locations.

In Kaiser’s Northern Region, the managed health care department found 22 percent of patients did not have timely access to either an initial or follow-up appointment. In one case, a sexual assault victim diagnosed with post-traumatic stress disorder and major depression was prescribed an antidepressant in an initial visit, but no follow-up appointment was scheduled.

The patient tried to schedule both individual and group therapy visits, but her psychiatrist responded by “offering psychotherapy in the community at the patient’s expense and suggested that the patient investigate appropriate group therapy in the community because weekly individual therapy was not available in the Plan, and Plan group therapy did not address sexual assault,” according to the report.

The patient was eventually able to schedule an appointment with a Kaiser therapist — five months after her initial visit, the report said.

According to another case cited by the department, a psychiatrist wrote an email to a patient saying that, “No one ever sees a therapist once a week in the Kaiser Health Plan. Not a covered benefit for the past 20-something years and will not be a benefit in the future.”

Based on Tuesday’s report, the managed health care department’s Office of Enforcement will consider whether Kaiser Permanente should face further disciplinary action, which could include another fine.

Kaiser Permanente is one of the largest not-for-profit health plans in the country, with an operating revenue of $56.4 billion and almost 7.5 million members in California.

The company has been in a protracted labor dispute with the National Union of Healthcare Workers, which represents the plan’s therapists. Union leaders have accused the health plan of a “chronic failure to provide … quality mental health care.” In its written statement, Kaiser blamed the union for continued problems in providing timely access to mental health care.

“We need union leadership to work constructively together with us to remove obstacles and solve problems more quickly …” the statement said.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.