The Price You Pay: Hospitals are posting procedure costs online, but consumers say price tags can still be hard to find

Experts say compliance with transparency rule is improving, but not all patients are experiencing the full benefits
Compliance with the price transparency rule is improving, but prices are still hard to find. Reporter: Rachel DePompa, Videojournalists: Daniel Heffner
Published: Aug. 7, 2023 at 12:29 PM CDT
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(InvestigateTV) — For more than two and a half years, hospitals across the country have been required to publicly post online their prices for standard charges and the negotiated rates for common health services and procedures.

The Hospital Price Transparency Final Rule was billed as a way to maximize transparency by helping consumers know costs before receiving treatment. The rule, which went into effect Jan. 1, 2021, requires each hospital to provide “clear, accessible pricing information online” in two ways:

  • A comprehensive machine-readable file with all items and services (e.g. excel, JSON files)
  • A consumer-friendly display for shoppable services (a cost-estimator tool)

Hospitals found out of compliance with these requirements can face monetary penalties of up to $5,500 a day.

However, despite the push to make finding prices easier for patients, an analysis by InvestigateTV found that, in many cases, the information is still hard to find and confusing, with inconsistencies from hospital to hospital.

“I think about clients I’ve dealt with in the past as a caseworker, in this day and age, there are some people who don’t even know how to use a computer,” Virginia resident Veronica Blount said. “There are some seniors who don’t know how to use this and people who don’t have access because they don’t have [a computer] in their home or they don’t have internet.”

Blount, who previously worked in health departments and is now a member of AmeriCorps, said it is critical hospitals simplify the process of finding medical costs, —particularly for patients who do not have insurance.

“For a lot of people who are under-insured or not informed enough about insurance and are not educated about insurance and not know what to ask, then yes, that’s an issue,” Blount said. “So, you should be informed on all accounts when it comes to your health care because it’s your body.”

Navigating hospital websites and compliance

In 2022, the Centers for Medicare & Medicaid Services (CMS), the federal agency that implemented and is tasked with enforcing the Hospital Price Transparency Final Rule, found 70% of hospitals complied with both components — an increase from the year prior.

While a majority of hospitals follow the transparency requirements laid out by CMS, researchers such as Morgane Mouslim and Morgan Henderson at The Hilltop Institute at the University of Maryland in Baltimore County, still believe there is work to be done.

Mouslim and Henderson have been studying hospitals’ compliance with the rule since it was first implemented. While their research has found compliance is improving, especially for larger hospitals, they’ve also found it can still be difficult for an average person with limited medical knowledge to navigate.

“Consumers right now, I don’t believe they are able to get the full benefit of [the Hospital Price Transparency rule],” Henderson said.

Mouslim agreed.

“It is very difficult for an individual patient to figure out the information they need to effectively shop,” she said.

Hospitals use cost estimator tools to help patients find the cost of different procedures. But...
Example of a price estimator tool. Patients are often asked to put in personal and insurance information before they can access the tool.(InvestigateTV)

If the rule is followed as intended, patients should be able to easily find and access a cost estimator tool on a hospital’s website. Once the patient provides certain personal details, including any insurance information, the tool calculates the estimated out-of-pocket hospital costs based on the selected procedure.

InvestigateTV spent months trying to find price information at 74 of the nation’s largest hospitals. Of those, 77% were found to have a tool designed to help patients determine hospital costs as well as a comprehensive price list.

However, finding the tool or the approximate out-of-pocket cost wasn’t always easy.

At one Atlanta hospital, patients have to scroll all the way down to the bottom of the homepage to find a “Price Transparency” tab, which houses the hospital’s cost-estimator tool. However, patients are required to put in insurance information to access the tool, and patients without insurance can’t access pricing information.

In another instance, InvestigateTV noticed the need to use specific keywords to access pricing.

On a New Mexico hospital’s website, information was difficult to find, as it was located at the bottom of the page under an “About your insurance” tab.

In other websites reviewed by InvestigateTV, some hospitals only had download links for large, complicated files that require a special program to open.

