Making Government Work

How Price Tags in Hospitals Can Help Patients Avoid Huge Medical Bills

October 16, 2014
by
Menu
How Price Tags in Hospitals Can Help Patients Avoid Huge Medical Bills
Medical costs are listed as a top reason for debt in the US. Mercy Health/Flickr
Massachusetts puts an actual dollar amount on health care.

The Affordable Healthcare Act created marketplaces to expand affordable healthcare and to underscore that promise, Massachusetts is now requiring private health insurance companies to use price tags on anything from an MRI to a general check-up.

Beginning Oct. 1, all heath insurers in the Bay State are required to list prices in real-time, outlining the otherwise hidden costs of healthcare, much like an online shopping site. While it’s unclear if every insurer met the deadline, there is no penalty if they failed to do so, according to 90.9 WBUR

By using an online calculator on their insurer’s website, users can find out how much they’ve spent this year toward their deductible. If coverage does not include a deductible, the calculator will add up the balance toward the out-of-pocket maximum. Blue Cross customers can find the calculator under “Find a Doctor,” Tufts is under Empower Me” and Harvard Pilgrim’s is under “Now iKnow.”

While the mandate underscores a sea change in health care practices, Massachusetts first began the process two years ago when the state passed a law to increase transparency among hospitals and health insurers.

“This is a very big deal,” says Undersecretary for Consumer Affairs and Business Regulation Barbara Anthony. “Let the light shine in on health care prices.”

But the new law has its flaws, and though it’s still early, WBUR points out a few glaring issues with the new health care price tags.

No standard price: There is no standard price and no list of priced tests and procedures. Pricing out a visit depends on the insurer and can range in price drastically. For instance, an MRI for the upper back can cost between $614 and $1,800 on the Harvard Pilgrim “Now I Know” tool. The prices are also listed in real-time, which means they can change day-to-day.

Prices are ambiguous: Since insurers negotiate their rates with hospitals and physicians, they may entail hidden costs. For example, a listed price tag may not include the cost of reading a test or a facility fee.

Prices focus on outpatient care: The information is not comprehensive and encompasses few prices outlining what it would cost for inpatient care or an overnight stay at the hospital.

However, as Tufts Health Plan Director of Commercial Product Strategy Athelstan Bellerand notes, the new prices “are a major step in the right direction.”

By adding price tags, state officials are forcing us to think more about our health spending and how much a procedure actually costs, rather than leaving it to our private insurance. Anthony is also hoping by illuminating the price difference, more physicians will become sensitive to where they fall on the scale and ultimately encourage more competition and drive down costs.

“I’m just talking about sensible rational pricing, which health prices are anything but,” she adds.

MORE: The Checklist That Can Reform Healthcare

Comments