One of the most frustrating things for many healthcare patients is understanding how much hospital procedures will cost. Even when patients have insurance, it’s helpful to have an estimate of how much a non-emergency procedure will be, how much your insurance company will pay, how much the hospital will accept in payment, and how much the is left over for the patient to pay.
Hospitals are normally required to make their prices available – if the patient asks in advance. Most patients are too focused on their health and what might go wrong to focus on asking a hospital administrator, “How much will it cost to fix my broken arm?” or “What will be the cost for my mastectomy?”
NBC News reported that, effective January 1, 2019, hospitals will be required to post the cost of their procedures online. In addition to giving patients some idea of the likely deductible they’ll have to pay, online pricing also gives the patient a chance to shop around to find the most cost-effective care for a voluntary procedure or an essential one. Prices can vary from state to state and from hospital to hospital.
These lists may not be accurate
As with most costs in the medical arena, a price list comes with a cautionary advisory. The prices the hospital posts are equivalent to the list price for buying a car. The online price is what the hospital recommends. Often insurance companies can negotiate this price down: in part, due to the quantity of payments they make to the hospital and, in part, because insurance companies understand what hospitals are actually likely to accept.
Patients who have adequate health insurance coverage usually rely on the insurance company to negotiate a price reduction from the list price. After insurance, patients are required to pay any deductible and co-payments. Patients without insurance usually have less ability to negotiate a substantial price reduction
While some advocates believe the new online prices will help patients, other consumer advocates think the price lists will just confuse patients even more. For example, the prices don’t affect emergency room treatments. And since they’re all listed à la carte, expenses can pile up quickly.
Finding price lists for the hospitals
Let’s take a look at the pricing at St. Thomas Health, which has hospitals throughout Tennessee. If you go to their page, you’ll see “Hospital Pricing” all the way at the bottom, placed as far out of the way as possible while still complying with the law. Under the listing for Saint Thomas Rutherford Hospital in Murfreesboro, you’re presented with a list of departments, each of which has its own price list.
This is where things can get tricky. First, not all procedures are listed. Second, not all procedures are explained. For example, if you click EEG (for an electroencephalogram), you’ll see the following:
EEG AWAKE AND ASLEEP
EEG CEREBRAL DEATH
EEG EXTENDED UP TO 1 HOUR
Does this mean that if you go in for a routine EEG, but then need it extended up to one hour, that you will have to pay twice? Or are you only charged once? And how do you compare this to another hospital, like UT Medical Center, which uses CDM codes and different descriptions of procedures?
The new law is a great first step for transparency, but it’s not perfect. And it may not be helpful at all for people with catastrophic injuries after a car crash or a fire, or who are transported by ambulance to a trauma center that may not take their insurance plans.
At Delius & McKenzie, PLLC, our Sevierville personal injury lawyers routinely deal with hospitals and health providers; we understand the costs you face, both economic and non-economic. We fight to make insurance companies pay for your medical care. To schedule a free consultation, please call us at (865) 428-8780 or use our contact form. We try cases and negotiate settlements for victims who live in Sevierville, Seymour, Gatlinburg, Pigeon Forge, and throughout Tennessee.