Los Angeles Daily News Runs PRA Op-Ed Featuring Research Showing Wild Price Swings for Same Care
The Southern California News Group, whose papers include the Los Angeles Daily News and Orange County Register, ran PRA’s op-ed featuring its research showing that Los Angeles hospital prices can vary by more than ten times for the same care — even at the same hospital. As Cynthia A. Fisher, PRA founder and chair, explains:
New research by PatientRightsAdvocate.org reveals how outrageous and arbitrary hospital prices, which can vary by ten times depending on the payer or hospital, burden Los Angeles-area consumers. Our findings reinforce the need for U.S. Health and Human Services, led by Secretary Xavier Becerra, to robustly enforce its hospital price transparency rules. Doing so will allow patients to protect themselves from price gouging and empower them to take control of their health finance decisions.
Hospitals currently blind consumers, including patients, employers, and unions, from prices, then blindside them with massive bills weeks and months later. This price opacity enables hospitals to engage in overcharging, waste, and vast price differences for the same care – even at the same hospitals. This status quo is responsible for saddling 20% of Californians with problematic or unpayable medical debt.
To remove the hospital price veil, a federal price transparency rule took effect last year requiring hospitals to publish their discounted cash and all secret contracted rates by plan and payer. Armed with actual prices, consumers can identify the highest quality care at the lowest possible prices and enjoy substantial healthcare savings. Unfortunately, this law has been marred by widespread noncompliance.
Our researchers recently examined the websites of U.S. News and World Report’s top 30 Los Angeles-area hospitals. We found accessible price information at only four: Cedars-Sinai Medical Center, Torrance Memorial Medical Center, Huntington Hospital, and Pomona Valley Hospital Medical Center. Yet even these limited price disclosures reveal how vulnerable Southland consumers are to the predatory American healthcare system.
Consider the wild price fluctuations at these hospitals for just one service: a standard outpatient non-contrast brain MRI (billing CPT code 70551). The price of this treatment at Cedars-Sinai varies by approximately ten times depending on the payer, from $367 for Blue Cross Blue Shield Medicare plans to $4,043 for commercial Kaiser plans.
The price for consumers with Blue Cross HMO coverage is $2,162, nearly half Kaiser’s price. These prices do not include additional facility and physician fees that patients must pay.
Brain MRI prices also vary wildly across nearby hospitals. The price disclosures indicate patients covered by a Blue Cross HMO at Torrance Memorial pay just $127 — 17 times less than Blue Cross HMO patients pay for the same scan at Cedars-Sinai just 20 miles away.
In other words, prices can vary by more than ten times for the same service at the same hospital with different insurance coverage. And prices can vary by more than ten times for the same service at different hospitals with the same insurance. Consumers lose either way.
If you include Medicaid prices — Huntington Hospital lists the Medi-Cal Los Angeles plan price for this same brain MRI at just $39 — prices can vary by 100 times.
Pomona Valley lists a cash price for this procedure: just $450. This reasonable price begs the question: What’s the point of paying thousands of dollars in healthcare premiums every month if hospitals charge insured patients thousands of dollars more than those paying cash? The Cigna price at Pomona Valley for the same treatment: $6,500.
Standalone, cash-based MRI centers in Los Angeles offer brain MRIs for as low as $225 with no additional facility fees. This cash discount demonstrates how health industry bureaucracy and profiteering drive up prices.
Read the full op-ed in the Los Angeles Daily News.
