Hospitals slow to disclose prices

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Hospitals must say how much they charge for hundreds of procedures. Here's why many don't.

More than half of U.S. hospitals have not shared pricing information as required by a new federal law. Consumer advocates urge federal enforcement.

www.usatoday.com

U.S. hospitals slow to respond to new price transparency rule - School of Public Health - University of Minnesota

A study conducted by a group of SPH faculty showed only 73% of hospitals posted pricing in a consumer-friendly format and far fewer presented data in ways that could be easily analyzed by researchers.A study conducted by a group of SPH faculty showed only 73% of hospitals posted pricing in a...

www.sph.umn.edu

Hospitals slow to disclose prices

Since the beginning of 2021, a federal law has required hospitals to p

heraldtimesonline-in.newsmemory.com

 

[BigRed]

"What do I do to keep my subsidies once my subsidizers demand me to be transparent....but not honest?"

 

[churchmouse]

Heck they are slow to send billing.
Then they bill you 3 or more times for the same crap. Ask me how we know.
Have a hellish fight on my hands.

 

[wtburnette]

Hospitals (and insurance companies) are full of

 

[churchmouse]

Hospitals (and insurance companies) are full of

Yup. It’s a game. We are the pawns.
They say life is precious and no price can be put on it.

 

[Jaybird1980]

Well, Hospitals are slow at almost everything has been my experience.

 

[Shadow01]

Again this is a matter of laws without teeth. Put the top 20 administrators of each hospital in federal prison for no less than 10 years for failure to comply. You can’t force compliance when their is no chance of personal loss. The way government and employers have acted the last 3 years should tell you that.

 

[hoosierdoc]

It's such a tough thing. Charges are one thing, but negotiated insurance rates are another. I can say my hospital charges $4000 for a level 5 ER visit. You have no idea what separates a level five from a level two, or when the next thing we do bumps you up a level.

The hospital may have a contract with Anthem that allows a $2000 charge, but a contract with United Health that allows $2600. Each patient has diff co-pays and deductibles. At the registration desk, the patient has no idea what these rates will be, or what imaging tests will be ordered, or labs, or meds. Neither does the doc or the nurse.

We can quote charges, but that has almost nothing to do with what the patient will be responsible for. My group collects under 20% of what we bill.

Price transparency is nice but it's hugely complicated and not as clear-cut as it sounds.

When's the last time Congress passed a budget? That's required by law.

 

[ws6guy]

It's ridiculous that at least 90% of the time we receive a bill from anything medical related we have to call either the provider or insurance to get the billing corrected. I cannot think of a single the error was in our favor, funny how that works.

I'm grateful for my wife who is a stickler for details and combs through every EOB and bill. She'll fight for every penny. I feel sorry for the folks that just pay they bill and assume it's correct.

 

[wtburnette]

It's such a tough thing. Charges are one thing, but negotiated insurance rates are another. I can say my hospital charges $4000 for a level 5 ER visit. You have no idea what separates a level five from a level two, or when the next thing we do bumps you up a level.

The hospital may have a contract with Anthem that allows a $2000 charge, but a contract with United Health that allows $2600. Each patient has diff co-pays and deductibles. At the registration desk, the patient has no idea what these rates will be, or what imaging tests will be ordered, or labs, or meds. Neither does the doc or the nurse.

We can quote charges, but that has almost nothing to do with what the patient will be responsible for. My group collects under 20% of what we bill.

Price transparency is nice but it's hugely complicated and not as clear-cut as it sounds.

When's the last time Congress passed a budget? That's required by law.

This is exactly the kind of garbage that gives the Left all the ammo they need for their socialized medicine push. Just because this is the way it is doesn't mean it's right, as a matter of fact it's not. There's no valid reason for the differences. People should have a clear understanding of the costs involved when a procedure is done, or at least a good rough estimate. If you need x done while there, it'll be another xx, if you need something else done, that'll be another xx. Pretty simple if the hospitals and insurance companies work it out, but they don't want to do that. They'll keep dragging their feet and then wake up one day surprised when we have social medicine in this country.

