Hospital Pricing Remains Cloudy — Even Under CMS Transparency Rule

For better or worse, in America’s health care market, patients would do well to shop around when they can. Even a very common procedure, like vaginal childbirth, can range wildly in cost depending on the hospital.

And according to a secret shopper study recently published in JAMA Internal Medicine, even those who comparison shop are likely to stay in the dark.

Although a U.S. Centers for Medicare & Medicaid Services (CMS) rule requires hospitals to provide pricing information about shoppable services, the study’s writers found major discrepancies between the prices listed online and those quoted over the phone. Estimates often differed by 50% or more.

Given the already extreme cost of medical care in the U.S. as relative to other high-income countries, those ambiguities can translate to thousands of dollars in medical bills, even for patients who’ve gone out of the way to comparison shop their care.

How much does medical care cost? Hospitals can’t say

While patients may have little control over where they receive emergency services, planned procedures, like childbirth and brain scans, are a different story.

Because costs can vary widely between hospitals — and even, some research has shown, at the same hospital, depending on a patient’s insurance coverage — the CMS rule was meant to increase price transparency and help consumers find the most affordable care possible.

In this case, clarity can mean the difference between a $0 childbirth and one that costs $55,221, according to the range of online prices collated by the JAMA Internal Medicine study, which queried 60 U.S. hospitals for price estimates both online and by phone between August and October 2022. (The researchers asked for prices for both vaginal childbirth and brain MRIs.)

Price discrepancies were, unfortunately, the rule rather than the exception: Of the hospitals that responded to both requests, the prices were identical only 14% of the time in the case of childbirth, and 19% of the time in the case of brain MRIs.

Worse yet, despite the risk of fines, only about a quarter of hospitals were compliant with the CMS rule as of February 2023 — so in most cases, patients are unable to get any price information whatsoever, let alone accurate price information.

How to ensure you’re getting the best price on health care

While there’s little consumers can do about the lack of price transparency in American hospitals, there are still steps patients can take to ensure they’re getting the most affordable health care possible.

For instance, comparing quotes when purchasing health insurance — and carefully reviewing policy materials to ensure the services you’re most likely to use are well priced — is one way to reduce overall yearly health care costs.

Furthermore, ensure you understand important insurance lingo relevant to your financial responsibility, like the difference between a deductible and an out-of-pocket maximum.

You can also find ways to save money on prescription drugs, like shopping around for the best Medicare Part D plan, if you’re eligible, or utilizing an online pharmacy.

And, of course, you can make the effort to call your hospital ahead of time or look for pricing information online if the service you’re in need of is a plannable one — although, as these studies suggest, your efforts may or may not give you an accurate picture of your actual financial responsibility.

And if you’ve already undergone a procedure and are facing steep medical bills, you may be able to negotiate with your provider or insurance carrier — or both. A professional patient advocate may be able to help if you don’t know where to start.