You have the right to know hospital prices before you go

According to a federal rule it’s your right to know the cost of a hospital service before you receive it.
Published: Feb. 20, 2023 at 8:06 PM EST
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BREVARD, N.C. (FOX Carolina) - Have you ever looked at a medical bill and it was much more than you expected? It’s happened to many of us. But according to a federal rule it’s your right to know the cost of a hospital service before you receive it.

The federal rule is called hospital price transparency. Just like you compare the cost of milk or eggs you are also supposed to be able to compare the cost of your health care services from hospital to hospital.

Palma Cohen lives with multiple sclerosis. It’s a disabling neurological disease that can impact her body’s ability to move and function.

“I did the 5k in October, so that was a big achievement for me,” Cohen said.

She is able to walk well thanks to her medicine. But treating her illness is not cheap and it’s caused her to go into medical debt.

“I am probably between $20,000 and 25,000 [in debt] at this point,” Cohen said.

Every six months she is supposed to receive a brain and spinal MRI to see if her medication is working. She often delays these because they can cost more than $1,000 each and her insurance doesn’t cover them.

“Sometimes I have to make the choice to go into medical debt or not walk and that is often the choice I have to make,” Cohen said.

But there is a way she could compare the costs of an MRI. It’s thanks to the federal hospital price transparency rule. Hospitals must post pricing on a machine-readable file. And they must display the standard charges for at least 300 shoppable services. This is often done through a “price estimate tool” on the hospital’s website. Cohen looked up the price of a brain MRI at Advent Health hospital without insurance.

“It is $669,” Cohen said. “That is pretty good. I will keep this one in mind. I didn’t even know Advent Health did MRIs.”

She then looked up the price at Transylvania Regional Hospital.

“Oh, wow this one is $3,000,” Cohen said. “That is insane, the other one was $600.”

Marni Jamerson Carey is the president of the non-profit Power to the Patients. She says it’s important people are educated on how to compare these prices.

“When prices are revealed, costs will start coming down because they have to be competitive,” Carey said.

Hospitals say their price tool is simply an estimate and not guaranteed. But consumers can also look up prices on a machine-readable file. Here they can compare prices based on different insurance plans, highest/lowest cash price and more. The easiest way to find this is to search “standard charges” on a hospitals website.

“So like you shop for an uber ride or airplane tickets, or you go to find out what your house is worth on Zillow, these machine-readable aggregators will be able to put together the best place for you to shop to have your baby or have your colonoscopy,” Carey said.

But according to a non-profit report a lot of these machine-readable files don’t have the complete list of information for consumers to compare.

“The administrative law is really good, but the enforcement is really terrible,” Carey said.

Hospitals also often use different formats for the standard charges list. For example, Prisma Health lists their “standard charges” in an excel sheet. Several AI devices can read excel sheets and quickly assess or analyze the information. These would be really useful for comparing prices. But other hospitals list the standard charges in other formats.

Fox Carolina reached out to the Centers for Medicaid and Medicare Services, which enforces the hospital price transparency rule. They say to date they have issued 437 warning notices to hospitals across the country that were not in compliance with price transparency. The hospitals are given a certain amount of time to fix the non-compliance issues or they will be fined. So far two hospitals in Georgia have received fines.

CMS would not disclose which hospitals were given warning notices saying this “prematurely could identify hospitals that have already taken corrective actions and come into compliance after issuance of the warning letter.”

“The two hospitals that did get fined, they instantly became compliant and now they have exploratory files,” Carey said.

But Carey says without people knowing their rights and comparing prices, the economics of the healthcare market will not change.

“I think it is just insane that there is that much difference between two hospitals that are so close,” Cohen said. “I think it is very helpful to see where you can go get an MRI for less money.”

If you think a hospital in your area is not compliant with the hospital price transparency rule you can submit a complaint to CMS.