How to Price Healthcare Services
Guides can help you contrast and compare as you would for any other commodity.
If you’re a smart consumer, you price shop for groceries, cars, appliances, and clothing. Why not healthcare?
As you pay more out of pocket through your insurance plan and costs for procedures and treatments keep skyrocketing, you should.
But it’s been hard to do that. Unlike retailers, most hospitals and health providers don’t put price tags on what they’re paid for procedures and treatments. Insurers, likewise, don’t generally tell you what those negotiated amounts are.
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If you can’t find the price, you can’t comparison shop as you would for a television. If you can’t comparison shop, you can’t help push prices down. “Getting prices out in the open is crucial to bringing prices down,” said Katherine Hempstead, senior program officer at the Robert Wood Johnson Foundation.
In addition, insurers don’t necessarily negotiate the same prices with different providers. In fact, prices for procedures can vary among providers widely, even in the same state.
Because the healthcare system has been so mysterious, so complex, Americans haven’t generally shopped prices to treat everything from cancer to bunions. But you can.
Because healthcare costs so much, “transparency” has become a buzzword and a movement. It’s also become a business strategy for healthcare providers who are drawing patients to them with clearly stated cheaper prices. The game is on, and you benefit.
Despite the pricing fog, a report by The Commonwealth Fund says that “price transparency may be spurred by the growing number of health care consumers who are being required to pay a larger share of their medical bills.”
An independent surgery center in Oklahoma City, for example, may have been the first such operation in America to publicize prices for every procedure it does – on its website.
Its CEO has reported that the surgery center has attracted patients from Canada, where the surgery it offers is essentially free but there’s a waiting list for months, and from cities across the U.S. The more this kind of “menu” is offered, the more competitive prices are getting.
It’s still up to you to do some research and compare prices, but there an increasing array of websites that help by offering price information and leading you to more sources.
There are two websites, for example, Cost Report Data and American Hospital Directory, that make it clearer and easier to understand how much it costs hospitals for each Medicaid and Medicare covered procedure that has a billing code.
Quality of care versus cost can be checked at Medicare’s HospitalCompare.hhs.gov and LeapfrogGroup.org.
The Wall Street Journal (WSJ) has a guide online that includes several healthcare pricing sites.
Also, if you’re insured, you should talk with your insurer. Some companies offer pricing tools to their customers, but keep in mind you probably won’t be able to look at healthcare providers out of their networks, and you’ll get prices in a range.
Other websites offer guides that help you understand healthcare pricing, which is often confusing.
The WSJ guide points out, “To find useful information, you’ll generally have to do some digging and check multiple sites. Each takes a different approach, and they can be confusing. Several sites, including some offered by hospital associations, use listed charges — the ‘sticker prices’ that are typically much more than insurers pay.”
It would be prudent for you to read an exhaustive report on healthcare pricing done by Time magazine’s Steven Brill. Using real cases, the report’s impact on the topic of healthcare pricing is enormous, and has created momentum that is still gaining speed.
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April 06, 2020
Janet O’Dell, RN