Hospitals now publish rates online
CHATTANOOGA, Tenn. (WDEF) — A new federal law will now make it easier for you to compare procedure costs among hospitals.
As of January 1, all hospitals must report its procedure rates online. The Trump adminstration pushed this new rule to help increase transparency in health care.
Now, you can go online and compare rates for procedures you or your loved one might need. Erlanger, CHI Memorial and Parkridge all have easily accessible spreadsheets online to see the different costs.
For example, according to CHI Memorial’s website, a knee replacement would cost around $50,000. This compares to similar procedures at Erlanger, which range from at least $61,000.
However, what you see on the website might not be what you pay.
“I think the thing for consumers to know is that they also need to talk to their insurance company. Make sure they understand their deductible, their maximum out of pocket is, because a lot of times there’s a price but insurance company’s all negotiate different prices with hospitals and with all medical providers,” Rae Bond with the Chattanooga-Hamilton County Medical Society said. “So the list price is not necessarily what something would cost.”
A statement from Erlanger says just that, citing that several factors could affect what you owe, including insurance and type of insurance.
“Keep in mind that Erlanger’s charges shown on this website are different from “cost,” “reimbursement,” or “payment.” Several factors could affect what you may owe for services at Erlanger, including whether you have insurance, the type of insurance you have, and your benefit plan. The amount collected by Erlanger almost always is less than the charges billed. Three common examples are:
1. Government programs, such as Medicare, pay hospitals much less than billed charges. These payments are determined by the government agencies and hospitals have no ability to negotiate reimbursement rates. A Medicare patient’s payment is determined by Medicare, not Erlanger charges.
2. Commercial insurers or other purchasers of healthcare services negotiate discounts with hospitals on behalf of the patients they cover. A patient’s out-of-pocket payment is based on the negotiated discounts and their individual benefit plan.
3. Erlanger has prompt payment discount policies and policies that allow self-pay patients to receive reduced-charge or charity care based on State law.”
Parkridge also released a similar statement:
“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. Parkridge has been providing pricing estimates and information about the billing process online since 2007, and we are complying with the regulation.
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.“
“The most important thing is to try to find care within your network of your insurance plan, because that’s always going to be your best health care price,” Bond said.
While the transparency is helpful, Bond wants to make sure no one is scared away from a medical procedure because of the listed price. All the area hospitals offer charity care for the uninsured. There are also other resources for low income patients.
“Transparency is a great thing, but people need to understand that just because a price is shown on a website or electronically or wherever you might find it, that that’s not necessarily what it would cost them to get a procedure done,” Bond said.