A new federal law means you get a better idea of what you’ll pay for health care, but it’s still just an idea.
Hospitals have to publicly post their charges for procedures, the discounted amount they’ll accept from people without insurance and the rates that insurers reimburse for those services.
The law went into effect Jan. 1, and Rochester Regional Health on Feb. 9 announced its price transparency and cost estimator tools for 300 of its most common procedures.
The information is at www.rochesterregional.org/billing-and-insurance/transparency. Click on “cost estimates” and “price transparency.”
The information comes with a disclaimer that the final amount may be higher if other services are provided or someone giving you care is not in your insurer’s network or an employee of RRH.
Things are better than they were just two years ago, when hospitals had to post only their charge. But that pretty much was a meaningless number because of insurance or discounts to people who lacked coverage.
“It’s a closer estimate, and I emphasize that word estimate, to what the out of pocket cost will be for that patient for that procedure,” said Tammy Imm, the vice president at RRH who oversees charging and pricing.
Imm said health care may never get to the point where patients who undergo any procedure will know ahead of time exactly what they’ll pay – like picking up items at the grocery store and heading to the checkout. Health care isn’t always predictable, and a provider may add a procedure to get more information about your condition.
“From my perspective, that’s very difficult because of the fact that you’ll always have that medical necessity component to it,” Imm said. “Will we get 80% of the way there, yes. I don’t ever envision us being 100% there just given the dynamic.”
Imm showed how the estimator worked, using a single view X-ray as an example. For someone without insurance, the procedure would cost $156 at Rochester General Hospital. For someone with an Excellus HMO, the copay would be $25.
For people with a deductible, the estimator would let them know what their insurance allows the hospital to bill. But right now, the individual would have to know how much of their deductible is left in order to know what they would pay.
The federal Centers for Medicare & Medicaid Services, which oversees the price transparency regulation, urges consumers to use the information to comparison shop. But that really isn’t practical in a place like Rochester, where two systems own or have affiliations with all the hospitals within a reasonable drive. There just aren’t many options. You may have more choice within one system than between the systems. Imm said prices at the RRH hospitals vary, based in part on location.
Another barrier to comparison shopping: The charges and the negotiated rates are contained in spreadsheets, so it helps to be able to navigate Excel.
UR Medicine also has a cost estimator tool, which is at www.urmc.rochester.edu/patients-families/bill-pay/cost-estimates-and-pricing.aspx.
The tool complies with CMS regulations, and you can scroll to “compare hospital charges.”