Area Hospitals Now List Prices Online
A new regulation that requires hospitals to post charges online is a good first step toward pricing transparency, but challenges remain to ensure patients can predict their out-of-pocket expenses, patient advocates, hospital and insurance officials say. Geisinger Health System, Commonwealth Health System and Wayne Memorial Hospital met the Jan. 1 deadline set by the Center for Medicare and Medicaid Services to post their prices for every procedure, known as the “charge master price,” online. That’s a significant breakthrough, particularly for people without medical insurance, who can now comparison shop to find the best rate, said Dr. Kevin Kavanagh, executive director of Healthwatch USA, a patient advocacy group based in Kentucky. “If you don’t have insurance, what you pay is based on the charge master price,” Kavanagh said. “They will give you a ... discount off that price. ... Obviously the lower the price you have, the more the discount.” Health care and insurance officials caution that, for people with insurance, the charge master price likely will not reflect their true out-of-pocket cost, which is based on a complex set of factors insurance companies consider in negotiating the rates they pay to each hospital. “It is a difficult issue for patients and providers because hospitals are paid different amounts by different payers and because hospitals can’t know in advance the exact cost of care — especially for complex cases,” said Renita Fennick, spokeswoman for Commonwealth Health System. Kevin Brennan, vice president of provider contracting for Highmark Blue Shield, said there also could be costs for other services that will vary from patient to patient. It’s difficult for hospital officials to say before a procedure what other variables will affect cost. “The level of complexity makes it difficult and challenging but it is important to recognize what the costs of services are and you should have some knowledge and some way to compare,” Brennan said. Pennsylvania Insurance Commissioner Jessica Altman said health systems’ efforts to increase transparency are beneficial to the consumer. She said it’s important for patients to recognize, however, that the charge listed by a health system is not the same as the negotiated cost between a patient and his or her insurer. “Consumers who are exploring these charges should continue to ask questions, including checking with their insurance plan to determine the cost based on their coverage,” Altman said. Kavanagh said the charge master price still provides useful information to insured patients because it gives them a baseline for what their insurance company may pay, which impacts their share of the cost. The online tools are not perfect, however. A review of charges posted online by Geisinger, Commonwealth Health and Wayne Memorial shows the hospitals use a different format for posting the data, which makes it difficult to compare procedures among the hospitals. For instance, Wayne Memorial’s price list, posted in portable document format, or PDF, includes a description of the procedure and the procedure code — a universal number attached to all medical procedures. Geisinger’s list, which also is in PDF format, includes a more detailed description of each procedure, but does not list the procedure code. Knowing the procedure code is important because there are often highly technical differences between procedures, which impacts the price. Without a code, a patient can’t be sure they’re comparing the same procedure among hospitals. Commonwealth Health System’s price list also does not include the procedure code and is difficult to understand. The list is in spreadsheet form and procedures are listed with technical abbreviations that, for most procedures, are hard to decipher. The regulation requires only that hospitals post prices. It leaves the decision on format up to individual hospitals. That’s a shortcoming that needs to be addressed, Kavanagh said. “It’s imperative that this information be standardized in such a way that a patient can readily compare prices between facilities,” Kavanagh said. There is help available for patients having difficulty understanding their potential out-of-pocket cost. Fennick said Commonwealth Health offers a variety of financial assistance programs, including charity care, prompt pay discounts and “generous” self-pay discounts for uninsured people. “Patients are encouraged to call our hospitals and speak with our patient access staff who can provide a personalized estimate of cost for non-emergency services,” Fennick said. “We believe that speaking with a member of our staff will provide patients with a clearer understanding of their out-of-pocket payment and a more precise response to their questions and concerns.” Geisinger and Wayne Memorial also provide personal service, as well as online cost estimators that allow patients to input information about their insurance so they can get a more accurate estimate of what they will owe. Barbara Tapscott, Geisinger vice president of revenue management, said Geisinger’s “MyEstimate” tool “allows patients to be active participants in their care and make decisions.” “We are looking forward to providing more transparency to the public by publishing our list prices and answering questions about individual patient liability through our financial counselors and our MyEstimate tool,” Tapscott said in a statement. Contact the writers: email@example.com; 570-348-9137; @tmbeseckerTT on Twitter; firstname.lastname@example.org; 570-821-2115; @CVAllabaugh on Twitter Find your cost Commonwealth Health posts pricing information for its affiliated hospitals on the website www.commonwealthhealth.net/pricing-information. To obtain a personalized estimate for services at Commonwealth Health hospitals, visit the patient access department at the hospital or call a member of the team Monday through Friday at Berwick Hospital Center, 855-890-3060; First Hospital in Kingston, 570-552-3900; Moses Taylor Hospital in Scranton, 570-770-5167; Regional Hospital of Scranton, 570-770-3168; Tyler Memorial Hospital in Tunkhannock, 570-836-2161, or Wilkes-Barre General Hospital, 855-890-3060. Geisinger features a “MyEstimate” tool on its website to assist patients with determining out-of-pocket expenses for medical treatment. Patients can access hospital charges at www.geisinger.org/patient-care/patients-and-visitors/billing-and-insurance. Click on “Tools You Can Use” and “Hospital Charge List” and then click on the specific Geisinger hospital used. Anyone who has difficulty accessing the information or has questions can call Geisinger’s Patient Service Call Center toll-free at 1-800-640-4206. Wayne Memorial Hospital has an online estimator that provides information on out-of-pocket cost based on insurance coverage at www.wmh.org/wayne-memorial-hospital/cost-charges/. Click on WMH Payment Estimator.