NOT THAT SIMPLE: Hospitals’ online pricing can be hard to analyze

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GREENFIELD — Amanda Hinkle’s big toe has been hurting every day, with every step, for almost two years.

A bone spur and arthritis, causing that nagging ache, led Hinkle to schedule an elective surgery for today at Hancock Regional Hospital to correct the issues. She scheduled another procedure earlier this month, knowing between the two, she’d reach her insurance deductible.

She expects a call from her insurance company telling her how much she’ll pay out of pocket for the surgery on her toe, she said. She didn’t do much research into how much the procedure will cost; the pain is affecting her quality of life, so she is willing to pay whatever it takes to make that pain stop, she said.

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Now, a new requirement put in place Jan. 1 is supposed to help people like Hinkle learn up front what a procedure will cost, taking some of the guesswork out of finding affordable care. Hospitals now must post a list of their procedures and how much every one costs, in an attempt to make it easier for patients to know what their bill will look like.

Hancock Regional Hospital posted its list of prices, known in the industry as a chargemaster, on Dec. 27, days ahead of the Jan. 1 deadline set by the Centers for Medicare and Medicaid Services as part of a new federal law requiring hospitals to post such costs in a “machine-readable format” to allow consumers to download them into a spreadsheet.

The sweeping law is part of the government’s Meaningful Measures initiative, an effort to increase patient safety, quality of care and transparency.

But while the effort is designed to demystify the billing of medical procedures, it’s a long way from the relatively simplicity of comparison shopping for, say, a new car. Officials say releasing hospitals’ chargemasters isn’t the best way for patients to get an idea of how much they will pay for their medical care, because the listed costs don’t reflect how much their insurance will cover. The chargemasters also don’t take into account other variables that might arise during the course of care. Nor do they cover physician costs.

In short, critics say, the data will be of limited help.

“The number one complaint from hospitals is, how is this going to be helpful?” said Brian C. Betner, a health care attorney at Hall Render Killian Heath & Lyman in Indianapolis. “Because the default rate in the chargemaster is rarely the price that the consumer is going to pay.”

And patients don’t often know how many different supplies and services might be a part of their treatment, said Jennifer Cox, director of marketing for Hancock Regional Hospital.

“The prices on the chargemaster list are generally not the actual payment rates that hospitals receive,” Cox said in an email.

So, what is the best way to figure out how much a procedure will cost? Working with the hospital and the insurance company is still the best way to get a good idea about the patient’s share of the bill, Cox added.

Hancock Regional Hospital offers a cost estimator on its website for some limited services, but Cox said other tools are available to get a better idea of what the real out-of-pocket costs for procedures at Indiana hospitals would be.

The Indiana Hospital Association offers an online tool, mycareINsight.org, that allows patients to compare hospital quality ratings and average charges for a few dozen medical procedures, from a heart bypass to a leg amputation. That information comes from data hospitals submit to the Indiana State Department of Health.

Cox said while the prices listed are for a basic procedure with no complications, the website can help patients get a better idea of what they’re likely to pay at participating Indiana hospitals.

Cox encouraged patients to work with their insurance company, hospital or other healthcare provider to get an idea of how much a procedure will cost before it takes place.

“We believe and agree with increased transparency, and releasing chargemasters is a step in the right direction,” she said. “But it doesn’t necessarily give the best answers.”

Other area hospitals serving county residents agreed that working with a hospital’s billing department or a patient’s insurance company will often provide a more accurate idea of the cost of services.

Community Health, which has imaging, rehab and specialists’ offices in Hancock County, has provided a link on ecommunity.com including standard charges and their associated descriptions, said Kipp Finchum, Community Health Network vice president of revenue advisory services.

He echoed the sentiments of Hancock Health in warning patients those listed prices aren’t reflective of what they’ll actually pay.

“The amount a patient pays is based on many factors including health insurance, benefit plan design, other applicable discounts as well as the services provided to the patient based on their unique needs,” Finchum said in a news release. “We believe the new requirement will likely be confusing and frustrating for consumers.”

In 2015, Community Health Network launched its central pricing office to provide customers with an out-of-pocket estimate based on their unique services required and their insurance coverage if they have it.

Consumers can access this service by contacting the Central Pricing Office at (844) 786-9503 or (317) 355-9279 Monday through Friday from 9 a.m. to 5 p.m., where analysts are available to answer questions and to provide an estimate of their financial obligation. Consumers can also initiate their request by completing an online form that can be accessed at ecommunity.com/central-pricing-office.

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Hancock Regional Hospital’s price list is  offered as part of a cost estimator on its website. Go to www.hancockregionalhospital.org, select “Patients,” and then click on “Cost Estimator.” You can access the spreadsheet there. It has more than 8,000 entries, so you might need to search for the price you’re seeking.

The Indiana Hospital Association offers an online tool, mycareINsight.org, that allows patients to compare hospital quality ratings and average charges for a few dozen medical procedures.

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