SUMMARY: Hospitals and for-profit surgical centers are joining the stampede to reveal their prices. But some kinds of transparency are more transparent than others.
How much does arthroscopy cost? How much does gall bladder surgery cost?
We blogged before about surgical centers posting online prices. The Surgery Center of Oklahoma is the one people point at most often (here is their price list), and there are other, more recent entrants, including Regency Healthcare in New York City (here is their price list).
Well, here come some more.
Southwest Orthopedic in Fort Worth, Tex, is listing online prices.
“In an effort to better serve our patients, Daytime Outpatient Surgery Center is proud to announce that we have created a pricing structure for a new cash option for our surgical procedures.
The prices for the medical procedures below include the facility fee, the surgeon’s fee and the anesthesiologist’s fee. The initial consultation with the surgeon is also included, as is uncomplicated follow-up care. The duration of postoperative care is different for each surgical procedure and may vary based on the patients’ specific needs. Therefore, your surgeon will inform you about the amount of postoperative care covered by the cash price during your initial consultation. The $250 initial consultation fee will be applied to the total cost of the procedure should surgery be indicated. If surgery is not indicated, the $250 will be retained by the surgeon as payment for your doctor consultation.”
How much does arthroscopy cost? $4,950 in New York City, and $3,740 in Oklahoma; it’s $3,720 in Fort Worth.
Others with different ‘transparency’ models
Of course there are many who reveal “chargemaster” prices, which is the rate they charge. That rate often doesn’t have anything to do with what they are paid — insurers and the government have rules about what they will pay, in the case of insurers fixed by contract negotiations and kept a secret, or in the case of government fixed by law. So while those prices are available in many places, they don’t always mean much.
Others have started to join the transparency movement, but in fits and starts: many of them will not post online price lists, but rather choose to offer a different kind of transparency — something like a “pre-surgery estimate.”
It’s not clear how these price transparency efforts stack up, because it’s still a transaction that takes place in isolation: provider to patient, rather than the public act of listing prices and saying “we will hold to these estimates,” which is the mode that Surgery Center of Oklahoma uses.
Oklahoma Heart Hospital is not listing online prices.
“Oklahoma Heart Hospital aims to provide you financial peace of mind so that you can focus on your health. We have developed very affordable all inclusive deeply discounted cost packages for our International patients that are significantly lower than other cardiac programs in USA. Our cost packages includes all costs from the hospital – physician’s fee, surgery fee, anesthesia fee, patient room charges and all other medical related fees during your stay at Oklahoma Heart Hospital. No hidden fees. You will know before you leave your home how much your stay with us will cost. Please call us toll free at 1-855-628-6790 or e-mail: International@okheart.com to find out more about your individual reasonable cost.
Intermountain Healthcare in Salt Lake City, Utah, is not listing online prices.
“Discounts for Uninsured Patients. Uninsured hospital patients who do not qualify for other assistance programs (such as Medicaid, CHIP, etc.) receive an automatic 25% discount on their bill. These patients may also receive an additional 15% off their bill if full payment is made before service is provided (total discount: 40%), or an additional 5% off their bill if full payment is made within 30 days after service is provided (total discount: 30%). For more information, contact the billing office at the hospital where you received services.”
American Thyroid Clinic in Austin, Tex., is not listing online prices.
“If you choose us to be your doctor (notice the freedom there) your health plan will almost certainly pay for the hospital, anesthesia, pathology, the hospital stay, and so on. The only odd duck in the equation is our surgical fee, which we ask you to pay. Your insurance plan will reimburse you whatever it is that they pay for your thyroidectomy, and my office manager assists you in every way possible to help you get reimbursed by your insurance company. In the last 9 years only three patients have been fully reimbursed, most have been reimbursed about 60% of our fee and some have been reimbursed 80%, and some have not received any reimbursement at all. … If you ask us to be your doctor, it will probably cost you a few dollars more than if you went to an insurance company doctor, or a doctor that works for a government program. …
“Since we don’t let big government or big insurance into our office, we don’t have to pay a gazillion dollars a month in overhead for paper and postage and computers and phone lines and employees and rent, and our surgical fees are therefore quite modest, usually in the range of $2800 to $4200 for most straight forward thyroid operations, and a little more for extensive cancers.
“We’re here to care for you if we can, and I’m not embarrassed to add that we will make a reasonable profit in the process. Call if you think we can help you in any way.
“R. Anders Rosendahl MD”
No Insurance Surgery in Las Vegas, Nev., does hernia, eye, spine, hand and cosmetic surgery. Price quotes are given after an interview. (Note: Las Vegas is a rising home to a medical tourism industry.)
“We do not publish the cost of hernia surgery. Instead, we give a guaranteed price quote after the doctor has interviewed you. This means that the inclusive price you are quoted does not change after you come see us. Your telephone consultation with the doctor is free of charge and usually takes about 15 minutes.
“If you are shopping for the best price for hernia surgery we caution you to insist on a guaranteed inclusive price quote before you travel. Unfortunately we have heard of patients traveling based on an advertised price ‘$2295 Special This Month’ only to find out the real price is over $6,000 once they get there.
“Non-routine procedures are those expected to take to take more than an hour to perform due to large size of hernia or other complicating factors. There is an addition charge for these procedures. You will be given a firm quote after the doctor has interviewed you. Most of our hernias are charged at the lower routine price but we welcome complex hernias.
A review of providers
Here’s a handy list.
Regency Healthcare. New York City, orthopedics primarily.
Good Shepherd Medical Center. Longview, Texas, has cash pricing program.
Surgery Center of Oklahoma. Oklahoma City Online price list for various procedures.
Southwest Orthopedic. Fort Worth, Texas–Online price list.
Rochester General Hospital. Rochester, N.Y. Posts prices for uninsured people — careful to say that doctor and anesthesiologist will charge separately.
The takeaway from clearhealthcosts
We’re really interested in talking to people who have used these centers, and especially in knowing how well their estimates lined up with the actual bill. If you have, let us know: info (at) clearhealthcosts (dot) com.
Meanwhile, if you’re thinking about using them, some thoughts:
- Know exactly what procedure you’re seeking. Make sure you and the provider are talking about the same thing.
- Ask for an estimate in advance, and then think about turning it into a guaranteed bid, in writing. It’s nice to have written evidence of what pledges you were made — or pledges that you made — about what you are seeking and what the provider can deliver.
- Enumerate the exact services expected: Will you be charged extra for a chest X-ray, for a pre-surgical consultation? Is there an expectation of a night or two in the hospital? How will that be charged?
- Are there other providers: a surgical center/hospital, a surgeon, an anesthesiologist, a lab, etc.? are they all included in the price tag?
- Is this price contingent on payment in advance? Is there a prompt-pay discount?
- Is that a guaranteed price? Or an estimate?
- Ask: “How much does that cost? How much will it cost me?”
- Can you talk to people who have had surgery at this place, and see what their billing experience was like? Do you trust those people?
- What kind of quality ratings do you want to see? Leapfrog Group has some; healthcare.gov lists some on this page; Consumer Reports has some on this page. Do you believe the source? Is it believable, reputable information?
- Remember: the people in the billing office are there to help. Most want to help, but the frustrations of dealing with the medical billing system are enormous. Take pity on them.
Finally, we have started to hear of providers offering a package plan including room and board, not just in exotic medical tourism destinations like Bangkok but also in the United States, including Las Vegas, which seems to be working on a domestic medical tourism specialization. Are they putting you up in a hotel? Do you want that? Examine such items carefully.