It's ridiculous that at least 90% of the time we receive a bill from anything medical related we have to call either the provider or insurance to get the billing corrected. I cannot think of a single the error was in our favor, funny how that works.

I'm grateful for my wife who is a stickler for details and combs through every EOB and bill. She'll fight for every penny. I feel sorry for the folks that just pay they bill and assume it's correct.

Yep, I'm fighting with a transportation company for an ambulance ride from 5 years ago. I paid my part and then got a collections notice. They've already taken ~$400 from me (my IN tax return and the $125 tax rebate check). I called both the insurance company and the transpo company and both admit I paid my part yet somehow they still say I still owe like another $700. For an ambulance ride that I already paid $1k for. Trying to figure out next steps to get the madness to stop...

 

[ws6guy]

It's such a tough thing. Charges are one thing, but negotiated insurance rates are another. I can say my hospital charges $4000 for a level 5 ER visit. You have no idea what separates a level five from a level two, or when the next thing we do bumps you up a level.

The hospital may have a contract with Anthem that allows a $2000 charge, but a contract with United Health that allows $2600. Each patient has diff co-pays and deductibles. At the registration desk, the patient has no idea what these rates will be, or what imaging tests will be ordered, or labs, or meds. Neither does the doc or the nurse.

We can quote charges, but that has almost nothing to do with what the patient will be responsible for. My group collects under 20% of what we bill.

Price transparency is nice but it's hugely complicated and not as clear-cut as it sounds.

When's the last time Congress passed a budget? That's required by law.

I understand this as it does get complicated. However it is frustrating that neither the provider or insurance can give you a cost up front for a procedure. At least for routine procedures such as a colonoscopy. The provider knows dang well the approximate charge they are going to bill insurance but cannot tell you how much insurance will cover. Then the insurance company cannot tell you anything until they get the bill. I cannot think of anything else where you are getting work done and have no idea of what it's going to cost.

 

[GodFearinGunTotin]

I understand this as it does get complicated. However it is frustrating that neither the provider or insurance can give you a cost up front for a procedure. At least for routine procedures such as a colonoscopy. The provider knows dang well the approximate charge they are going to bill insurance but cannot tell you how much insurance will cover. Then the insurance company cannot tell you anything until they get the bill. I cannot think of anything else where you are getting work done and have no idea of what it's going to cost.

Yep. Even when building a custom house a builder can give you an estimate of the costs. There’s a lot of moving parts, subcontractors, unforeseen conditions and costs, yet the contract can give a reasonable idea what the final bill will be. Certain medical procedures may be very difficult as the course of actions and their costs cannot be reasonably or accurately foreseen…but for routine procedures, the ones some doctors do many times a week?—those ought to be fairly easy to give the consumer a good idea of what to expect.

 

[hoosierdoc]

Have you ever heard of a DRG-based payment model? Very common for inpatients.

Health Insurance: How Does a DRG Determine What a Hospital Gets Paid?

Medicare and some private insurance companies pay for hospitalizations of their beneficiaries using a DRG payment system. Find out how it works.

www.verywellhealth.com

What also needs to happen is the patient is responsible for paying the bill. Imagine the cost of groceries if the product was handled like healthcare.

Problem with that is sometimes insurance sends the check to the patient who is supposed to send it to the doctor or hospital. Then the patient buys a car and laughs at the hospital/provider telling them they spent the money. Sue 'em.

 

[Ingomike]

I cannot think of anything else where you are getting work done and have no idea of what it's going to cost.

I cannot think of anything else where you are getting work done. and expect others to pay for it…

Mother always said two wrongs don’t make a right. This whole mess started when wage controls were instituted in WWII and benefits were ruled not to be a part of wages. I read that back then the biggest expense hospitals had was bed linens. The unions then jumped on the bandwagon and soon employers were responsible for healthcare.

