We’ve learned some interesting things about providers publicizing cash or self-pay prices in our New Orleans partnership, “Cracking the Code.” Perhaps not surprisingly, when the people we’re talking with understand how this can benefit them, they give up the prices — information that for years has been a closely kept secret.
We start out, as always, by surveying providers by phone. This has a reasonably good rate of success in general — probably 90 percent of the non-hospital providers we ask supply data. With hospitals, it’s a less certain thing — probably around 50 – 60 percent success rate. (A certain number of the providers are unreachable by phone — either they don’t call back, or leave us on eternal hold, etc.)
Providers’ willingness to disclose prices has changed significantly since we started doing this in 2011. Then, it was much harder for us to find pricing information. We surmise that the providers are more willing to disclose these days because more people are asking for a cash price — maybe because they were uninsured at some point, or between insurances, or they have a high deductible, or a combination of those factors.
It’s also true that when we first started doing this, we had to learn how to do it well.
Hospitals
In our New Orleans partnership, we decided to go back to all the hospitals after our launch, and do a story about the ways they think about revealing prices. We asked questions like this: What’s your pricing policy? How do you think about it? If you don’t give prices over the phone, how’s a patient to know what something will cost? If you give prices over the phone only for patients, is there anything you can tell us that will help them? Oh, and here’s a spreadsheet with the prices we’re looking for, for around 20 procedures. Would you reconsider and fill it out and send it back to us?
Perhaps not surprisingly, one big hospital chain that had declined to supply prices to our reporters in our early survey later chose to supply prices after this request. It’s the LCMC Health System — a group of five, including Touro Infirmary, Children’s Hospital, University Medical Center, New Orleans East Hospital and West Jefferson Medical Center.
North Oaks Health System also sent in prices in response to our partners’ request.
Several weeks after we launched, Slidell Memorial also chimed in with prices.
Here is a report from one of our partners about how that transpired.
For the text of the hospitals’ response about how they think about this, look below.
Non-hospital imaging providers
After we launched, one self-standing radiology center, Doctors Imaging, reached out and asked if we could put all their prices in our database. We said “sure!”
Then journalists at our partners reached out directly to some other non-hospital providers and asked them to supply prices.
We immediately heard from several self-standing radiology centers who wanted to be included. Diagnostic Imaging Services, Medical Center Diagnostics, River Bend Imaging and Houma Medical Imaging all sent prices.
To see what that looks like, you can go to our interactive software and search on a common MRI, say 72148 MRI of the lower back/lumbar spine without contrast. The prices we collected pre-launch are in orange; prices shared by our community members are in blue; prices sent in by providers are in green.
Non-imaging providers
We also heard back in response to our request from Metropolitan Gastroenterology Associates, a chain of ambulatory surgical centers with 21 doctors at three locations in the metro area.
They sent in cash prices for a screening colonoscopy at all three locations. We noticed, though, that they offer other procedures, and we asked if we could have cash prices for them also.
Their response: “We do colonoscopies at all locations. Cash prices are available for the screening colonoscopies because they are more straight-forward and self-limited in nature and virtually never result in additional charges. The other procedures, performed on people who are ill, involve consultation and at times referral to other physicians and further testing at other facilities which we have no say in. We are reluctant to give a cash price for other procedures because although we would adhere to any amount quoted for our charges, patients generally assume it would be for all services associated with their treatment.”
We then asked if their providers do these procedures at non-MetroGI facilities as well, say, at a hospital. Their response: “We do procedures at hospitals as well when the health plan requires it. Doing them in the ASC [ambulatory surgical center] is much less expensive.”
To read more about our New Orleans partnership, go to this page.
Statements from hospitals
Below are excerpts from statements from hospitals that did not provide cash prices for the
“Cracking the Code” project. Hancock Medical Center in Bay St. Louis, Miss., and Slidell
Memorial Hospital did not send statements. (Slidell later sent in prices.)
HCA Healthcare (Tulane Medical Center, Tulane Lakeside Hospital, Lakeview Regional
Medical Center)
“Our position remains that for a patient to get the most accurate account of what he or she will
pay for a procedure, that patient should call and discuss that specific circumstance with one of
our representatives. There are too many variables that affect a patient’s out-of-pocket expense for
broad estimates to be meaningful.
“This is an incredibly complicated issue. We want our patients to have a clear understanding of
their financial responsibilities for services at any of our facilities and have provided several
resources dedicated to helping them do so.
“We have had pricing information available online since 2007. This includes estimates for what
an uninsured patient should expect to pay for the most common conditions treated at the hospital.
It’s not possible to provide online estimates for insured patients because what they would be
expected to pay depends on their insurance coverage. We also provide a toll-free number for
consumers to call for financial information on services which are not listed and to ask questions
about their bills. We provide the same financial resources as all HCA facilities.
“The amount patients actually pay for hospital services has more to do with the type of insurance
coverage they have than ‘prices’ or ‘charges.’ Government programs like Medicare and
Medicaid determine how much they reimburse hospitals, and insurance plans negotiate rates.
Uninsured patients are eligible for free care through our charity care program or they receive our
uninsured discounts, which are similar to the discounts through private insurance plan. This is
why we urge patients with insurance to contact us for estimates specific to their procedure and
insurance coverage rather than relying solely on the online estimates provided for uninsured
patients.”
East Jefferson General Hospital
“East Jefferson General Hospital offers a standard 50-percent discount off of total billed charges
to our private pay patients. This policy best suits the needs of both our hospital and our patients
who choose to pay out of pocket.”
(Update: After we finished our reporting, a community member sent us this note in an email:
“Here is info I received some time back from EJGH:
‘Some patients prefer to not put their diagnostic procedures through insurance. For those patients, EJGH offers cash pricing on MRI, CT, X-Ray, and more.’
Contact an EJGH Financial Counselor for pricing @ 504-503-6961. www.ejgh.org
“I hope this info is still accurate & hope it helps.”)
Terrebonne General Medical Center
“Terrebonne General Medical Center (TGMC) takes a leadership role in educating our patients
and their families so that informed healthcare decisions can be made. TGMC accepts a wide
variety of insurance types; offers payment plans and works with patients to ensure an accurate
understanding of quality, safety, patient experience and financial considerations are
provided. Each insurance company negotiates pricing with healthcare providers based on numerous factors. Patient responsibility is based on the patient’s individual or employer based
health plan.
“TGMC works with each patient to determine an overall estimate of anticipated procedure and
payment options for the patients’ out of pocket portion. These individual consultations are
provided by financial counselors as we strive to meet the financial needs of each and every
patient.”
