Hospital hallway

National Survey Finds Limited Access To Price Estimates For Routine Hospital Procedure

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Price for MRI of knee ranges from $400 to $4,544

BOSTON – A survey of 54 hospitals in six metropolitan areas across the United States reveals that consumers seeking a price estimate for a routine medical procedure face a difficult and frustrating task, despite price transparency provisions in the Affordable Care Act and five of the six states, according to a new Pioneer Institute Policy Brief.

For “Healthcare Prices for Common Procedures Are Hard for Customers to Obtain:  Survey finds hospitals not prepared to give price information to consumers,” researchers called hospitals in and around Des Moines, IA, Raleigh-Durham, NC, Orlando, FL, Dallas-Ft. Worth, TX, New York, NY and Los Angeles, CA asking for the price of an MRI of the left knee without contrast.  For 57 percent of the hospitals it took more than 15 minutes to get a complete price that included the radiologist’s fee for reading the MRI.  Two-thirds of the time, researchers had to call a separate number or organization to obtain an estimate for the reading fee.

Watch: Report authors Barbara Anthony and Scott Haller interviewed on nationally syndicated investigative news program, “Full Measure.”

Also covered in Modern Healthcare: “Hospital prices are still hard to come by (and not very useful),” Becker’s Healthcare: “Healthcare price transparency across the US: How did hospitals in 6 cities fare?“; CNBC: “There are better prices for health care—know where to look.“; Healthcare Finance: Price estimates for routine medical procedures prove elusive, study finds; MarketWatchPrice your colonoscopy like you would a TV; The Washington Post: Why savvy shoppers can’t fix health-care spending

“With the rise of high-deductible health plans, the wide variations in price, and the fact that in the areas surveyed there are 15 million uninsured people, it’s more important than ever for consumers to have access to accurate price information,” said Pioneer Institute Senior Fellow in Healthcare Barbara Anthony, who wrote the report with assistance from Scott Haller.  “We must create a culture of consumer-friendly price transparency in healthcare.”

Complete price estimates could not be obtained from 14 of the 54 hospitals despite as many as 11 calls.

Of the 40 hospitals that provided complete information, MRI price estimates ranged from $400 at Huntington Hospital in Los Angeles to $4,544 at New York City’s Montefiore Medical Center.

It was clear to the researchers that front-line employees at most of the hospitals had no idea what to do with price requests.  They experienced long waits on hold, had to call multiple times and leave messages, endured multiple transfers and ultimately a number of dropped calls.

Almost none of the hospital websites provided easy access to price information.

“The fact that there are people with high-deductible health plans who are foregoing care rather than value shopping has led some to conclude that consumers aren’t interested in price data,” said Pioneer Institute Executive Director Jim Stergios.  “But the real issue is that price information isn’t readily available in the healthcare marketplace.”

The following nine of the hospitals did very well and appeared to have systems in place to provide price information in a relatively organized, consumer-friendly way:

  • The Iowa Clinic, Des Moines
  • Dr. P. Phillips Hospital, Orlando
  • Dallas Regional Medical Center
  • Cedars Sinai, Los Angeles
  • NYU Langone, New York
  • Mount Sinai, New York
  • Wake Med Cary Hospital, Raleigh/Durham
  • Duke University Hospital, Raleigh/Durham

Anthony and Haller recommend that governments, providers and insurance carriers educate consumers on the importance of price transparency.  They also call on hospitals to train their staff on how to handle price estimate requests.  With guidance from the federal government, hospitals should also make price information more accessible on their websites.

Barbara Anthony, a lawyer, is a senior fellow in healthcare at Pioneer Institute focusing on healthcare price and quality transparency.  She is also a senior fellow at the Harvard Kennedy School’s Center for Business and Government.  She served as Massachusetts undersecretary for Consumer Affairs and Business Regulation from 2009 to 2015.

Scott Haller is a senior at Northeastern University pursuing a degree in political science.  He began working at Pioneer through Northeastern’s Co-op Program and has continued as a research assistant.

Pioneer Institute is an independent, non-partisan, privately funded research organization that seeks to improve the quality of life in Massachusetts through civic discourse and intellectually rigorous, data-driven public policy solutions based on free market principles, individual liberty and responsibility, and the ideal of effective, limited and accountable government.

  • Pav Sterry

    There is no reason doctors and hospitals can’t post online what prices for their time and services are. After much investigation I found The Surgery Center of Oklahoma will give you the price up front and Mercy hospital in Las Vegas has discounts for cash and will tell you the price for the operating theater , nurses, anesthesiologist, and some area surgeons will tell you their prices. They also have discounts arrangements with local hotels for people coming out of town/state/ country.

  • Mary Smith

    It is such a secret what hospital services cost. I had the run around after the fact with my daughters bills because the hospital couldn’t explain why certain things were charged. The one I was shocked the most is she was in the hospital, a neurologist came to her room to see her for about 15 minutes. She received a large separate bill because that physician group didn’t take her insurance. So are we supposed to ask everyone that walks into our hospital room if this is going to be covered? The lack of transparency is created by healthcare services to “fool” the patient and regain costs by the patients who give up fighting the bill and give up and pay.

  • Ed

    The simple solution is a consumer protection law making it illegal to attempt to collect any medical bill that doesn’t meet the stipulated transparency criteria — prohibit it from going onto people’s credit rating, which MA can do in a number of ways. When people start realizing their bills will be uncollectable unless certain documentation is met, it will be met…

  • BYoung

    I am middle of arguing with University of Utah health system with charged service fee which it never served us. Last year we went Utah for mountain bike trip and my son had accidentally broke his arm. I am educated in Nursing although never practiced, and HIT in billings and coding. I understand why they have charged me without service, because it was “automated system” in billing that Physician has to sign out as service provided. Here is truth not many other people understand, we do not have access to charge master( hospital pricing) but we can access or ask for coding for what has been charged. When you know the coding put in online for it, most you will get the answer what service is under that code. If it has not related to you but has been charged, you can contact them and ask or dispute the charges. But I am also having difficult communicate with hospital, after many time over phone expression and emails and letters and they are still “right” and I am wrong, when the facts are other way around. I need to know where to look for help, if anyone please le tme know!!!