Surprise, you’re in debt now! Thank you for choosing our hospital, please come again!
This statement might be satirical or even humorous, but it represents an issue that patients face every day. Hospitals fall short when it comes to transparency and pricing. Proposed rules within the Centers for Medicare and Medicaid (hereinafter CMS), are seeking an antidote to this ubiquitous issue that has been a standard of the hospital billing field for decades.
Not so transparent hospital price transparency
When a patient ends up at the hospital, it is safe to say they generally remain ignorant as to who is servicing them and what the price will be. Within these facilities, there are many out-of-network providers (e.g. out-of-network anesthesiologists or radiologist) and services being used at point of care, with the patient generally being none the wiser. That is, until they receive a bill later, with abominable charges and out-of-pocket costs they are not prepared for.
“We are just beginning on price transparency,” said Seema Verma, head of the Center for Medicare and Medicaid Services.
Hospitals are and have been required to disclose prices to the public, but not online. In the modern world, having a book of prices somewhere is nearly moot. Some would say it’s a troubleshoot to the requirement to be transparent by making this information hard to find. If the prices must be posted on the internet, that is bound to change.
“We know that hospitals have this information and we are asking them to post what they have online,” continued Seema Verma.
There are many first-hand accounts in regards to the ongoing billing process. The company vox.com collected more than 1,000 emergency room bills submitted by readers in all 50 states, in an effort to investigate billing processes. Even when patients refused service to avoid paying burdensome amounts of money, they still received bills.
This puts a spotlight on one of two things, the hospital pricing and billing process are either faulty, negligent, or downright criminal. For many patients who are unable to pay, this begins to snowball into a debt cycle that can completely derail their lifestyles.
This proposed rule under the Trump administration builds on Obama’s effort to increase transparency. These posted prices, however, may not reflect the actual amount most patients pay since insurers and the government frequently have exclusive prices for their members/beneficiaries after negotiations.
Patients — educated decision-makers
We encourage you to consult with your insurer about possible out-of-pocket costs from hospitalizations. The posted prices will be standard prices, and your insurer might have a negotiated rate or annual limits that might alter the price, regardless of a hospitals transparency.
People are being educated about their own health and charges, to become better decision-makers.
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