Did you know hospitals are now required to disclose how much common services such as a brain MRI or a knee replacement surgery costs before a patient has the procedure ? Federal rules from the Centers for Medicare and Medicaid Services (CMS) have mandated a new price transparency policy that requires hospitals to provide online information about how much 500 different common procedures cost, and how much they will cost you depending on the insurance you have (or don’t have). And by the beginning of 2024, hospitals will be required to post the costs of all services, not just the most common ones.
Unfortunately, not every hospital system is following the law. Multiple reports from the advocacy group PatientsRightsAdvocate.org show some hospital chains have been almost entirely ignoring their duty since the first transparency regulations were rolled out in 2021. Not St. Luke’s Health. We’re committed to sharing price transparency information with our patients and we are in full compliance with the law. But what does that really mean for you?
What Is Hospital Price Transparency?
Usually, if you’re going shopping for something, you want to know how much it will cost. When you’re shopping for something inexpensive, a small price difference might not be worth the hassle of driving to a different neighborhood. (Gas costs money, too!) But when you’re looking at buying a big-ticket item, like a new television or a car, you want to know where to get the best deal.
Traditionally, the health care system hasn’t made it as easy for patients to know what a medical procedure costs, compared to shopping for just about anything else. But the new CMS rules are designed to change that. Prior to their implementation, most patients found out what a CT scan or echocardiogram cost after they received an explanation of benefits from their insurance company, or a bill from their doctor.
Now, hospitals must post estimates of costs from everything to heart transplant surgery to the cast you might get after a broken arm. These cost breakdowns include what the price would be without any insurance, if you have Medicaid or Medicare, and the costs associated with different private insurance companies. That means you can know roughly how much it might cost to get a procedure at one hospital versus another so you can factor that information into your decision on where to receive your care.
Complying With the Rules
The new CMS rules allowed hospitals to slowly roll out the prices for a number of services, recognizing that especially for smaller health care organizations, getting that data organized and online would take a little bit of time. Hospitals are required to post pricing information in two ways:
As a comprehensive file with all items and prices — a spreadsheet, in most cases
In a consumer-friendly display.
Statistics compiled by PatientsRightsAdvocate.org show that most hospitals — including St. Luke’s Health — missed getting the data online by the initial deadline. But over the ensuing months, some companies have made big pushes to comply system-wide, while others still have not. As of February 2023, over 75% of hospitals are still not in compliance.
While this may not make a difference in where you choose to seek care in an emergency, you may want to consider what it means when you have a planned medical expense looming, along with a selection of hospitals to choose from for services. Don’t you deserve care from a health care system that believes in transparency?
Price Transparency Made Easy
St. Luke’s Health has two ways for you to estimate your medical costs beforehand. One is a list of downloadable spreadsheets for every hospital location in our system, from Brazosport to The Woodlands. This list allows you to compare our negotiated rates for procedures with different insurance companies, which could be helpful for you during open enrollment. The other tool is our patient cost estimator. Choose your location, plug in your insurance information and select the procedure you need to get an estimated out-of-pocket cost.
As you explore our price transparency tools, it’s important to remember the upfront costs provided are only estimates. Unlike shopping for televisions, the final cost of medical procedures may vary depending on factors like how long you have to stay in the hospital, whether you have complications or if additional treatments are prescribed due to your specific health circumstances.
You should also keep in mind that estimated costs listed on St. Luke’s Health website — or any other hospital’s site — cannot tell you about the quality of the services you will receive. If you are comparing costs in advance of scheduling a needed medical procedure, you should also consider whether the hospital will provide everything else you need. Does it offer holistic and comprehensive care for your mind, body and spirit? Does it have a longstanding history of excellence and pioneering medical achievements? Will you have access to research and clinical trials if you need additional or ongoing care?
At St. Luke’s Health, the answer to all of these questions is yes. We will always remain committed to providing the highest quality care at a transparent cost.