JACKSONVILLE, Fla. — Action News Jax investigates if local hospitals are keeping some price information hidden from you as new federal regulations demand more price transparency.
Brianna Reese is the mother of 5-month old Marlo, who was specially delivered along with a massive hospital bill.
“When you saw the bill at first you thought what?,” asked Action News Jax Ben Becker. “Oh wow,” says Reese.
Reese showed Becker her bills- the total before insurance almost $30,000.
Thankfully for her, the final cost was far less because of insurance, but not everyone is so lucky.
In the past -- knowing specific hospital pricing before a procedure has practically been brain surgery.
“The government has laid a path to price transparency,” says Chris Severn with Turquoise Health, a company that collects hospital price transparency data.
In January, the federal government mandated hospitals across the country post prices for the insured and uninsured on their websites in two ways. First at least 300 shoppable services - in a “consumer-friendly” style. This includes procedures like CT scans, knee replacements, and childbirth.
“Does the federal law go far enough?,” asks Becker “There are some things the law could have done better,” said Severn.
In an Action News Jax investigation, Becker dug through the websites of local hospitals, including Memorial Hospital, Baptist Health, UF Health, Ascension St. Vincent’s, The Mayo Clinic, and Flagler to see if they’re in compliance with the federal law.
All the hospitals are meeting the shoppable services requirement, although it often took numerous clicks to find the information on their websites.
However, there is a second part of the law that doesn’t require information to be displayed in a “consumer-friendly format.”
Hospitals must list a quote “machine-readable file” - usually a spreadsheet - of all standard charges for all items and services provided, which is everything from the cost of aspirin to a bandage.
These spreadsheets may spread your patience thin with hundreds of thousands of lines.
When Becker started looking into this story in February, Baptist Health was not in compliance with the law.
But since he started asking questions, the Baptist site was updated, although it still omits major insurance carriers in its 102,000-page document.
Baptist sent Action News Jax a statement:
“Baptist Health is committed to providing education to our patients about our healthcare services and offering patients the ability to price shop and estimate their financial responsibility. We encourage our patients to utilize our self-service patient cost estimator tool, which is primarily determined by insurance coverage. Estimates are for hospital services and do not include the services of physician providers. Our machine-readable pricing list provides the cost for hospital services; however, each patient’s experience is different and can include various services. Patients may also call Customer Service 904.376.4161 if they have questions.”
Like Baptist, the Memorial spreadsheet with more than 35,000 lines doesn’t list major carriers.
Memorial Hospital sent Action News Jax a statement:
“We are using one of the machine-readable file formats listed in the regulations to provide the five types of “standard charges.” This includes contracted rates with insurers. We started with the less complex contracts and will continue to post information as our teams work through additional contracts.”
Mayo’s spreadsheet has more than one million lines. The only way Becker found what he was looking for on any of the spreadsheets was doing a quick search using the keyboard command “Control F.”
It enabled Becker to find individual aspirin prices anywhere from 50 cents to $35 – which was similar to other hospitals.
Mayo sent Action News Jax a statement:
“Mayo Clinic has been working diligently to prepare the negotiated rates data for all our sites, at a time when our most urgent priority has been responding to the COVID-19 pandemic. We have met and exceeded the criteria for Shopping Services data at our destination centers for years. Like many other providers, we found it challenging to prepare the negotiated rates data for our many sites in a machine-readable format that also is readable and usable by consumers, and we’re pleased that it’s now available (as of April 1). I encourage you to visit the sites to learn more.”
“Everyone isn’t able to afford those prices,” says Reese who believes the changes are better than nothing.
“Everyone isn’t given that opportunity and lot of moms struggling out there because of it.”
Hospitals that do not comply with federal law face a penalty of $300 per day.
In addition, starting next year, the federal law will require transparency for physician fees to reduce your sticker shock when multiple bills arrive in your mailbox.
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