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Many hospitals ignoring new pricing rules: What to know before you go

Thanks to a new law that went into effect Jan. 1, you can comparison shop for procedures at different hospitals, but many aren't adhering to the new rules

CLEVELAND — When you go to the hospital for a procedure, do you ever ask what it will cost? Kim Cromwell does because she's uninsured, and you might be surprised what she's found.

"I paid about $3,500 for a surgery that should - that bill through insurance would have been over $12,000," she said.

Cromwell got a cash discount simply by asking, which most uninsured don't know. And those with insurance don't take advantage of because they assume the costs will be covered.

It's something hospitals count on, according to Cynthia Fisher, founder of PatientRightsAdvocate.org, "because they're making way too much money keeping us in the dark, blindsiding us many times with overcharging or price gouging or up-charging."

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But as of Jan. 1 of this year, hospitals are now required to provide easy-to-read pricing free of charge, so people can shop around.

That sounds great in theory, but unfortunately most hospitals aren't following that law. 

"So over 6,000 hospitals in this country, only a third are slowly putting their pricing data up," Fisher said. "And the reality is the hospitals didn't want to do this and insurance companies didn't because they're making too much money."

But how about our hospitals? We searched for the cost of a hip replacement at the Cleveland Clinic, we found the price for an uninsured patient to be just over $106,000. With my insurance it cost $2,750.

Credit: Danielle Serino
Price estimates for a hip replacement from the Cleveland Clinic, University Hospitals and MetroHealth. Insured prices may vary by plan

We did the same search with MetroHealth and University Hospitals. So good news for Ohio patients, who can see how widely prices vary. And Cromwell says prices are even better at non-hospital facilities.

"I had blood work done, it was $42 dollars," Cromwell said. "If I went to a hospital laboratory it would be over $600."

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But here's the problem with prices hospitals post. They're "estimates," so you can still get socked with a huge bill.

When Liv Cannon needed spinal surgery, she verified first that her hospital and doctors were all in network. Still, she got a a $94,000 bill for something called neuromonitoring, a service she didn't know she was getting and which was done by an out-of-network company. 

"The odds of seeing an out-of-network doctor are shockingly high and overwhelmingly patients don't want to play medical roulette," said Chuck Bell from Consumer Reports.

The other issue, the prices posted for the uninsured don't show the discount, as Kim proved with her surgery. "I'm paying the same rate as an insurance company that would pay directly to the provider," she said.

Still, patient advocates say posting prices will create competition, and believe we'll soon be able to search for healthcare just like we search for travel.

"And we the consumers could demand getting the best price and the best quality of care at the lowest possible price," Fisher said.

Next January, there's a new law which will prevent insurance providers from charging out-of-network rates for emergency room services, or for services provided by out-of-network doctors if the patient is in an in-network facility. 

Hospital Ratings

Statements from Cleveland-area hospitals:

University Hospitals:

     Statement for WKYC TV3 

     UH provides price transparency for patients

     University Hospitals is continuing to improve the experience of our patients through price transparency.

     UH has provided patients with estimates upon request for over six years, using technology and financial counselors to help patients understand their benefits and costs for care. The service includes qualifying the patient for financial assistance and/or other options, such as insurance coverage, interest-free and extended payment plans, and potential charitable support.

     Furthermore, in September 2019, UH launched the UH Hospital Price Estimator, an easy-to-use, online self-service tool that helps patients better understand their planned or scheduled hospital cost for health care services before services are performed. It provides patients with tailored estimates of their personal out-of-pocket hospital costs for over 300 of the most common hospital services and procedures by facility, based on their specific insurance benefits, and associated deductible, co-pay and coinsurance. Patients can also call 1-866-771-7266 to obtain estimates and discuss estimated out-of-pocket costs and other patient service options with a financial counselor.

     UH continues to invest in improving the price transparency experience. Future enhancements will include a proactive estimate upon scheduling services and more intuitive search and display capabilities for the patient. UH continues to improve the Financial Counseling services and now includes Financial Navigation services. We are committed to further investing in more advanced and integrated technology that will provide greater capabilities to the patient and their families.

     It’s important to emphasize that UH is a charitable organization that provides medically necessary care to individuals regardless of their ability to pay; all individuals are treated with respect, regardless of their individual financial circumstances. No patient is denied or delayed emergency or medically necessary care. In 2019, UH’s Financial Assistance Program provided $50 million of charity care discounts to patients who qualified for the program and received financial assistance for their health care treatments and procedures. Please access our financial assistance policy, program materials and support services on our website at www.UHhospitals.org.

Cleveland Clinic:

     We have comprehensive hospital charges information available on our website and regularly make estimates for care available to patients when scheduling surgical and diagnostic services, and upon request for all other services. Our patient self-service module offers patients the ability to use their MyChart account or our Cleveland Clinic’s website to produce their own estimates for common services so they can compare the same services between hospitals.

     Regarding price variations within a health system, hospital charges are based on numerous factors including internal costs, local market pricing, insurance contracts, as well as differences in the complexity of care needed by each patient. 

     We recommend that patients check with their insurance provider for detailed information about their specific insurance benefits, including co-pays and co-insurance, to better understand their potential financial obligations for care.

     We understand that surprise billing can be a challenge for patients. At the time of scheduling a service, patients with a non-contracted/out-of-network status are notified and advised of their estimated costs. Also, our financial advocates are available to help patients understand and calculate their potential financial obligations before they receive care, and we offer financial assistance to patients who qualify.

     More information will soon be available to patients as health plans will be required by the federal government to begin posting information for their members in 2022, including treatment prices, cost sharing information and negotiated rates with in-network providers. Payers will also be required to provide detailed estimates to members for services based on their specific benefits.

Metro Health:

     “MetroHealth, years ago, realized that it can be very confusing for a patient to navigate the complexities of insurance billing, benefit plans, and personal expenses. That’s why we created a set of tools, including our online cost estimator to calculate and understand likely out-of-pocket expenses and why we created our Patient Financial Bill of Rights.”

MetroHealth Patient Financial Bill of Rights:

Editors Note: The video in the player below is from a previously-aired story