The problem is a party gets healthcare from a second party, that gets paid by a third party, that is paid by a fourth party. The fourth party promises the first party healthcare, the fourth party then has a contract with the third party to pay for the healthcare that then has its own contract with the second party to provide the healthcare.

In this system the party needing the healthcare in not in the loop of what things cost. This is where the health savings accounts were good, but could have been better. We need to get the employer/fourth party out of the loop. Then the party can decide what they want to buy from third party or maybe direct from the second party. Then publicized rates might be helpful…

 

[bwframe]

I wonder if a lot of the issue is that providers take "honest" advantage of playing the system to their favor? For every budget conscious party that goes through their bill (from months, maybe years ago ) how many are there that just send in the figure on the bottom line?

The same would apply to the insurance company dealings? Do the medical providers bill in their own direction? Do they make up for low negotiated rates by tossing in ancillary charges for services that are often involved, but not necessarily in every case?

 

[spencer rifle]

We were charged for a circumcision when our oldest was born. We went into the office and offered to show them proof that no such procedure was done. They passed, but took it off our bill. They depended on no one noticing. Or were just incompetent.

SWMBO needed a shoulder X-ray. She called around to compare, and got figures from $60 to $2000. The most common answer was "We don't know."

 

[Cameramonkey]

And if you dont know whats going on, they scam you.

For my 2nd child, my wife was doing natural childbirth at Methodist. The midwife was starting to get concerned, so she called down and asked VERY VERY clearly for the on call OB to be on standby. She explained didnt need them yet, but wanted them to be aware they might be needed and not to wander too far. But we would call if they were actually needed.

A short time later, as the head crowned, a random doctor walked into the room. She stood back for 15 minutes and watched as my beautiful daughter was delivered.

Eventually the doctor, who turned out to be the on call OB walked up, patted my wife on the shoulder and told her "Good Job Mamma."

We were later billed almost $3,000 for the OB's services, even though we had our own midwife who actually did all the work.

Needless to say we called the hospital billing department and told them the story. We never heard from them again.

We were charged for a circumcision when our oldest was born. We went into the office and offered to show them proof that no such procedure was done. They passed, but took it off our bill. They depended on no one noticing. Or were just incompetent.

SWMBO needed a shoulder X-ray. She called around to compare, and got figures from $60 to $2000. The most common answer was "We don't know."

the first rule of diagnostic imaging is NEVER go to a hospital radiology dept. they are outrageously expensive.

I had to get a knee MRI. Hospitals wanted $1800 to $2500. A private sports medicine place charged me $400.

 

[hoosierdoc]

We were charged for a circumcision when our oldest was born. We went into the office and offered to show them proof that no such procedure was done. They passed, but took it off our bill. They depended on no one noticing. Or were just incompetent.

SWMBO needed a shoulder X-ray. She called around to compare, and got figures from $60 to $2000. The most common answer was "We don't know."

Most docs have no idea what gets billed. We do our work and document it, then coders/billers take over and determine appropriate charge based on approved fee schedule and file it. Medical coding is incredibly complex and usually done by third-party companies if not a massive organization.

Outpatient imaging can be really affordable if you use Indepedent imaging companies not affiliated with a hospital. Usually includes the radiologist fee also.

RayUS and Northwest Radiology are two examples. Fees posted online.

 

[eldirector]

I count myself kinda lucky in the arena. My wife did medical billing for about 10 years. She scrutinizes every single EOB, and knows the lingo. She has caught numerous errors, and they are never in OUR favor.

 

[Ingomike]

In many cases, the multiple parties involved, as I posted above, make it so the consumer does not really care. I didn’t care about what charges there were after I met my deductible. I never even saw an itemized bill. Just a bill saying what my parts were. All the rest were paid by insurance.