FIRST REPORT: Local hospital prices are about to go public
There are several layers to understanding a hospital bill. There’s the full list price. Then there’s the discount off the list price that each insurer negotiates for. Then the bill is divided into the portion that the insurer pays and the portion of the bill the patient pays.
Scott McGohan, CEO of McGohan Brabener said its hard for employers — major health care payers — to get transparent information and his insurance brokerage is often prohibited by contract from sharing information about what different plans actually pay.
Posting the price list online is a start toward a more transparent system, he said
“I’m not sure its going to help the commercial market initially, but now we can’t get any information, so it’s a step in the right direction,” McGohan said.
The full price lists, known as chargemasters, were what the Trump administration required hospitals to post.
Area hospitals have complied with the new law. The Dayton Daily News examined the price lists at the area’s two largest hospital systems — Premier Health and Kettering Health Network.
The full charge lists for Premier Health hospitals can be found by going to the hospital's Pricing tab, clinking on the "average charges" page for any of the hospitals and then clicking through at the top to download the charge list CSV file.
Next to the download link, the hospital states that the charge list “is not a helpful tool for patients to comparison shop between hospitals or to estimate what health care services are going to cost them out of their own pocket.”
Premier said in a statement that “we have not seen much interest from patients as it pertains to the list of charges. We have had patient requests regarding how much their care is going to cost them out-of-pocket. Since the final bill a patient receives is almost never the same amount as the ‘retail charge,’ we encourage patients to obtain more accurate price estimates by contacting Premier Health’s Price Line at (937) 499-7364.”
To find Kettering Health's charge list, go to their Patient Pricing tab online, and patients can click to download either the standard charge file or diagnostic related group charge file.
For the standard charges, the hospital lists the price for each procedure code but doesn’t say what each procedure code stands for.
MORE: Some local hospitals charge triple what Medicare pays
For example, at Soin Medical Center the full price for procedure code 12100005 is listed as $7,263 and the full price for a 40400014 is $14,037.
Seema Verma, Centers for Medicare & Medicaid Services administrator, which created the price rule, wrote editorials urging patients to monitor hospitals to see whether they could find the hospital prices and had encouraged patients to tweet their findings using #wherestheprice.
“We are just beginning on price transparency,” Verma previously said.
Kettering Health Network said in a statement that the hospital “has provided a detailed charge master in compliance with the Centers for Medicare and Medicaid Services (CMS) requirements.”
“In addition, we implemented a more comprehensive and understandable price estimation tool which is available online at our website. This tool helps our patients understand their out-of-pocket costs before receiving care. This tool is available at www.ketteringhealth.org under the ‘Billing’ tab,” the health network stated.
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