Patient Struggles to Access Hospital Prices: Here’s Your Right to Know

Patient Struggles to Access Hospital Prices: Here’s Your Right to Know

GREENVILLE, S.C.

Patient Cristy Gupton’s struggle to find hospital prices for her husband’s pelvic MRI highlights ongoing problems with price transparency in American healthcare. Even though federal laws now require hospitals to provide this information, a breakdown in compliance and execution appears to be common, raising concerns about the system’s current state.

Gupton’s Quest for Price Transparency

Knowing to shop around for the best deals, Gupton aimed for the same approach when her husband was referred to the Mission Hospital Mcdowell in Marion, NC. Given their high-deductible insurance plan, Gupton aimed to find out whether the cash price or the insurance-negotiated price would be cheaper. After all, the price differences can be significant, potentially saving thousands on healthcare costs.

Lack of Compliance with Price Transparency Rules

According to federal law, since 2021, hospitals are required to post their prices in both a machine-readable and consumer-friendly format. However, Gupton found that only the cash rate was listed, without reference to any negotiated rates with insurance companies such as Aetna, Blue Cross Blue Shield, Cigna, among others.

She is not alone in her experience. The Patient Rights Advocate group found approximately 40 hospitals in North and South Carolina currently not in compliance with hospital price transparency.

The Potential of Complete Price Transparency

A complete list of prices would allow various stakeholders, including technology companies, to develop tools that simplify the process of comparing prices. These tools could potentially fuel competition and drive prices down as consumers opt for the best value for money.

The Patient Rights Advocate Founder, Cynthia Fisher, argues “People want to know, what am I going to get in healthcare and what is it going to cost me. Nobody wants to be surprised.”

Price Estimator Tools: A Partial Solution

Price estimator tools can help patients identify potential costs by factoring in their insurance provider, plan, and deductible. It can estimate additional potential charges known as CPT codes, which may cover medication or overnight stays.

However, these tools still have a significant shortcoming—they do not display the prices other patients or insurance companies negotiated. This opacity prevents patients and companies from knowing whether they are truly getting the best care at the best possible price.

Finding the Best Price: The Power of Shopping Around

Gupton found a better deal closer to home at UNC Health Blue Ridge. Compared to the prices at McDowell, Blue Ridge’s cash price was approximately $3,000 less. Moreover, their negotiated rate with Blue Cross Blue Shield revealed a cost of $1040, cheaper than McDowell’s cash price. Consequently, Gupton questioned the original referral as the procedure was available at a lower cost within her town.

Ultimately, Gupton’s experience underscores the importance of asking the right questions and seeking as much information as possible to ensure access to affordable medical care.

Improving Future Healthcare Pricing Transparency

This situation indicates the need for improvement in how hospitals comply with price transparency laws and how much easier it should be for patients to shop around for their medical care. While savvy individuals like Gupton may navigate this process, others may struggle and be confronted with unexpected healthcare bills.

As Fisher duly emphasizes, “When patients and employers and unions all purchase insurance coverage to help with costs, when we can see this, we know whether we are getting the best care at the best price.” For patients, the fight for complete price transparency in hospitals remains ongoing, with the hopes that the system will evolve to become as easy as finding the best prices on everyday items.