CHARLOTTE, N.C. (WJZY) – The new year will bring new transparency to health care costs.
Starting Jan. 1, hospitals are now required to disclose privately negotiated charges with private health insurers, allowing patients to know what a procedure will cost before they get the bill.
“Nobody mentioned that they were out-of-network,” said Amy Daniels, who was hit with a surprise $8000 medical bill. “And I didn’t have any experience to think to ask that.”
When Daniels delivered her third child in May she thought she knew what to expect. It turns out the hospital she gave birth in was in-network but her anesthesiologist was not.
The bill was for the out-of-network cost of the epidural.
“I mean, I guess going in now ask is this in network? Is this in network?,” the new mom said.
Monica and Michael Dickerson were also hit with surprise medical bills.
They were overjoyed by the birth of their daughter, Olivia and overwhelmed by what happened next.
“We were completely shocked,” said Monica, after also receiving an $8000 bill for what turned out to be anesthesia from an out-of-network provider at a hospital that was in-network.
Asked how much her insurance company paid for the anesthesia: “Zero.”
A 2017 study found one in every five emergency room visits resulted in an unexpected expense. It can costs patients tens of thousands of dollars. In September, President Trump visited Charlotte and said he would “end surprise medical billing.”
He signed a new law in December that will effectively to that. It goes into effect next year on Jan. 1, 2022.
In the meantime, every US hospital must now provide clear, accessible pricing information online about its services in response to the president’s executive order. The Centers for Medicare and Medicaid Services will begin auditing a sample of hospitals this month. Any that do not comply with the new transparent pricing rule can be fined.
“This rule is intended to improve price transparency and increase access to pricing information for patients,” said Novant Health Vice President of Pricing Strategy Melonie O’Connell. “This is a great step towards price transparency.”
Novant has already created an online portal where patients can look up out-of-pocket costs for hundreds of common procedures based on their own individual insurance plans. It will not replace the hospital’s financial counselors, who discuss pricing with patients, she said.
Still, there are gaps.
“Now, this is the hospital portion of that bill,” said O’Connell. “Of course, it doesn’t cover any physician bill, anesthesia bill, or that kind of thing.”
Patient advocates say this is a step towards reducing the sticker shock of unexpected big bills while transparency in healthcare costs.
The American Hospital Association, which fought the measure, disagrees.
“The AHA continues to believe that the disclosure of privately negotiated rates does nothing to help patients understand what they will actually pay for treatment and will create widespread confusion for them,” said AHA general counsel Melinda Hatton in a statement. “We also believe it will accelerate anticompetitive behavior among commercial health insurers and hinder innovations in value-based care delivery. Lastly, the requirement imposes significant costs on care providers at a time when scarce resources are needed to fight COVID-19 and save lies.”
The process of setting up a “very personalized” system so patients can plan ahead and shop around was a “very heavy lift,” O’Connell said, that took thousands of man hours.
“Healthcare is complicated and it’s also very personal and that’s why creating estimates is so difficult,” she said. “Our industry is so complicated so no one solution is going to be a perfect solution but this is a great step forward.”
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