What does upfront, straight-up pricing in healthcare mean?
As of January 1, 2021, it is now your right to know the real price of your medical care and treatment at hospitals BEFORE you receive care. Seeing prices upfront will give you the power to shop, choose the best care at the right price, and not be surprised by unexpected bills you cannot afford. Finally, you will have the power to choose the care you want at a price you can prepare for.
Why is it important to see prices in healthcare?
Imagine dining at a restaurant and you don’t get to see the prices for your food until you get multiple bills in the mail weeks or even months later, and in some cases you may even be served food you didn’t even order or need, but still be forced to pay for when the bill arrives. Healthcare is the only industry in which we cannot see prices. That is why one in five Americans have medical debt in collections and one third of the population is in debt due to medical expenses. This is also why 64% of Americans have delayed or forgone care out of fear of surprise medical bills.
By knowing prices, we the patients will be able to know before we go, and will not be burdened by the fear the comes with being blind to prices.
Will it be hard for hospitals to post their prices?
Health and Human Services has calculated the burden of complying with the transparency rule as de minimis, or minimally impactful – a mere 150 hours per hospital, less than one month’s worth of work for a single employee.
Fortunately for the hospitals, the data is already in digital form. Hospitals heavily use this digital pricing data to bill patients, and they use it analytically to optimize their revenues. Additionally, they often use these digital pricing files to calculate pro formas in assessing potential merger and acquisition activities.
In summary, hospitals already have the data digitally and can quickly post their prices for all to see. That’s why patients should be aware it is their right to know and demand that information. As patients, the control over your health and wellness (both physically and financially) should be in your hands, not I the hands of hospital administrators who can easily provide information to empower patients, but have chosen not to.
What are hospitals required to do?
The Hospital Price Transparency Rule requires hospitals to disclose on their website and make public all standard charge information for all hospital items and services. This consists of two price lists (see below) of consumer-friendly displays of common shoppable services that are easily accessible and in a comprehensive machine-readable format.
1. Hospital standard charges for all items and services
This list is primarily meant for data analysts to track pricing over time, for employers to choose the best plan, and for tech innovators to create tools to help patients shop (e.g. price aggregator tools like Google Flights or Amazon). This list is more complicated, not easily readable, and includes codes that may be confusing for the general public just trying to shop.
To be compliant, this list must have a description of each item and service, and any relevant codes for billing or accounting purposes. It also must include five standard charges for each item and service (gross charge, discounted cash price, payer-specific negotiated charge, de-identified minimum and maximum negotiated charge).
2. 300 shoppable services in a consumer-friendly manner
The second requirement is a list of the hospital’s 300 shoppable services with the five standard charges to allow consumers to shop based on price and quality. Unfortunately, hospitals can avoid this consumer-friendly requirement by implementing a “cost estimator” tool which only gives an estimate, not a real price and does not include all of the five standard charges.
How Can I Shop?
Now that hospitals must show their prices, you can go to their website and look for their price list or price estimator tool. If it is not immediately obvious, you can search “cost estimator,” “price estimator,” “price transparency,” or “standard charge data” in the search bar. If you are still not populating any search results, you may also find these tools in their “patient and visitor” portions of their website.
Once you find it, search for the procedure and service you need. When you find the price, you can then compare to other hospitals in your area based on your budget. If you also prefer to use a hospital with a higher price, you can negotiate and use the lower-priced option as leverage.
What if I can’t find prices at my hospital’s website?
If a hospital does not properly post their prices, you can submit a complaint to the Department of Health and Human Services (HHS) here. You should also call the hospital, inquire about the price, and inform them that you will be reporting them to HHS for noncompliance.
Take action by clicking here.
Still want to learn more? Check out our Myths and Facts page here.
