Floyd Medical Center, Redmond Regional Medical Center and other local hospitals now have their full-price charges for all hospital services listed on their website as part of a new federal rule in effect today. The idea behind the mandate is to introduce price transparency for patients/consumers, but the price lists may bring more confusion than clarity.
According to a report in the AJC, hospital pricing isn’t a menu where everybody pays the same amount. “It’s more like an insanely complex version of airline pricing where one passenger pays $200 for pre-booked aisle seat in coach, while the person sitting in middle seat may pay $750 to travel the same route. The new federal rule requires hospitals to publish their ‘chargemaster’ prices. That’s the ‘list-price’ charge that almost nobody actually pays. Government health care plans, such as Medicare and Medicaid, ignore the list prices and decide on their own what they will pay for care. Every private insurance plan negotiates with hospitals to agree on prices that can vary greatly from one health system to the next.”
Floyd Medical Center, as well as its affiliates Floyd Polk Medical Center and Floyd Cherokee Medical Center, along with Redmond and Cartersville Medical Center, had their chargemaster prices listed online on Monday. Gordon Hospital did not yet have prices listed.
A look at the lists shows that few consumers will be able to use them to find out how much an emergency room visit or gallbladder surgery costs and use that information to comparison shop. There are thousands of items listed with little to no descriptions that consumers would understand. Floyd Medical Center’s list is alphabetical by service, but there are multiple listings for each one. For example, a search of MRI scan of the pelvis shows 15 different listings ranging in price from $1,530 to $3,380, some with contrast and some without, plus that cost doesn’t include the physician charges to review the scan.
“There are several components that determine your total out-of-pocket cost for your health care, these include, among other factors, whether you have insurance, the type of coverage you have, whether you have secondary or supplemental insurance, whether the care being provided is covered by your insurance and whether the service was authorized by your insurance carrier. Also, there may be unforeseen costs related to your care, such as medical complications, additional services that were performed that were unknown at the time of the service, or any special accommodations or considerations that were necessary,” says Daniel Bevels, Public Relations manager at Floyd.
“The chargemaster amounts listed on our websites are the amounts billed to an insurance company, Medicare, or Medicaid. Those insurers and government payors then apply their contracted reimbursement rates to the services that are billed. Patients who do not have insurance may qualify for a financial assistance. A better, more reliable way to compare pricing is to call the hospital for an estimate. Once you supply information about your insurance coverage and the procedure or service your physician is recommending, the hospital representative will be able to estimate how much your insurance will cover, your copay amount and whether you qualify for financial assistance.”
Redmond’s detailed price list is a little more confusing that Floyd’s in that it is a downloadable Excel spreadsheet with a list of charges that are not alphabetized. The services are probably listed by codes, but the consumer would not understand those and have a harder time finding specific charges. However, in addition to the price list, Redmond also lists an ‘average procedure price report’ for various services. That report shows that the ‘average charge per case’ for a carotid artery stent procedure is $85,940.68, but the ‘average Medicare payment per case’ for same procedure is only $15,892.18.
“We have been focused on pricing transparency for many years because we believe it’s important for patients to be able to make informed choices about their healthcare and understand their financial obligations. Redmond Regional Medical Center has been providing pricing estimates and information about the billing process online since 2007, and we are complying with the regulation,” says Andrea Pitts, Marketing and Public Relations director at Redmond.
“The amount patients actually pay for hospital services has more to do with the type of insurance coverage they have than amounts on the chargemaster. Government programs like Medicare and Medicaid determine how much they reimburse hospitals, and insurance plans negotiate rates. Uninsured patients are eligible for free care through our charity care program or they receive our uninsured discounts, which are similar to the discounts a private insurance plan gets. In 2017, we expanded our discounts to help more patients, including those who are uninsured or underinsured, who may have trouble paying for hospital services by capping bills for eligible patients who earn up to 400 percent of the Federal Poverty Level.”
Here is a quick link to local hospital’s price lists:
Floyd Medical Center: Chargemaster
Cartersville Medical Center: Chargemaster
Gordon Hospital: Estimate out-of-pocket charges
Polk Medical Center: Chargemaster