When hospitals say you should “avoid” looking at how much services cost…

Note: This is Part 1 of a 3-Part transparency series.

As we’ve pointed out, time and again, Americans shouldn’t have to find out, AFTER the fact, how much something will cost.  Like giving an airline your credit card and waiting until you land at your destination before finding out how much the plane ticket cost!

Worse still, finding out that they charged somebody else HALF as much for booking the same seat at the same time!  Or, how about if you were part of their “Frequent Flyer” program, only to find out that they charge NON-members 1/9th as much.  All that sounds pretty far-fetched?  Total hyperbole?   Not according to OUR research and not according to a story published Aug. 22, 2021 in the New York Times.

Nothing to see here!

How did they find out?  Espionage?  Computer hackers?  Aliens?  No, but what’s even MORE far-fetched is, this information is being revealed because of a bi-partisan action started under President Trump and defended/advanced under President Biden.  I know, I was amazed too.  It’s called “Hospital Price Transparency” and the hospitals (and their trade associations) do NOT LIKE IT, not one little bit.  In fact, AHA spokesperson Molly Smith said of these price lists, we should all just “set them aside and avoid them.”

What happened a few years ago, under Trump, was that CMS (the Centers for Medicare and Medicaid Services) ordered hospitals to publish, in an easy to access place, and usable format, a list of their most common 300 procedures and what their negotiated rate is from each major insurance company (and for the uninsured).  Hospitals sued to keep the information secret.  They lost.  Hospitals appealed and lost again.  So, starting January 1st of 2021, they were required to publish the information.  Right now, the “per-day” penalties for refusing are low and are being waived.  But CMS has advised hospitals that the fines will go WAY up, and be enforced, before much longer. 

Well hell, anybody with half a brain would know that huge companies, like Blue Cross/Blue Shield, Cigna and Aetna must SURELY have negotiated the best rates they could, right?  I mean, NO WAY it would cost more when the patient is covered by “Blue” than for some uninsured person.  Right????  Well, actually, I’ve found quite a few times where that *IS* the case, and so did the researchers for the NYT.

One NYT example was for a pregnancy test.  If you are paying out of your own pocket, the Hospital of the University of Pennsylvania wants $10.  Not bad right?  Amazon and Walgreens EACH sell those over the counter for $10, so the UofP is actually charging the same as other (much larger) resellers.  Oh, but wait!  What if UofP finds out that YOU HAVE Blue Cross of Pennsylvania?  Well, your price just about DOUBLED!  That will be $18 madam! 

You DID say Blue Cross of Pennsylvania, right?  Not New Jersey (7 miles away)?  Because if you’re a member of a BC HMO from New Jersey, well, they’re gonna need to charge you THREE TIMES more!  That will be $58 please, and let that be a lesson to you about living in New Jersey.  Wait a second, you stammer, “I didn’t mean Blue Cross HMO, I’m paying extra to have PPO coverage, that must change the price, right?”  Oh, yes ma’am, that DOES make a difference.  We’re going to raise your charge to $93!  NINE TIMES MORE THAN IF YOU WERE UNINSURED (or had swung-by the Walgreens that is 2.1 miles from the hospital.)  You have insurance and they are gonna pay!  (and you and your employer are going to pay, every month, in the form of your “premiums”).

So, what are you supposed to do?

I mean, the nice lady from AHA said you shouldn’t look at how much things cost (surprises are so much more fun), and hey, you’re made of money.  You’re the kind of person who goes into a restaurant and hands the waiter your wallet and says “Bring us dinner and take as much cash out as you like.”  (must be nice)

Or, maybe you’re a bit more savvy.  If your visit is “non-emergent” (you didn’t arrive in a helicopter/ambulance, about to die), then do what you do for EVERY OTHER PURCHASE you make, whether it’s a car or headphones, check around, look for the same/similar item at nearby vendors.  ***READ THE REVIEWS*** (yes, doctors and hospitals get reviewed by some sites and they get “star-ratings” from CMS).  THINK about what you’re buying.  If it’s a pregnancy test, ask yourself if that should just be something you do in the privacy of your home or with your personal doctor, instead of in a hospital.  If it’s a procedure like a knee replacement or other “ambulatory” procedure (something you can schedule at least a day in advance), then DO some homework.  Jeez, it’s your knee!  Do at least as much research as if you’re buying a cell-phone charger.

Join us for more on this topic.  It *IS* big and can be complicated, but we can help you cut thru the fog, especially if you are an employer who is responsible for the cost of your employees’ healthcare.  Or, you know, just go ahead and pay NINE times as much.

3 thoughts on “When hospitals say you should “avoid” looking at how much services cost…”

  1. Nice read, Daniel. I love it when I go to a clinic or hospital in Hermosillo, Son., MX. The have the prices posted for different procedures. Would be great to have that here.

    1. Totally agree. At the very least, a doctor’s office could publish the range and average, which is sort of what CMS is trying to force hospitals to do. I understand that not everything is as simple as drug-store pregnancy test, but some things are.

      Another reason it is (or seems so) hard is the variability due to what type of insurance coverage you have (and have you met your deductibles, etc). Still, this is a good start and we (consumers) need to keep pushing this forward!

  2. Author Update:
    Updating our database of these price-transparency files for the Las Vegas area and thought I’d check that 81025 code.

    While you may have thought the example cited (above) by the NYT for a pregnancy test (varying from $10 to $93) was bad, it’s actually worse at a hospital in Las Vegas. While they ding the uninsured $93 (for that $10 test), they hit First Health members for a whopping $161. However, the folks at Anthem BCBS have negotiated an excellent rate of only $5 (that’s a very good price!)

    While they have one payer they charge as much as $183, their actual “gross charge” for this “pee stick” is $233, which actually is kinda gross.

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