Hospital tool aims to end pricing surprises

Cost comparisons have been hard to come by

By: Ken Alitucker
USA Today

..... The day before she underwent surgery to remove an ovary, Laurie Cook drove to a Nashville hospital for a written estimate of how much the operation would cost.
..... She'd already paid the $783 surgeon's fee. But she needed to know what the hospital would bill for the operating room, nurses, medications, lab tests and more. She felt with a written estimate: $5,535.
..... Her insurance plan required $12,000 out of pocket before her coverage kicked in. she and her husband determined they could fit the surgery into their household budget using a payment plan.
..... The following day, the operation was completed without complications. She was home within a few hours. weeks later, she received the hospital's bill: $61,314.
..... Cook knew hearth care pricing is notoriously mysterious, but she was astonished to get a bill more than 11 times the estimate. She asked the hospital to audit the bill and explain, but they haven't given her a breakdown.
..... It's an astronomical charge," Cook said. "And it;s just not fair."
.....A federal law that went into effect in 2021 is supposed to prevent surprise charges like those Cook experienced. The price transparency law requires that horsetails post cash prices and rates negotiated with health insurers for a broad list of procedures. One hundred million Americans are in medical debt.
..... But price comparisons have been hard to come by - until now. This week, [12/07/2023] the Patient Rights Advocate released its Hospital Price Files Finder: a free, searchable database that compiles pricing data from nearly 6,000 U.S. hospitals.
..... PRA officials said the toll fulfills a necessity, letting people compare prices and save on medical procedures and services. Cynthia Fisher, founder and chair of PRA, said the data is incomplete because as of July, [2023] just 36% of the nation's 2,000 largest hospitals have fully complied with the federal price transparency law. She hopes the PRA database convinces the department of Health and Human Services it's time to "expedite enforcement" of the law.
..... "Every day that prices are withheld from consumers, Americans are harmed by overcharges, unexpected bills and unwarranted debt collection," Fisher wrote Monday [12/11/2023] to Health and Human Services Secretary Xavier Becerra.
..... Had such a database been available to Cook, she would have used it to compare prices, she said - like shopping for a car with the Kelly Blue Book.
..... Instead, she's fought the charges as the hospital hired a collection agency to get nearly $8,800 from her. She also received a separate, surprise $2,700 bill from a anesthesiologist.
..... Bill collectors "blow up my phone daily," Cook said, when she's teaching school and at home. She's always paid her bills on chime and earned a lifetime of good credit before the surgery.
..... "People want to be responsible," she said. "they should have the ability to do so."
..... Several health insurance companies have introduced price-lookup tools for their customers. These tools often include information about out-of-pocket requirements, deductibles, copays and coinsurance, tailored to an individual's plan and network.
..... But these tools typically list average costs, not the actual billed amount, according to a paper in Health Affairs. consumers and employers that purchase healthcare have little use for estimates, the authors argue.
..... Ge Bai, a Johns Hopkins University professor of accounting and health policy and management, said price transparency has tremendous potential for patients and employers seeking to keep spiraling health costs under control. But she also says that people need better incentives to seek lower-cost services.
.... In a recent study, Bai found that in nearly half of cases, hospitals charged patients who paid cash less than those who used insurance, In other words, consumers with high-deductible plans would have a lower bill if they paid in cash rather than using their insurance.
..... But consumers and employers would know this only is they shopped around and asked for prices. And people might not be willing to do that unless they know they have a financial incentive to do so, Bai said.
..... "We engage in comparison shopping only when the financial benefit directly flows to our own wallets," Bai said.
..... Some state insurance plans are beginning to sue price information when making coverage decisions. The California Public employees Retirement System has directed retirees and their families to lower-cost surgeons for joint replacements and outpatient operations. Montana's state employee plan administrators demanded better rates when they discovered hospitals charged them up to five times as much as they charged Medicare.
..... Consultants predict employers and other health care purchasers will use the hospital pricing tool from PRA or something like it to scrutinize medical charges and insurance claims.
..... Stephen Carabba, president of Claim Information, which analyzes insurance claims on behalf of unions companies, states and local governments, said the PRA toll could be a boon. It "will help us more easily track and fight waste, fraud and abuse that makes coverage and care unaffordable for employers and their members," he said.
.... Suzeette Sontag learned to shop for medical prices when her adult son slipped off the tailgate of a truck and injured his knee a few years ago.
..... He need an MRI to find out the extent of his knee injury. Because her son was uninsured, Sontatg, who lives in Wisconsin, suggested he call several hospitals and clinics to find out how much they would charge.
..... Her son phoned eight hospitals and clinics and received prices from four of them. The prices ranted from $499 to $7,000, Sontag said. He went to the least expensive imaging clinic, located in the Minneapolis-St. Paul region, and paid $499 for the MRI. which included a radiologist's review of the image.
..... Sontag said she was "just floored" by the price difference.
..... Since that experience with her son, she has tried to find out prices for medical services - with mixed success.
..... Sontag said paying for health care has been challenging because she and her husband are farmers. They have to buy their own health insurance.
..... She also trains and boards horses. she lists her training and boarding prices on a website so customers aren't surprised. Some seek out more inexpensive places. Others don;t mind paying more because they're seeking fancier stalls with more amenities.
..... She said she would like to see hospitals, doctors, and labs be just as transparent about the prices they charge.

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