New requirements for hospitals to post prices begin January 1

National and World

KANSAS CITY, Mo. – Starting January 1, hospitals will have to tell you how much you have to pay for certain services ahead of time. 

The American Hospital Association just lost its appeal of a federal agency’s new rule Tuesday.

These days you can shop for just about anything online, except healthcare. On the surface the Centers for Medicare & Medicaid Services rule should create a system as easy as online shopping. But experts say it may not be quite as transparent as it sounds. 

“There really isn’t any other area of our lives where you find out what it’s going to cost when its time to pay. And at that point you can’t give it back and if you don’t like it you can’t get your money back,” Michael Abrams, Numerof and Associates Managing Partner, said. 

The final rule requires hospitals to post their “standard charges” online. That means they have to post negotiated insurance payer rates online for 300 services that patients are likely to shop around for.

Seventy requirements include things like X-rays, MRIs, lab work and joint replacements. But examples provided in the rule differ on what’s considered consumer-friendly price information.

“When you get a hospital bill that’s what it’s going to look like, all this complexity line item by line item. If that’s what they are going to show it’s going to put the burden on the consumer to add it all up and make sense of it,” Abrams said. 

What’s still unclear is whether the pricing will be interactive. Lots of factors can affect what you pay, including your deductible and co-pays and maximums.

“Unless you can provide all this data you can’t get a final answer to what’s my out of pocket which is what everybody wants to know,” Abrams said. 

In its appeal, the American Hospital Association said it believes the disclosure of privately negotiated rates won’t help patients understand what they will actually pay for treatment and the rule will only create widespread confusion.

With that appeal just denied December 29 and a new administration coming in, there are also questions whether hospitals will comply with the new rule. But they’ll face $300 a day fines starting Friday if they don’t.

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