Hospitals across the nation rang in the new year with a new federal mandate.
The regulation that went into effect on Jan. 1 is aimed at disclosing to the public the pricing for all medical procedures performed at hospitals nationwide.
“This is a complicated issue,” said Allison Pollan, director of communication for UT Health East Texas, which includes the hospital in Athens. “The pricing online is a gross price. It does not include any discounts available to insurance companies or cash paying patients. This is more of a snapshot of the cost of hospital stays and procedures.”
According to the mandate through Medicare and Medicaid, all hospitals are required to make transparent all charges for every procedure, drugs and supplies available online. Most prices will not be paid by insurers such as Medicare and Medicaid because of lower negotiated pricing. And many hospital officials say after negotiations with insurance providers, patients could pay something different that what is posted online.
Some have argued that posting transparency will better inform the patient. The law is expected to allow patients to view the cost of a procedure or surgery before setting an appointment.
According to news reports, the Affordable Care Act requires hospitals to make such information available. The hospitals were not required to publish the information until this year.
“In an effort to promote price transparency, the Centers for Medicare and Medicaid Services (CMS) requires hospitals to post a list of standard charges annually,” according to the UT Health in Athens website. “While we support greater transparency around hospital pricing, billing for medical services is a complex issue and the charges listed in our hospital chargemaster do not provide a complete picture of what you may actually pay. Patients should view this information as only a starting point in determining their total financial responsibility.”
Some of the information provided on the website includes:
• Hospital chargemasters (or "list prices") only represent the hospital's gross charges for a service and do not include discounts negotiated by insurance companies or those provided to qualifying self-pay patients.
• In most cases, the patient's responsibility for these services is much lower than the posted price.
• In addition to special rates negotiated by health-insurance providers, individual patient payment responsibilities may vary based on the length of the hospital stay or the complexity of care.
• Hospital charges do not include fees from specific providers, such as surgeons, radiologists, anesthesiologists and pathologists. Those providers bill patients separately for their services.
The online pricing known as the 'chargemaster' includes thousands of entries using codes. For UT Health in Athens, it can be viewed at uthealthathens.com/billing-inquires. The website has a list of the hospital's chargemaster and a list of diagnostic related grouping (DRG).
The DRG determines how much Medicare will pay for a patient's hospital stay. Medicare pays the hospital a fixed amount based on the patient's DRG or diagnosis.
Patients who would like more information on UT Health pricing may call 903-676-1155.