Hospitals must now post their prices online. How can consumers benefit

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You may be familiar with a common health insurance coverage question: not knowing the cost of services until after the fact.

A new price transparency rule that went into effect on 1 January is an attempt to change it.

Originally, hospitals are now required to post online in a consumer-friendly format, the rates they have negotiated with insurers for 300 general medical services.

“This information was very vague to the public,” said Nisha Kurani, a senior policy analyst at the Kaiser Family Foundation.

However, the change is not without some challenges, including lack of public awareness, Kurani said.

And whether health care can be more useful to consumers – they will pay out of pocket based on those prices – is a few years away. At that point, a recently finalized rule that takes effect in 2023 would require insurance companies to post their negotiation rates with providers, as well as the patient’s projected out-of-pocket for various services Cost also.

“Rates may be useful given the payer interaction, but generally the patient cost share is more useful,” said Kurani.

Outside of Medicare and Medicaid, there is no price regulation in the private insurance market, which includes employer-sponsored plans and which are available through the federal market (or state-based one). This means that the ultimate cost to consumers for any service can vary wildly even before considering insurance companies such as deductibles and copies.

For example, the average cost of negotiating with insurers for a low-back MRI in 2018 was $ 1,106 by large employers, compared with $ 404 in Las Vegas, according to Healthcare data by the Kaiser & Peterson Center.

In Baltimore – in a state (Maryland) where regulators set prices that hospitals can charge for services – the average cost of a patient’s admission for a complete knee or hip replacement is about $ 25,000. This compared to more than $ 55,000 in the New York area. The national average is around $ 35,300.

With the rule now in force, the idea is that consumers can shop at the best price for the service they need. Of course, they usually still have to figure out what their share will be.

Of the 300 services that should be included in consumer-friendly information, 20 are mandated by the Center for Medicare & Medicaid Services. The remaining 230 can be determined by each hospital.

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“The rule requires that the cost of the service be bundled in a way that makes sense for those services … so there is no digging around for consumers,” says the cost of a swab.

Of course, many medical services in hospitals are unplanned. Additionally, even if you are prescribing a service or procedure, you must visit the website of each hospital you wish to compare. And it is generally up to each one to display the information as long as it is consumer friendly.

“It’s not like there are many specifics on how to present it,” said Kurani.

Still, she said, pricing information can be useful if you want to make a purchase. The challenge may be to find information for any hospital.

Kurani looked at more than 100 websites last year to compare the cost of Kovid testing in various hospitals across the country.

“Some websites had information up front, others were easily accessible under their billing and insurance pages, but for others it was difficult to find and I had to dig for it,” he said.


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