Learn how to Look Up Costs at Your Hospital, if They Exist

This year, some Americans can do something that was previously impossible: look up the price of care before going to the hospital.

A new federal rule requires hospitals to publish the prices they negotiate with private insurers.

The data is a rich source of new information. We have shown that some insurers pay twice or three times as much for basic services as their competitors – and that paying in cash instead of using your insurance cover can often result in a lower price.

But most hospitals have not yet released the necessary data. Even if it does, it can take time and effort to find. Also, you may have to be a computer programmer to open it.

“Get some coffee and drink because it will take a while,” said Touré McCluskey, co-founder of the health start-up Redu Health, which collected some of the data files. “There’s information out there, but it’s not consumer-friendly.”

To help those who’d like to try, we interviewed several researchers who spent months collecting the data. They recommended several simple strategies.

Before you start looking for prices, you want to know what type of health insurance you have – both the name of your insurer and details such as: B. Whether you opted for an HMO plan or a PPO option during open enrollment.

Insurers often have half a dozen tariffs in the same hospital. Some are specific to the plan you choose and whether you purchased the insurance through the Obamacare marketplace or a specific employer. Others have to do with the network you chose to have coverage for when you signed up.

Knowing the type of insurance you have is the best way to see what the rates in the dates are for you.

Most hospitals publish the data on a page called “Price Transparency”. Many researchers say they start looking for price files by searching Google for that term and the name of the hospital.

“This search should lead you to a top result related to billing for quotation or patient information,” said Morgan Henderson, a University of Maryland-Baltimore County health economist who worked with The Upshot on the Used to collect price files in our recent articles. “Sometimes what you want is at the bottom of this page or you have to follow a few links.”

The page should look something like this from the MedStar Hospital Center, the largest hospital in Washington, DC

The hospital pricing transparency page is likely to have multiple sections and links, and the labeling of the pricing files is not always clear. You should look for something like a “comprehensive machine readable file” or a “negotiated price list”.

It is also worth opening files described as “Standard Loads” or “Chargemaster”. Here’s what these Indiana University health look like:

When you open the files, you’ll see that the hospital-negotiated rates and cash prices are also included.

The government has not established a standard format for hospitals to report their pricing data, and each hospital seems to have a slightly different approach.

Some post their details in Excel or CSV files that you can open with free software such as Google Sheets. However, some use JSON files, a data format commonly used by computer programmers and professional data scientists that ordinary people may find difficult to open.

“I trained in health economics and policy and work on a machine that has a lot of storage space,” said Morgane Mouslim, also a health economist at the University of Maryland-Baltimore County who helped The Upshot collect and standardize File. “If a file is not in Excel, you may need additional software.”

A typical data set lists rates by procedure for each insurer, like this one from the University of Pennsylvania Hospital:

The leftmost five-digit numbers in this table are CPT codes that hospitals use to describe each service they offer. Most files also contain brief descriptions of each code, but they can be confusing. For example, code U0003 translates as “PR COV 19 AMP PRB HIGH THRUPUT” – a jargon description of a coronavirus test.

In order to determine the cost of a particular service to expect in a hospital, you will most likely need to call the facility and ask what CPT codes will be charged for your visit.

You may also see other numeric codes, sometimes called procedural codes or sales codes, as in the file below from the Baptist Medical Center in Little Rock, Ark. You probably don’t need to pay much attention to these and should focus on the CPT codes. (If the CPT codes aren’t labeled, you can generally recognize them as five-digit codes.)

Usually you should see dollar numbers that represent real prices. However, you might come across files where the price is listed as “variable”, which means it may be different for two patients on the same insurance who have received the same treatment in different circumstances.

Molly Smith, vice president of public order for the American Hospital Association, gave the example of a patient who is hospitalized for a flu shot versus one who happens to get one while having an operation there.

“In the contract, we generally negotiate the price for the main service, but if it is an ancillary service, maybe 15 percent is deducted,” she said. “That cannot be reflected in these files.”

The files should also contain two other prices: the “fee” or “gross price”, the sticker price for a particular service that hospitals often use as the basis for negotiating discounts. There should also be the “cash price” that the hospital charges to patients who do not have insurance. Whether this price applies to insured patients varies from hospital to hospital. Some low-income patients may be eligible for even higher discounts based on how little they earn.

Once you have found the data point you are looking for, you may need to understand it even better. Most hospitals report prices as dollar numbers, but some display the data as a percentage of the gross charge – which means that patients have to calculate their costs in order to understand their costs.

Most hospitals have not published the required data, so a lot can happen.

For example, NYU Langone’s pricing transparency website only has standard fees and a patient estimation tool that uses information about your insurance plan to create a custom estimate of the cost of a particular procedure.

These tools provide limited information. The standard fees can tell you the maximum amount that you can pay for a particular service, and the patient estimator shows the costs associated with simple services such as mammograms and blood tests. However, when a Times reporter attempted to use the NYU website in late July, error messages were generated for all of the services investigated.

A representative from NYU Langone declined to comment on why the hospital hadn’t released its full data.

With compliance rates still low, the federal government promises to increase enforcement. It has sent nearly 170 warning letters to non-compliant hospitals and plans to increase penalties for non-compliance from $ 109,500 to up to $ 2 million annually.

If you believe a hospital has not released the required information, you can file a complaint with the federal government to inform them of the problem.

Some health professionals say the large data files become more useful after third-party data companies clean up and organize the information so that patients can search across multiple hospitals and health services.

A data transparency company, Turquoise Health, has already developed a free price search tool. Others are expected soon.

The Times has so far examined records from 60 hospitals. But there are many more.

If you see something surprising on a hospital’s price list – for example, exceptionally high prices or large differences in the cost of a service – we’d love to hear about it. You can email us what you found.

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