Hospital Price Transparency. It's finally a law !!

The CMS (Center of Medicare and Medicaid Services) administration, passed the final rule that requires all the Hospitals in the country to make their prices (for all services and procedures) available to general public via their websites. And since it’s a law, most hospitals have to abide by it. Unfortunately, there has been lots of confusion around how to access this information, where is it displayed and how is it displayed. Most of the information currently exists in machine readable form (so probably Alexa can read it but not you 😂) and requires knowledge of the numeric “codes” used by billing services. Also, there is the issue of the difference between the prices listed in the “chargemaster” vs .the actual negotiated prices paid by the patients with insurance plans. Despite these limitations, in my opinion, it is a positive tool for the healthcare consumers to compare prices of similar healthcare services in their local communities, and assess the value of the care provided and the utility of their health insurance plans.

And for the sake of transparency (which is not new to us), here are the price comparisons of our services at TOCDOC:

  • New Patient Evaluation (billing code 99205): $300 (vs $1040)

  • Established Patients Follow-up Visit (billing code 99214): $150 (vs $700)

BTW, Kudos to Carle Hospital for displaying prices of their most frequently provided services in an easy to understand and easily accessible format. Here’s the link (just in case)

Other interesting discussions on this topic:

Hospitals Must Now Post Prices. But It May Take a Brain Surgeon to Decipher Them.

H.R.6508 - Hospital Price Transparency and Disclosure Act of 2018

Good luck finding them