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New hospital price transparency rule

Published: Jan. 19, 2021 at 3:33 PM PST
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RENO, Nev. (KOLO) - Surgeries, imagining, prescriptions, all of them part of the healthcare system at hospitals, all of them with a price tag.

If you could anticipate a hospital procedure, would you go to a hospital website and look up the cost, as well as what your insurance company’s negotiated price for the procedure?

That’s the idea behind the Hospital Price Transparency Rule which went into effect January 1, 2021.

“Hospitals have to have a consumer friendly tool on line on their website for patients to see the price of common services--300 common services,” says Nisha Kurani, chief policy analyst for Kaiser Family Foundation. The new rule was formulated by the Centers for Medicaid and Medicare Services.

It requires hospitals to list the cost of the most common medical procedures performed by at their facility, along with what a contracted insurance company will pay for the procedure.

We checked local hospital’s new price transparency pages to see what’s being offered to the consumer. As you might expect the information is nearly overwhelming. However, there is no question about costs.

If you have time, in the end you’ll have a good idea about what your insurance will pay. However, your portion of the cost is not on the website. You’ll have to get that from your insurance company.

No doubt there is plenty of information.

The question is, will it bring hospital costs down? As an insured patient do you have a choice of facilities to receive your surgery? Will your portion of the bill be less if it costs less at another hospital? Should consumers assume the lower price means less quality care?

If there is only one option and you have insurance, there is no room for negotiation the price is as listed.

“The cost of care doesn’t necessarily the quality of care,” says Kurani. “The other thing to know is patients might have a restriction on what providers of what hospitals they can go to. They might not necessarily have the option of shopping around between different hospitals,” she says.

For those who have no insurance, the websites are required to list billing services to contact and negotiate prices or payment schedules.

This is just the beginning of billing transparency.

By 2023 insurance companies will have to list what their paying for common procedures as well as be more detailed so consumers can determine out of pocket expenses, and deductibles.

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