Earl Winter lost an appendix and gained a multimillion dollar business model.

His company is nTelagent Inc., and it was born after Winter spent one day in the hospital and three months fretting about his medical bill.

“During that time, I start looking at my insurance policy and I start getting angry thinking, ‘Oh, my gosh, this thing is going to be thousands of dollars.’” Winter recalls. “But, it turned out it was about half of what I thought it was going to be.”

Winter says if he had known the cost of the procedure up front, he would have paid the bill on the spot. He also says he would have been spared a lot of anxiety about how much he would owe.

And, he says, he might have yielded his inflamed appendix to a surgeon’s scalpel four years earlier, he says.

In the end though, he gained a profitable idea for his health care revenue-cycle management firm, nTelagent.

The Franklin-based company’s Self-Pay Management System is designed to alleviate sticker shock by putting pricing on the front end of the service. The Web-based system, dubbed The Retail Application, lets health care providers determine a patient’s payment responsibility and ability to pay before care is delivered.

For most consumers, there is no upside to the anxiety associated with health care costs. The results of two studies paint an unhealthy portrait of the consumer health market.

About 80 million American adults had medical debt or bill-paying problems in 2007, according to a study published in August by The Commonwealth Fund, a private foundation that aims to improve health care in the United States.

Furthermore, Deloitte’s “2008 Survey of Health Care Consumers” revealed 93 percent of consumers are insecure about their ability to handle future health care costs.

New health care pricing mindset

“We haven’t been in a mindset where the price of that care has been something that a lot of people were worried about on the front end,” says Jamie Stockton, senior health care

technology analyst for investment firm Morgan Keegan & Company.

“Now, as people are consuming more health care and health care is getting more expensive and more of it is coming out of pocket, and less is being covered by your insurance or the government, people care more and more about what the costs are.”

nTelagent and two other Nashville-area companies, change:healthcare and Passport Health Communications, are helping to uncover the mystery of health care costs and advancing health care’s “pricing transparency” movement.

Like nTelagent, Passport offers a bill-estimation product. Change:healthcare offers a Web-based platform that lists pricing for services from more than 1.5 million health care providers and the estimated costs for more than 10,000 medical services.

“You are seeing some stuff like bill-estimation popping up at hospitals,” Stockton says. “I think we will eventually see a lot of transparency online. There will be Web sites that you can go to and look at what a

specific hospital or a physician charges for a variety of services.

Pricing now is ‘very opaque’

“My sense is that today it is very opaque and there is very little transparency,” Stockton adds. Stockton refers to Accuro Healthcare Solutions’ CarePricer bill-estimating service to illustrate his point. The service is used by about 200 health care providers.