Cost of health care
Hospitals post prices online, but actual charge still hard to decipher
Hospitals post costs online, but the real charge may be hard to find.
As of Jan. 1, in the name of transparency, the Trump administration required that all hospitals post their list prices online. But what is popping up on medical center websites is a dog’s breakfast of medical codes, abbreviations and dollar signs — in little discernible order — that may initially serve to confuse more than illuminate. Anyone who has ever tried to find out in advance how much a hospital test, procedure or stay will cost knows the frustration: “Nope, can’t tell you” or “It depends” are common replies from insurers and medical centers. While more information is always welcome, the new data will fall short of providing most consumers with usable insight. That’s because the price lists, called chargemasters, are massive compendiums of the prices set by each hospital for every service or drug a patient might encounter. To figure out what, for example, a trip to the emergency room might cost, a patient would have to locate and piece together the price for each component of their visit — the particular blood tests, the particular medicines dispensed, the facility fee and the physician’s charge, and more. “I don’t think it’s very helpful,” said Gerard Anderson, director of the Johns Hopkins Center for Hospital Finance and Management. “There are about30,000 different items on a chargemaster file. As a patient, you don’t know which ones you will use.” And there’s this: Other than the uninsured and people who are out-of network, few actually pay full charges.
A ‘small step’
The requirement to post charges online in a machine-readable format, such as a Microsoft Excel file, came in a 2018 guidance from the Trump administration that builds on rules in the Affordable Care Act. Hospitals have some leeway in deciding how to present the information — and currently there is no penalty for failing to post. “This is a small step” toward price transparency amid other ongoing efforts, Centers for Medicare & Medicaid Services Administrator Seema Verma said in a speech in July. But finding the chargemaster information on a hospital’s website takes diligence. Patients can try typing thehospital’s name into a search engine, along with the keywords “billing” or “chargemaster.” Even when consumers do locate the lists, they might be stymied by seemingly incomprehensible abbreviations. The University of California San Francisco Medical Center’s chargemaster, for example, includes a $378 charge for “Arthrocentesis Aspir&/Inj Small Jt/Bursa w/o Us,” which is basically draining fluid from the knee.At Sentara in Hampton Roads, Va., there’s a $307 charge for something described as a LAY CLOS HND/ FT= .
When the bill doesn’t add up
Which services, treatments, drugs or procedures a patient will face in ahospital stay is often unknowable. And the charge listed is just one component of a total bill. Put simply, an MRI scan of the abdomen has related costs, such as the charge for the radiologist who reads the exam. Even something as seemingly straightforward as an uncomplicated childbirth can’t easily be calculated by looking at the list. Comparisons between hospitals for the same care can also be difficult.An uncomplicated vaginal delivery charge at the Cleveland Clinic’s maincampus is $3,466.
Looking for that same information on the Minnesota Mayo Clinic’s online chargemaster page shows two listings, one for $3,030, described as “labor and delivery level 1 short” and the other for $5,236, described as “labor and delivery level 2 long.”
But, what’s a short labor? What’s a long one?
How is a patient who didn’t go to med school supposed to know thedifference? Also, those are just the charges for the actual delivery.
‘Entirely unhelpful’
Though chargemaster rates are quite different from the lower, negotiated rates that insurers pay, they do become
the basis for what patients pay who are without insurance or who are treated at hospitals outside their insurer’s network. Outof-network patients are often surprised when they get what are called “balance bills” for the difference between what their insurer pays toward their care and those full charges.
Still, even knowing chargemaster rates
“would be entirely unhelpful” infighting a high balance bill, said Barak Richman, a law professor at Duke University who has written extensively about balance bills and hospital charges.
Nevertheless, some experts say that merely making the charges public shines a light on the often very high — and widely varying — prices set by facilities.
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Consumer Protection fact sheet on billing
This document from the Wisconsin Bureau of Consumer Protection includes great information on what common medical billing errors and upcharges to look for, aswell as tips on how to report and challenge them: https://datcp.wi.gov/Pages/ Publications/Medical Billing147.aspx.