Posted and filed under Commentary.

Thank you Scott Rosenbaum, Wine & Spirit Business Advisor, who is one of our most well read and insightful/thought provoking collaborator shared this New York Times article with us: Hospitals and Insurers Didn’t Want You to See These Prices. Here’s why.

Scott is an experienced, process-driven strategist and educator working in the wine and spirits industry. He’s inspired by design thinking and analytical reasoning that improve protocol, profitability and efficiency. He’s also an adjunct professor. Bottom-line: he’s a pretty cool guy. 

The reason we shared Scott’s background is to show how our collaborators come from all different areas and industries.  More importantly, this article impacts all of us. Even if you don’t follow health insurance and healthcare prices (not sure who that person is because now everyone cares about the cost of healthcare), you still have probably seen that the federal government ordered hospitals to begin publishing a list of the prices they negotiate with private insurers. So what does that mean?

“An MRI at Mass General costs $1,019 with a Cigna plan, $3,809 with a Humana plan”, as shown in this NY Times article.

Highlights around this issue include:

The insurers’ trade association America’s Health Insurance Plans (AHIP) called the rule unconstitutional and said it would “undermine competitive negotiations.”. It isn’t only MRIs, it is also simple procedures such as pregnancy tests that cost widely different amounts for basic services. “More Americans than ever are enrolled in high-deductible plans that leave them responsible for thousands of dollars in costs before coverage kicks in.” and “Patients often struggle to afford those bills. Sixteen percent of insured families currently have medical debt, with a median amount of $2,000.”

These prices aren’t the be all end all because “a single insurer can have a half-dozen different prices within the same facility, based on which plan was chosen at open enrollment, and whether it was bought as an individual or through work” or “Employers are the largest purchasers of health insurance and would benefit the most from lower prices. But most select plans without knowing what they and their workers will pay.”

However, NY Times showed “At the Biggest U.S. Hospitals, Few Prices Are Available”. Six months after the new rules took effect, The Times reached out to the 10 highest-revenue hospitals that had posted little or no data about their negotiated rates or cash prices. Here’s what they had to say:

  • “Services that do not have a fixed payer-specific rate are shown as variable.”
  • “We do not post standard cash rates, which typically will not reflect the price of care for uninsured patients.”
  • ” We are continuing to work on the machine-readable file that includes payer-negotiated rates. … It involves analyzing a daunting number of data points.”

Here’s How to look up prices at your hospital (if they exist)

By Jeanmarie Loria