Hospitals Are Supposed to List Their Prices, But Many Aren’t Complying

Have you ever looked at the price of a product or service from a hospital and thought, “I am probably being overcharged for this?” Well, depending on the product or service, you were probably right. Prior to this year, hospitals and private insurance companies were not required to share their prices with the general public.

This year, however, a new federal rule went into effect requiring hospitals and private insurers to post the prices they negotiate with private insurers. (Health insurers will also be forced to post their prices, starting next year.) It is supposed to ensure that patients will know what their estimated costs for care will be. Hospitals, however, are not universally on board with this new required transparency, and some  are going to great lengths to hide that information from patients – if they post it at all.

Today, we discuss how you can find the information you need, and what you can do to make sure you are getting the best care possible for the money you spend.

What does the consumer need to know before beginning to search for hospital prices?

It is important to know what type of health insurance you have before beginning your search. You will need to know information like the name of your insurer, and the type of plan you picked (i.e., H.M.O. or P.P.O). Insurers contain multiple rates based on the types of plans, and how the insurance was purchased; for example, did your insurance come through your employer, or did you purchase it on the marketplace?

Another decision that influences rates is the type of network the individual opted into when he or she signed up for coverage. Just because a hospital is in your network doesn’t mean all its doctors are, and that can affect the cost of your care.

What are the best steps to conduct a web search for hospital prices?

The next step is to conduct the search. Many hospitals post price data on a page labeled “price transparency.” Several researchers also recommended looking for price files through a Google search under that phrase and the hospital’s name. That search will guide you to a top result that shares information such as price estimates, billing, or patient information. Some hospitals will either post that type of information at the bottom of the page or request that the consumer follows a few links.

The hospital’s price transparency page will consist of multiple sections and links with labeling that is not always clearly defined. Consumers should search for titles such as “comprehensive machine-readable file” or “negotiated price list.” Consumers should also browse for files that contain phrases such as “standard charges” or “chargemaster.” These types of files should possess the hospital’s negotiated rates and cash prices.

What happens if the consumer does not find anything?

This happens often, as most hospitals have not posted their price data, and there is not much you can do about that – for now – except to file a complaint with the Centers for Medicare & Medicaid Services (CMS). The agency has issued nearly 170 warning letters to hospitals that have failed to post price data online. The next consequence involves penalizing hospitals for noncompliance to the federal rule. The federal government plans on increasing fines from $109,500 a year to as much as $2 million.

You deserve the highest levels of care when you visit a hospital or emergency room. At Plaxen Adler Muncy, P.A., we advocate on your behalf when a negligent doctor or staff member has caused you serious harm. To schedule a free consultation at one of our nine offices throughout Maryland, please call 410-730-7737 or fill out our contact form. If you cannot come to our office, we can make arrangements to visit you.