DOTHAN, Ala. (WDHN) — In 2019, former President Donald Trump signed an executive order meant to provide transparency in healthcare.
This new federal rule went into effect at the beginning of this year, and while the name may allude to more clarity of medical pricing, that may not be the case.
“Hospitals were required to provide patients with information on the cost of various procedures and what they required hospitals to report was not necessarily the cost of a procedure, but we are required to provide the public with what our contracted rates are for all the various insurance companies,” said Dale Medical Center CEO, Vernon Johnson.
The mandate required every hospital to put a link on their website with a pricing grid. Unfortunately, the prices are listed by hospital billing codes, which most people are unfamiliar with. Johnson says for the general public, this means that this information may not be useful because every insurance carrier has different contracts.
“It all goes back to when someone is going to have services performed at a hospita. You need to number one, first and foremost, contact your insurance company and find out: Is it covered? What is your deductible? What is your copay? And your out-of-pocket expense. The contracted rates that hospitals negotiate with the large insurance companies across the country really does nothing in providing information for the patients as far as what a procedure will cost.”
One important thing to remember is the prices hospitals provide are just estimates; there are variables that could change the total cost of hospital care.
“The cost is going to depend on the status of your insurance, any changes in your insurance, how long were you in the hospital, did the doctor order additional tests that were required to help treat you while in the hospital that were unforeseen, and what kind of costs were affiliated with your recovery that were unforeseen. So, any information that you get prior to going and having a procedure is just that, an estimate,” Johnson said.
As the Price Transparency Act goes, Johnson says he thinks the stance of the Alabama Hospital Association is that there is just a lot of confusion surrounding the information the hospitals were forced to put out.
“I think in its current state it’s going to prove to be more confusing for the general public than it is beneficial,” Johnson said.
For individuals who do not have health insurance, they are encouraged to call the hospital ahead a time and set an appointment with a patient representative who will help work out the estimate of care and, if needed, work out a plan for payment.