Hospital Chargemasters Leading to Confused Patients, Questions About Costs

March 18, 2019

A new federal law praised for what some considered a giant leap toward increased healthcare transparency may be making an already-confusing experience even more confusing. The rule effective Jan. 1 requires hospitals to publicize prices online for any services they offer. Unfortunately for patients, early reports on the process have not been favorable.

While the spirit of the law is rooted in helping consumers with upfront information to guide them in making decisions about their healthcare, the “chargemaster” lists hospitals are using have been anything but helpful.

One of the most alarming snafus with the pricing lists is that they’ve been flat-out wrong. In fact, several of the files have displayed the amounts billed to insurance companies, Medicare or Medicaid and not the amount actually charged to the patient. These rates are generally much higher than what a patient would see.

A recent Gallup poll found that three in 10 Americans have put off medical care in the last year due to the cost of treatment, which means these inaccurate and inflated rates could be the tipping point in someone not pursuing treatment for a medical condition.

Some hospitals in North Carolina are taking steps to ensure patients realize that what they see may not be what they pay.

For instance, WakeMed posted an online notice that informs patients its chargemaster amounts are “almost never billed to a patient or received as payment by a hospital.” The Triangle-based health system goes on to say that the insurance provider is the one who receives a bill with the amounts listed before applying contracted rates to billed services.

DukeHealth encourages its patients to request a pre-visit estimate for the most accurate expectation of cost, bluntly stating that the information on their chargemaster is not an estimate of the amount owed. A page on the UNC Health Care website prominently features a similar warning.

And even if the prices were correct, patients would likely have trouble understanding the lists due to the way they’re organized.

When we covered the new law shortly after its launch in January, we suggested that it could take a formal medical education to know what to look for when reviewing a chargemaster. Hospitals simply detail services in a much different way than a consumer would. As an example, surgery isn’t just “surgery”—it includes individual components like operating room time, anesthesia, and medications, just to name a few.

But for one nurse and patient advocate who spoke to ABC11, her 30 years of healthcare experience wasn’t enough to crack the code on the chargemaster in some cases. Many of the individual items listed have billing codes and not actual procedure names or supplies that a patient would recognize, she added.

If you are having treatment, or are considering having treatment, healthcare professionals strongly encourage you to perform your due diligence in advance. Your insurance company or a hospital financial navigator can help you understand potential costs you to ahead of time for some peace of mind.

And if you ever find yourself in a situation where you received a bill much larger than you expected or that you can handle, there are opportunities to ease that burden. Most hospitals are willing to negotiate rates or work with patients on payment plans, so be sure to call the hospital’s billing department to hear your options.

Have the sky-high costs of healthcare in our state impacted you and/or your family’s lives? Do you want to do something about it? Join the Coalition now to receive updates about new legislation and policies that will affect YOUR healthcare. ​Sign up now!


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