A new federal law requires all U.S. hospitals to post a complete price list of their services online.
The rule was created by the Centers for Medicare and Medicaid Services and aims for more transparency for patients.
Prices for all medical procedures of the local hospitals including Advent Health Central Texas in Killeen, Seton Medical Center in Harker Heights and Baylor Scott & White Medical Center in Temple can now be found on their websites.
Copperas Cove resident Nadja Gerst was happy about the new development.
“I think it’s a great idea,” she said. “It just gives you the opportunity to research when you come home from the ER … to know what kind of medical bill you can expect.”
She was also planning to do her calculations before a scheduled doctor’s appointment.
“If I have an appointment I can actually look it up upfront to see what my bill might be and not just be surprised by it when it arrives in the mail,” she said. “You can already start putting money to the side if you know what to expect.”
However, critics across the country are saying the price lists can be confusing, hard to read and hard to find.
A list of the costs of medical services on a downloadable spreadsheet made up of thousands of lines of data labeled under medical billing codes can be confusing for someone outside the health care industry, according to a report in the Post-Crescent in Appleton, Wisconsin.
“It shows a level of transparency, but it’s not all that useful,” Brian Potter, senior vice president of finance and chief operating officer for the Wisconsin Hospital Association said.
“We don’t think it adds much value to the consumer by looking at some kind of a spreadsheet with a bunch of codes and costs,” Potter said. “First of all, you’d have to understand what those codes meant, and second of all, you have to know how those codes apply.”
Advent Health Central Texas, formerly known as Metroplex Hospital in Killeen, released the following statement on the issue.
“At Advent Health, we have readily complied with the Center for Medicaid and Medicare Services recent requirement to publicly provide cost estimates for patients to assist them in making informed decisions about health care costs prior to receiving care. Our estimates are based on the patients’ insurance coverage and the typical care experience for patients receiving similar services in our market from the same provider. We believe consumers should be equipped with personalized and accurate estimates. Because every individual is unique, broadly comparing prices for health care services without taking into account a person’s condition, their insurance and other factors can give consumers an inaccurate reflection of what their true out of pocket costs may be.”
Baylor Scott & White Health spoke out their support of the new rule in a prepared statement.
“We believe that pricing transparency needs to be meaningful for patients seeking information about actual out-of-pocket costs, and our organization has made significant investments over the past five years to implement technology and processes to help patients get the information they need to make decisions about their care.”
The hospital provides an automated price estimation tool on their website BSWHealth.com, including hospital prices, contract terms and rates to give patients a reliable source for their final bill.
However, the new law doesn’t come without problems. While some patients are happy to be able to research the final costs of their medical treatments beforehand, the complete price list can also be confusing.
It is especially difficult to calculate an exact price when a single doctor’s or emergency room visit contains different components. The patient would have to know the exact performed tests, dispensed medicine, individual physician’s charges and facility fees.
But most patients, who have insurance and don’t see a doctor out of their network, usually do not pay full charges. The actual price to pay depends on the annual deductible and other details of the individual insurance plan.
Seton Medical Center addressed this problem in an official statement:
“While we support greater transparency around hospital pricing, billing for medical services is a complex issue and the information hospitals are required to post provides only a snapshot of a much larger picture. We urge patients to use the information as a starting point for determining their financial responsibility.”
Prices listed on the hospitals’ websites do not include any discounts negotiated by insurance companies or self-paying patients.
“In most cases, the patient’s financial responsibility for these services is much lower than the posted price,” the statement said.
Although the new law is controversial, all local hospitals followed the new rule and posted their complete price charts on their websites.
While the price sheets are designed to create more transparency, patients are still urged to talk to their insurance companies or a hospital billing expert to find out about a more accurate price for their expected treatment.
Patients concerned about their potential out-of-pocket costs from a hospitalization would still be advised to consult with their insurer. Most insurance plans nowadays have an annual limit on how much patients must pay in copays and deductibles — although traditional Medicare does not, according to an Associated Press report.