TRAVERSE CITY — The cost of health care is a major concern for millions across the U.S., and in a world where information readily is available at a person’s fingertips, the call for greater price transparency is increasing.
A new rule that went into effect Jan. 1 requires hospitals to post a list online of their current standard charges for items and services.
It must be in a machine readable format and updated at least annually.
The rule updates a section of the Public Health Service Act set forth by the U.S. Department of Health and Human Services’ Centers for Medicare and Medicaid Services. Enacted as part of the Affordable Care Act, it aims to improve the transparency of hospital charges.
Price lists most often are in the form of a chargemaster and contain thousands of entries with costs that vary widely hospital to hospital.
But they're not a good way to determine actual costs, hospital administration and insurance companies warn. They also advise against using the chargemaster to comparison shop.
Take an MRI of the brain with contrast: It's listed as $3,016.20 at Munson Medical Center; $2,673.50 at Kalkaska Memorial Health Center; $2,280.30 at Spectrum Health Big Rapids Hospital; or $2,083.08 at the Helen DeVos Children's Hospital
“What a patient will see online as a chargemaster price, that is not what a patient will pay out of pocket,” said Dianne Michalek, vice president of marketing and corporate communications for Munson Healthcare. “Just because a hospital charges a higher price doesn’t mean the patient will pay higher."
Figuring out what a patient will pay out of pocket requires very specific background information, regardless of if a person is insured, said Mary Southwick, a Munson Healthcare financial counselor. Financial counselors work to help patients understand their own unique circumstances.
Patients without insurance are screened for Medicaid eligibility and helped apply if they are, Southwick said. If not, financial counselors will help them apply for financial aid through the hospital, she said.
For those with insurance, the coverage can differ employer to employer and even employee to employee, said Nathan Foco, senior director of market and sales intelligence for Priority Health, the second largest carrier in Michigan.
“What we found is the complexities of your everyday average consumer’s insurance plan and the charges associated with benefits and the hospital … aren’t taken into account (with the chargemaster),” Foco said.
Prices seen on chargemasters likely aren’t even what would be billed to an insurance company, since many have negotiated rate agreements with hospital systems, Foco and Michalek said.
One of the biggest concerns with the chargemasters is that patients will look at it and delay care because they think they’ll be unable to afford treatment, Michalek said.
Jeanne Pinder, founder and CEO of www.clearhealthcosts.com, agrees that chargemasters could cause people to stall.
“Because these are chargemaster or list prices, they’re much higher than anything the insurance company or government would pay and, most likely, much higher than what an individual would pay,” she said.
On top of that, they’re full of “medical gobbledygook” that’s incomprehensible to most people, Pinder said.
For example, there’s “HIP BIL MIN 2 V” for $519.30 or “TX CARPAL/IP FX W/O MANIP/1” for $404.20.
Some are easier to interpret, like “room & care ICU” for $3,881, “biopsy of salivary gland” for $1,787, “foreign body removal nose” for $252.50, “fracture walking boot” for $196.80 or “blood draw” for $21.
Yet, a search on the Spectrum Health chargemaster for those terms finds no matches.
“It’s overwhelming,” said Levi Britton, a recent patient at Munson Medical Center, when he was shown the list. “... At the end of the day, the average American citizen isn’t going to be able to afford half this stuff.”