Hospitals now have to follow the rules set by the Centers for Medicare & Medicaid Services (CMS) and post their standard charges for at least 300 services.
We’re talking about everything from X-rays and colonoscopies to outpatient imaging tests and lab work visits.
This post is a part of our 30 Days of US Healthcare series. You can watch all the videos in this series on YouTube and learn more about the content behind the videos here.
HOSPITAL PRICE TRANSPARENCY SOUNDS AWESOME! 👏
It really does. So, let’s dig into this healthcare transparency law.
The idea is simple. When hospitals share their prices online, we’re in control. We can compare prices and find a hospital that suits our needs and budget.
IF I HAVE AN EMERGENCY, I CAN’T SHOP AROUND.
No, you can’t. And there are other situations where shopping around for healthcare is tough. Like when you don’t have access to multiple medical providers, you’re too sick to do research, you lack transportation to get to another provider, or you need more time or resources to shop around.
SOUNDS LIKE IT’S NOT ALL IT’S CRACKED UP TO BE. 🤔
Well, it’s definitely an essential step toward fighting back. Now, hospitals can’t surprise us with huge bills, and at least we can see what they’re charging for some standard procedures. Plus, this requirement puts pressure on hospitals to set reasonable prices for these standard services.
BUT WHY ISN’T THERE MORE TRANSPARENCY?
Health insurers tell us that they negotiate super secret prices with hospitals to help us. We are told it’s a perk. But those negotiations happen behind closed doors, and the interests of insurance companies and hospitals often take precedence over those of patients like us. Without transparency, we have no idea how these negotiations between healthcare giants affect our costs.
Sometimes, we are paying more than the cash price for a medical service or prescription when we run it through our insurance!
Yes, this happens. A lot. 😳
Why? Because hospitals and insurance companies both make more money when they secretly set their prices higher.
Insurance companies lose money when we have high deductible plans, and we pay a lesser cash price by not running the medical service or prescription through our insurance. They also make less money when we shop around for the lowest price.
Transparency in pricing is not in the best interest of insurance companies.
OOO, I CAN USE THIS LAW TO LEARN THE PRICE I WOULD PAY WITH DIFFERENT INSURANCE PLANS. THAT’S COOL.
That’s what I thought, too! But hospitals are being sneaky with some loopholes. For example, a local hospital requires me to provide my insurance policy number BEFORE telling me the price. So, while they’re technically being transparent about the price I’ll pay, I can’t compare prices across insurance providers. Clever. 🙄
SO IS THERE ANY GOOD NEWS?
Yes, people are scraping the healthcare transparency data and creating tools to help us navigate healthcare prices.
✅ The Center for Medicare Services (CMS) has a provider comparison site where you can find healthcare providers in your area with quality ratings. This can be a helpful starting point to learn what providers are in your region and assess their quality.
✅ Marshall Allen, the author of Never Pay the First Bill: And Other Ways to Fight the Heal Care System and Win, has shared a bunch of resources for checking prices. One of them is Billy, an app that allows you to enter your medical procedure and zip code and see the prices that providers have negotiated with insurance companies and the cash prices. You can do a few searches for free each month or pay a fee for unlimited searching. And on top of prices, the app also includes the CMS quality rating.