Healthcare Pricing – No Longer “Clear as Mud”

Did you know the actual costs prior to your recent hospital visit or surgical procedure? If you answered “No,” you’re not alone. Healthcare pricing is a gray (very dark gray) area for most patients. Thankfully, as we head into 2019, there are steps being taken to make healthcare pricing more transparent.

Based on a new federal rule that took effect January 1, 2019, all hospitals are required to post a list of standard charges for any service they offer. Hospitals are required to posts these lists online, and in a format that is easily downloadable and accessible for patients. While hospitals were always required to have a “price list” available for patients, in most cases those lists were only available to patients that “asked” for them. Under the new rule, hospital pricing is now available to everyone, at any time, at the click of a button.

This new rule will give patients a better understanding of the financial implications of any service they receive at a hospital, and will also allow them to “price shop” among multiple facilities in their area for the best value for the care they need.

It probably comes as little surprise that most hospitals are not welcoming this new rule with open arms. According to a recent poll (, 92% of providers are concerned about the new hospital price transparency requirement. It seems the basis for these concerns is “public perception” – or simply put, “sticker shock.” In other words, providers are worried that patients now have easy access to how much they are being charged for services!

In another, much needed, step towards providing transparent pricing for patients, the Centers for Medicare & Medicaid Services (CMS) launched a new tool in late November that allows patients to compare Medicare payments and copayments for certain procedures performed in hospitals or ambulatory surgical centers (ASC). This “Procedure Price Lookup” tool displays the national averages for the amount Medicare pays the hospital or ASC and the national average copayment amount a beneficiary with no Medicare supplemental insurance would pay the provider.

According to CMS Administrator Seema Verma, “the Procedure Price Lookup will help patients with Medicare consider potential cost differences when choosing where to have a medical procedure that best meets their needs.” The Procedure Price Lookup tool is available here.

For too long, the majority of patients have been kept in the dark when it comes to healthcare prices. How much is this going to cost me? How much is my insurance going to cover? Is there a cheaper alternative? Thankfully, some of these questions are now being answered, and as a result, the power of personal healthcare is being returned to the people – where it belongs!