How much will a medical procedure cost you? Hospitals are now (kind of) required to tell you
A new year, a new health law. As of Jan. 1, 2019, hospitals will be required to post the cost of medical procedures online, providing patients with more transparency for the treatments they’re getting.
But here’s the problem: the prices hospitals post won’t include the costs of having a doctor look at you, and because insurance often covers some of the cost, it’s unlikely that the price you see will be the price you pay.
So how helpful will this new law be? Knowing the price of health care services could be helpful, but there are important considerations to keep in mind. Here’s what you should know.
The new law builds on an existing one requiring hospitals to disclose prices upon request.
You could have always gotten the cost of procedures by requesting them. But this can be difficult when it’s unclear who to go to for this information. The new law will make it easier for patients to find this information, and give them a clearer idea of how much they may owe in advance of receiving a bill.
The retail “cost” of a procedure probably won’t be the out-of-pocket cost.
Time spent in the operating room, anesthesia and the cost of a doctor are just a few variables that affect total costs, and they can’t be predicted ahead of time.
The list of charges, called the “Chargemaster” in the hospital industry, is an itemized accounting and coding tool that hospitals use to account for resources that are used and calculate insurance reimbursement, so it’s unclear how helpful the listed price of a procedure will be to the average patient before they see any additional charges.
“Due to differentiating factors, such as health insurance coverage, deductibles and out of pocket maximums, health care costs are simply not one-size-fits-all,” Bob Seeshausen, senior vice president of business development at Novant Health, told ABC News. “Hospital charges only reflect one bill that a patient will receive for a service. The physician charges are not represented.”
Posting the prices for hospital procedures may just end up being more confusing.
Since the price of a procedure will likely not reflect what a person pays, it can be misleading and confusing.
“The chargemaster is the equivalent of getting a full parts list for a car you purchased, down to every bolt, part and component — likely hundreds of items,” Seeshausen said. “For instance, you will not find a knee replacement on most hospital standard charge lists. Instead, you will find all the resources required for the procedure, such as [operating room] time, anesthesia, recovery room, implants, drugs, physical therapy, etc.”
People will still have to speak with their insurance companies in order to determine their out-of-pocket costs, Seeshausen said, recommending that patients “contact a financial navigator or their insurer to find out how much they will have to pay for a service.”
Dr. Saumya Dave is a resident physician of psychiatry in New York City and a member of the ABC News Medical Unit.
