This week, Gainesville’s North Texas Medical Center posted a spreadsheet of its standard prices in response to questions we’d asked about its compliance with new federal regulations.
We published two news stories regarding the price list. If you missed them, you can read them online. The takeaway is, the public now has access to the list of “sticker prices” for hospital services.
Thing is – and NTMC isn’t unique here – it may as well be written in Greek. Hospital price lists use industry lingo that healthcare experts and consumer advocates have all acknowledged is difficult for the average person to understand. Some entries, like “EMERGENCY ROOM LEVEL I,” are fairly straightforward, but many entries in the list, like “NAIL GAMMA 10X340MMX125DEG L,” do little to improve patients’ understanding of what their care might cost.
In addition, all these “sticker prices,” like the sticker price of a new car, are almost never what the consumer actually pays. They don’t account for your insurance or for discounts that may be offered to you if you’re uninsured or out of your insurance network.
So what’s the use?
Not much – yet. But with time, we believe it will promote healthy competition between healthcare facilities, and third parties like researchers and app developers will be able to use the raw data to build price-comparison tools. Elizabeth Rosenthal, editor-in-chief of Kaiser Health News (a nonprofit news service providing in-depth coverage of the healthcare industry), put it this way:
Maybe, just maybe, a hospital will think twice before charging a $6,000 “operating room fee” for a routine colonoscopy if its competitor down the street is listing its price at $1,000. Making this information public should bring list prices more in line with what is actually paid by an insurer, a far better measure of value.
And while the lists are far from user-friendly, researchers and entrepreneurs can now create apps to make it easier for patients to match procedures to their codes and crunch the numbers. With access to list prices on your phone, you could reject the $300 sling in the emergency room and instead order one for one-tenth of the price on Amazon.
In the meantime, it’s crucial that you take steps to understand how the cost of your healthcare may impact your wallet.
If you have health insurance, take the time to understand your plan. Know how much you’ll need to pay before your insurance starts paying anything (your deductible) and how much of the cost beyond that you’ll also be responsible for (your coinsurance). Learn how to look up what facilities and doctors are in your network, because that can make a big difference in the bottom line later on.
Ask for a price quote from the healthcare facility’s billing department before you have a procedure done – even in emergencies, if you are able. Make sure to get quotes from other providers involved in a procedure, like your primary care physician or specialists like anesthesiologists, whose costs are not included in a hospital’s quote. Facilities should be able to give you a list of who all would be involved in a procedure.
If you don’t have insurance, asking beforehand what a procedure will cost is especially important. It will often get you a better price than if you just wait for the bill to come: The “cash” or self-pay rate is usually lower than the sticker price and sometimes lower than the insurers’ negotiated rate, according to healthcare costs analyst Jeanne Pinder. Many providers have special “hardship” rates that are even lower, too.
You can also use online price estimator tools like Healthcare Bluebook (healthcarebluebook.com) or FAIR Health (fairhealthconsumer.org) to better understand the costs of your healthcare.
It’s a rough road for patients concerned about their health costs. It’s worth doing what you can to lessen your costs, at least until others can harness the power of hospital price lists on your behalf.