Published Hospital Pricing and How it Affects You
Let’s say you hurt your knee in a car accident and your doctor is now telling you-you’ll need a total knee replacement. You want to be sure to get the best care at the best price, so you want to do some research before selecting a hospital and doctor to perform the surgery. You decide to start by calling up hospitals in your area, whether it be Solano and Napa County or the Bay Area, to find out how much it will cost. Sounds easy, right? Not quite. If you have ever tried to get information on medical costs, you know that calling it difficult is a huge understatement.
Even though hospitals have long been required to disclose pricing upon request, getting answers can be a nightmare. When trying to access pricing about medical procedures, every step of the way seems full of obstacles, and it can feel like everyone is against you. It appears, however, that things are starting to change.
New Legislation Brings More Transparency or Does It?
As of January 1, 2019, hospitals are required to post their pricing on their websites. If you have an upcoming procedure, or if you are pricing emergency room costs in Vacaville, for example, in the future, you have a new resource. This is a definite step forward in transparency in medicine, but it isn’t as clear cut as it seems.
CNN recently wrote an article titled,
Hospitals must post prices online, but they may be more confusing than helpful.
Hospital Price Negotiations?
The prices hospitals post are list prices. You can think of them as the MSRP on the sticker of that new car you have been eyeing. But we all know that no one actually pays the sticker price. When you go to buy a car, you sit down with the dealer and negotiate the price. The same thing happens when it comes to medical expenses—except the consumer isn’t usually the one doing the negotiating. The actual price is determined based on negotiations between the providers and the insurance companies and how they define your level of treatment. Of course, no one publishes those negotiations and resulting prices for consumers to access. How your attending physicians classify your treatment can change an emergency room visit from being a couple hundred dollars to a couple thousand.
See this snippet of a spreadsheet we downloaded from North Bay Hospital.
The image above is 100% in compliance with the new legislation but fails to provide insight into how much an average person can expect to pay for an emergency room visit.
Are patients any better off?
After a car accident, many people are caught in a maze trying to track down information on the costs of medical procedures because insurance companies will have different agreements with different providers and hospitals. Looking at the pricing lists on the hospital websites will tell you almost nothing. The actual cost to a patient will depend on the negotiated price between the insurance company, hospital, and the injured parties’ ability to represent their interests. This is why we always recommend speaking to a personal injury lawyer to review your situation and confidently get the best deal.
Why Is this on a legal blog?
You might be thinking, what do medical pricing rules have to do with personal injury lawyers working in Solano County? The answer is that we care about our community. And we think you should know that you might not have to pay those emergency room costs at all. If you’ve been injured due to someone else’s carelessness, you may not be responsible for medical expenses. We can help you take on the big auto insurance companies and get your bills paid. Contact us and let us fight for you.