In the category of “be careful what you wish for…”
Well-meaning policy people have now created a monster. We can name this monster “Good Start,” but it’s not a very useful monster – yet.
That monster rears its ugly head in the form of the new law that became effective January 1, 2019 that requires most hospitals to make their pricing available to the public. The idea – a good one – is that there is nothing else in this world that we are required to buy or pay for where we can’t find out what the pricing is before we commit to the purchase, so why should hospitals be any different?
The result is what thousands of patients – and journalists – have discovered during the past week or so. That is, that master lists of service-by-number, codes, and prices that are indecipherable by the lay person. So what use are they?
Rather than just throw in the towel, let’s take a look to see what they are and what, at this early stage, we can really do with them.
First – how can you find pricing for the hospital you might need to use?
It’s a great question, and believe me, most hospitals have done everything they can to obscure the pricing from your peering eyes. But a little diligence and you should be able to find their list.
Here’s one way to get your hospital’s pricing:
Do a search (Google, Bing, Yahoo) with the name of your hospital, and “pricing” or “price list” or “prices”. From there you should see something that references these lists of charges, or tells how you can get an estimate. What you will probably find is what hospitals call the “Charge Master” – their document, sometimes hundreds of pages long, with lots of med-speak and pricing that means very little to us. My local hospital’s Charge Master is 143 pages of lists like you see at right. The Cleveland Clinic’s Charge Master lists 5,760 CPT codes (Current Procedural Technology) and their pricing. But nothing that lines up a CPT code with a need for services.
Now, there is almost nothing YOU can do with this list. Why? Because any one service from the hospital is actually made up of many of these charges. There might be a price for a room, but there will also be prices for the bedding, the equipment, the box of kleenex, or the numbers of gloves your doctors and nurses use… you get the picture.
Further, the Charge Master is only a starting point. Your insurance coverage (their negotiations with your hospital), co-payments and deductibles will affect what you have to pay.
And – this is only the hospital’s pricing. It’s totally unrelated to what the professionals charge – the doctors, surgeons, radiologists, surgeons, anesthesiologists… Their pricing is not at all reflected on these lists. You’ll be paying them, too.
So – what have we learned about what it will cost for a specific procedure in the hospital, or a visit to the ER? Almost nothing.
But at least you have the list, and yes, that’s a start. So – what are we supposed to do now?
I suggest you try three things:
- Call the hospital and work with them to get an estimate. Ask them for all the names of what they will charge you so you can line them up with the Charge Master. They won’t guarantee a price, of course, but it will give you an idea anyway. Then pray nothing else goes astray while you’re there.
- Call your insurer and ask them to help you estimate. Ask them to match up their reimbursements with the pricing you see. If you haven’t gotten any satisfaction from the hospital, then ask your insurer to fill in the gaps.
- Your very BEST bet, the easiest, and possibly most accurate approach, will be to connect with a professional, independent patient advocate who can do this estimating and legwork for you. It will cost you some money out of your pocket, but probably very little compared to the amount of time and grief it would cause you to try to figure it out yourself. Further, often advocates can work with you to minimize the pricing before, during, and after the care takes place. Find a comprehensive list of professional advocates here.
As I said, making the pricing available at all is only a first step. At some point I hope (expect) this will evolve to a more formal price estimation policy and THEN we’ll be making some strides for patients!