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Hospital prices can be hard to access and decipher

Do you need a colonoscopy?

Whether someone is insured or uninsured, Cornwall at Montefiore St Luke’s in Newburgh will cost the lowest and Putnam Hospital Center in Carmel will be the most affordable. NewYork-Presbyterian Hudson Valley Hospital in Cortlandt Manor is a relative bargain, although the negotiated price for patients covered by United Health is more than double the standard cost.

Local hospitals generally adhere to a federal mandate to announce prices for procedures and services, although patients will occasionally encounter incomplete or mind-numbing amounts of data.

The hospital’s price transparency rule, which took effect in January 2021, requires hospitals to publish a “machine-readable” file for standard charges, as well as a “consumer-friendly” list of costs for 300 scheduled services. Hospitals that fail to publish rates can be fined up to $5,500 per day. (A similar rule went into effect on July 1 for insurance companies.)

Rates to be posted include standard charges, cash-discounted rates, and fees negotiated with private and public insurers for services and procedures ranging from daily room rates and routine X-rays to hip and knee replacements, pacemaker implants, and spinal fusion.

Supporters of the disclosures, which took effect after an unsuccessful legal challenge by the American Hospital Association, say it will lower costs by giving patients and employers the ability to shop.

Locally, Hudson Valley Hospital and St. Luke’s Cornwall, Putnam Hospital and Vassar Brothers Medical Center are searchable online databases showing standard rates and costs paid to insurance companies.

However, the St. Luke Online is an external tool. Users are required to provide their name, date of birth, and insurance information, although the law states that people must be able to search without having to enter personal information.

Each hospital also publishes links to a file with a more comprehensive price list, but the files must be downloaded, opened, decrypted, and searched.

Those with the time, knowledge, and patience will discover clear price discrepancies between hospitals, private insurance companies, and Medicaid and Medicare, two major public insurance programs.

A pregnant woman will learn, for example, that the standard fee for a delivery at Hudson Valley Hospital is $28,893. The price is about the same if it’s insured by the Empire Blue Cross Blue Shield but less than half if it’s covered by Aetna. With either insurer, she will be billed $7,313 in St Luke’s Cornwall, compared to the standard rate, $23,758, for the uninsured.

People without insurance will find a standard fee of $15,517 in St Luke’s Cornwall, which it says are discounted rates and reflect Medicare self-pay rates. Hudson Valley Hospital lists standard fees six times higher for deliveries, and Putnam Hospital nearly three times higher.

Hudson Valley Hospital, on its website, warns that rates do not include “fees from your own physician and other providers” and that patients may receive bills from emergency departments, radiology, anesthesiologists and surgeons.

In addition, according to the hospital, the personal costs of insured patients depend on the scope of their coverage, including co-payments, co-insurance, and deductibles.

In a statement, NewYork-Presbyterian said it has been “committed to complying with the Hospital Pricing Transparency Rule since its inception.”

“We’ve worked to be as helpful as possible with the pricing information we provide to our patients,” she said. “As the rule has been made clear, we remain committed to continually improving and updating the information we make available to the public for the benefit of our patients.”

But according to an annual survey released in August by PatientRightsAdvocate.org, only 16 percent of 2,000 hospitals, and 9 percent of 47 hospitals examined in New York State, were fully compliant with the law. Hudson Valley Hospital was among 43 hospitals in New York that were classified as noncompliant for failing to publish any information or having missing or incomplete data.

Compliance with the requirements “almost stopped,” said Cynthia Fisher, founder and president of the organization.

“With enforcement, fines, and transparent hospital accountability, we will see the power shift to healthcare consumers and employers to cut costs,” she said.

A similar survey was published in June in Journal of the American Medical Association Out of 5,000 hospitals, only 300, or less than 6 percent, were found to be fully compatible. It found that many hospitals were partially compliant, but 50 percent had no published information.

The researchers found that hospitals with lower revenue, in urban areas or in places with few healthcare clinics or competition than other hospitals, were more likely to pay prices.

from San Jose News Bulletin https://sjnewsbulletin.com/shopping-for-healthcare-highland-current/