LEWISTON — Thanks to new federal rules, Mainers can now find the price of a hospital visit with a click.
However, experts warn that the new costs posted online amount to sticker prices. Patients’ circumstances vary – including whether they have insurance coverage – so the actual cost may be different from the list price.
The federal Centers for Medicare & Medicaid Services began requiring hospitals to post prices Jan. 1. The postings must be easy to download and read, and they must include current charges for every service and item provided by the hospital, including medications.
Hospitals that do not follow through are at risk of being penalized by CMS, which oversees Medicare and other federal health insurance programs.
Maine hospitals began posting charges on their websites this week.
Some price sheets are easier to find than others. They typically are available by going to the hospital’s website, clicking on “patient information” or “billing information” and finding “billing price estimates” or “pricing transparency” among the options.
Some price sheets are also easier to understand than others. With tens of thousands of items to list, hospitals abbreviate many procedures or medications, leading to listings such as the $1,191 “manip knee jnt w/anes, bilat” – a bilateral manipulation of knee joint with anesthesia – at Northern Light Eastern Maine Medical Center in Bangor.
“In the coming weeks, we plan to refine and simplify this information even further for our patients as we strongly believe health care should be accessible and straightforward,” Northern Light Health spokeswoman Rebecca Parent said of the hospital’s price sheet.
While hospitals must post their charge lists, CMS is encouraging them to add extra data, such as quality information and additional pricing information. Some Maine hospital leaders say they will post more.
“We fully support being transparent and empowering potential patients to make well-informed decisions about their health care,” said Steven Jorgensen, president of St. Mary’s Regional Medical Center in Lewiston. “We’ve posted hospital, procedure and pharmacy prices. In addition, to make this data more comprehensive yet still consumer-friendly, we expect to post bundle prices for a variety of standard procedures soon.”
This is the first time hospitals have been required to publicly post their full charge sheets online. However, Maine hospitals have been required by state law to provide some information to patients on request, and have been required for years to send some cost information to the Maine Health Data Organization for its price comparison website, www.comparemaine.org.
Ann Woloson, executive director of Consumers for Affordable Health Care in Augusta, said she likes pointing patients to the CompareMaine site, but she believes this new comprehensive, hospital-by-hospital listing will be helpful, too.
“Any transparency with health care costs, especially hospital costs, is very important to Maine consumers who are paying more out of pocket for the health care they need,” she said. “Any information they can gain that reflects what their bottom line is going to be is obviously important.”
She cautioned, though, that a hospital’s list price may not reveal the full cost for a procedure. An anesthesiologist’s fee, for example, may be additional.
“It’s probably helpful to do a little bit more work,” she said. “Don’t just think that if you’re going to get a knee operation at some hospital that that price truly reflects all of the costs associated with it.”
At the same time, experts cautioned that hospitals are listing their sticker prices – the amount they charge to people who are uninsured or earn too much to qualify for charity care. The average patient typically pays a lot less after insurer-negotiated discounts and insurance coverage.
“Many patients are interested in their exposure to costs, which generally requires a conversation with their insurance company since that is who sets deductibles and co-pays and can provide patients the most up-to-date info on those cost factors,” said Jeff Austin, spokesman for the Maine Hospital Association. “We encourage patients to speak to their providers and their carriers to get an estimate of costs.”
To make sure potential patients do not get scared by that list price, hospital officials encourage people to call their hospital’s billing department or other patient services department for more information about the listed procedures and their actual costs.
Lindsay Tice can be contacted at:
ltice@sunjournal.com
Send questions/comments to the editors.
