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New Healthcare Law Could Provide Confusion, Not Clarity on Costs

January 16, 2019

For many of us, the new year is a time for rebirth, reawakening, or an optimal time to enact change. Whether you decide to commit to those new habits remains to be seen, but one change that’s legally mandated to stick is taking place in hospitals around the country.

As of January 1, a new federal healthcare law will require all hospitals to post prices online for services they provide. This change in policy aims to help better inform consumers in search of healthcare services. Previously, these patients could request the information from the hospital, but the process was seldom smooth or easy.

As a result of the new law, patients will now be able to compare “retail” costs at hospitals near and far, and of all sizes, in a move that’s meant to supply more transparency to the consumer than ever before. However, these prices can dramatically differ, and that’s where the simplicity and intention of the plan gets a little sticky.

For example, when exploring “chest pain” costs at three local Raleigh hospitals, you’ll find a gap of more than $15,000 between the least expensive and most expensive. REX Hospital, recorded as the highest, lists its associated costs at $28,655. Of the three hospitals researched, Duke Raleigh’s $18,866 ranked in the middle, with WakeMed’s $13,314 charge appearing to be the least expensive.

But hospital staff are warning patients about the disclosure of these prices, citing the influence that differentiating factors like health insurance coverage, deductibles, and out of pocket maximums can have on a patient’s financial responsibility.

These prices simply are not one-size-fits-all quotes, and the patient may be the one who suffers the consequences. Uninformed patients may not realize that the listed prices do not reflect those variables and could make a pivotal healthcare decision based on what is fundamentally incomplete data.

Though lawmakers envisioned the posting of prices to simplify the healthcare process for patients, some are arguing that it may result in more confusion. Because of the sheer number of services offered at larger facilities, hospitals could post a dizzying number of quotes—some as high as 50,000 different prices.

The way hospitals add and detail services in the database could also lead to a lack of clarity for patients. Those without formal medical education are unlikely to know just what to look for when combing through these quotes. Price-shopping patients would need to compile the individual components of a surgery—things like operating room time, anesthesia, and medications.

To truly understand what these prices mean for you, patients should always perform extensive research on preferred hospitals or needed procedures. By proactively speaking with your insurance company or a hospital financial navigator, you can receive the clarity you need to decide about your healthcare. These skilled professionals can evaluate the procedure or services you need, and what the benefit your insurance plan will provide toward that service, and provide you with an accurate estimate of your out-of-pocket responsibility.

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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