For most major purchases that we make, we pay close attention to price and services.
But, when was the last time you asked the price of a surgery? When was the last time you shopped prices?
Insured patients go in for procedures and services without any real concept of costs, and hospitals have not been required to disclose pricing for certain services in advance.
A new Centers for Medicare and Medicaid Services (CMS) rule for hospital pricing took effect on Jan. 1 that could affect the insurance plans and the hospitals you choose. The Trump administration rule requires hospitals to disclose pricing for a range of services and update the price list annually in a bid to normalize health care pricing, according to Health Affairs. This rule clarified a segment of President Obama’s Affordable Care Act that required hospitals to publish certain price information, but the ACA-compliant disclosures were widely seen as inadequate for health care consumers.
According to National Public Radio, the final rule requires facilities to post pricing — including reimbursement rates negotiated with insurance companies — for every service, drug and supply they provide. Under a separate rule, health insurers must take similar steps in 2022. Advocates for the new rules hope that the changes will allow consumers to see the huge price variations between health care providers and more accurately estimate their out-of-pocket costs before receiving services.
How much do prices really vary? According to Crain’s Chicago Business, insurers pay an average of 32 percent more for hip replacement surgery at Northwestern Memorial Hospital in Streeterville, Ill. than they pay for the same procedure at Amita Health St. Joseph Hospital, just three miles away in Lakeview. Prices differ between facilities and insurers. At Northwestern, Health Alliance insurance plans pay $53,236 for a hip replacement while Blue Cross & Blue Shield plans pays only $30,382.
Suppose you have a 10 percent copay — you will owe $5,323.50 at Northwestern if you have a Health Alliance plan. But if you go to another hospital where the cost is $30,000 to your insurer, your 10 percent copay would only be $3,000. It may pay to shop around.