Tags: hospital pricing

Hospital Pricing Transparency Kicks Off

illustration of a medical bill with money coming out of a wallet

Jan Dubauskas By Friday, 15 January 2021 03:05 PM EST Current | Bio | Archive

On the night before a major surgery, you’re worried about the outcome of the surgery, sending prayers for the surgeon’s steady hand. And then the morning of your surgery, the focus abruptly changes. When you go to the hospital and before you are admitted, the hospital requires you to sign their paperwork stating that you will pay any charges that your insurance does not cover.

Do you hesitate before signing, wondering about the oddity of a process that requires you to sign what is essentially a blank check before you can get the healthcare you need? Most of us have been in this untenable situation.

In fact, in a recent survey from Healthinsurance.com, 35% of respondents are afraid to contract COVID-19 because of the cost of treatment. Hospital pricing transparency will give consumers a better idea of the general prices at a hospital so that they have a greater sense of comfort about the treatment they may receive.

In no other industry have prices been opaque, leaving consumers in the dark about what their out-of-pocket costs will be. Thankfully, the Centers for Medicare and Medicaid Services (CMS) addressed consumers needs for more transparency in the pricing of the services they receive in hospitals.

Starting on January 1, 2021, all hospitals are required to provide the prices of at least 300 services online so that you can know the approximate cost of treatment or services from a hospital before you receive it. The listed services will be items such as: X-rays, outpatient visits, labs and bundled services such as colonoscopies.

While bundled services will be quoted, the amount is an average that cannot take into considering factors such as how much you have already paid on your deductible or any medical emergencies you may have.

CMS designed pricing transparency to be online and easily accessible so that consumers have the opportunity to research the cost of treatment at multiple hospitals and then decide which hospital meets their needs, creating a new era of competition between hospitals.

In an attempt to stop the rule from taking effect, hospital groups argued this fall to the U.S. Court of Appeals for the D.C. Circuit Court that it would be impossible to implement pricing transparency because rates are unknowable, since some rates are negotiated and finalized after the procedure.

However, on December 29, 2020, the Circuit Court found the argument unpersuasive, as the rule only requires base rates and that allows for some variation. As such, hospital pricing transparency took effect January 1.

What remains to be seen is whether hospital pricing transparency will drive costs down. Will consumers shop the local hospitals for the best price? Will consumers choose a hospital based on lowest price alone? And what is next – doctor’s offices? Pharmacies?

Only time will tell how successful the pricing transparency program will be. Yet, one thing is sure, the night before a surgery, instead of worrying about the blank check the hospital requires before they’ll operate, now you can focus on the surgery itself; what a relief!

Jan Dubauskas is a healthcare expert, enthusiastic insurance pro, attorney and mom serving as Vice President of healthinsurance.com.

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Do you hesitate before signing, wondering about the oddity of a process that requires you to sign what is essentially a blank check before you can get the healthcare you need?
hospital pricing
Friday, 15 January 2021 03:05 PM
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