CMS has imposed civil monetary penalties on seven hospitals — two in Georgia, two in Texas, one in New Hampshire, one in Arkansas, and one in Illinois — for noncompliance with price transparency requirements. The penalty for one of the Texas facilities is listed as “under review” on the CMS website.

Those penalties totaled just under $2.3 million.

Before receiving a penalty, the hospitals were first sent warning letters and asked to create a corrective action plan to follow these regulations within 45 or 90 days but failed to do so.

CMS told InvestigateTV it has issued more than 730 warning notices to hospitals out of compliance with the rule, with more than 260 of those facilities receiving a follow-up letter requiring a plan to come into compliance.

Hospitals noncomplaint to the hospital price transparency rule received warnings and follow-up...
An example letter issued by the Center for Medicare and Medicaid Services. The agency has sent more than 730 warning notices to hospitals for noncompliance.(InvestigateTV)

In April, the federal agency finalized updates to its enforcement process in an effort to streamline the compliance process.

“These enforcement updates will shorten the average time by which hospitals must come into compliance with the hospital price transparency requirements after a deficiency is identified to no more than 180 days, or 90 days for cases with no warning notice, and will complement future efforts,” the announcement for the changes reads.

U.S. Sen. John Kennedy criticized CMS’ enforcement of the rule and said the agency has the authority to call out hospitals that are “playing games” with consumers.

“I’ve gone to these hospital websites. They either don’t post their prices, or it would take ‘Dog the Bounty Hunter’ to find out where on their website they’ve posted it,” the Louisiana Republican said. “You got to click here and click there and click there and then click there to get there and then it’s written in a foreign language.”

Kennedy introduced a bill in February — the Hospital Transparency Compliance Enforcement Act — to increase the civil monetary penalties for hospitals that fail to comply with the transparency rule.

Senator John Kennedy (R-Louisiana) is working to pass a bill that requires hospitals across...
Senator John Kennedy (R-Louisiana) is working to pass a bill that requires hospitals across the country found noncompliant to the rule to pay fines in civil monetary penalties. Only seven hospitals have been fined since 2021.(InvestigateTV)

The bill would double the current penalties for noncompliant hospitals, with larger hospitals paying as much as $11,000 per day.

CMS declined an on-camera interview request. Instead, a spokesperson provided InvestigateTV with the following statement on behalf of Deputy Administrator and Director Dr. Meena Seshamani:

“CMS is committed to ensuring consumers have the information they need to make fully informed decisions regarding their health care. We expect hospitals to comply with Hospital Price Transparency requirements, and are actively enforcing these rules to ensure people know what a hospitals charges for items and services.”

The spokesperson also noted that the specifics surrounding compliance and the status of hospitals are not publicly available until after civil monetary penalties are issued.

Streamlining the process

While Kennedy’s bill has not yet been passed, at least 23 states have enacted laws to help enforce the price transparency rule.

Arizona passed SB 1603 in March. The law requires the Arizona Department of Health Services to confirm hospitals are following the federal hospital price transparency regulations annually.

Under Illinois’ Hospital Price Transparency Act, licensed hospitals are required to maintain publicly available lists of standard charges and shoppable services.

Colorado took a different approach: The state passed legislation that prohibits hospitals not in compliance with the price transparency rule from pursuing collection actions against patients for outstanding medical debt.

Molly Smith, vice president for public policy at the American Hospital Association, which lobbies on behalf of hospitals across the country, said implementation of transparency regulations is an evolving process.

“There’s just a lot of noise out there about price transparency and where to get estimates,” Smith said. “Frankly, I can appreciate why it can be very confusing for patients to try to navigate all of that.”

Smith said AHA helps hospitals understand what’s required of them and provides information on resources available to help them comply. She said the AHA has provided the government with recommendations it feels will help streamline existing transparency policies.

“We really need to streamline all of that and probably remove some of those just to get rid of confusion and really focus on these patient-specific cost estimates that we think will matter most to them,” Smith said.

Conversations about clarifying transparency requirements have already happened within the U.S. House of Representatives. The House Committee on Ways and Means held a hearing in May concerning price transparency.

“We can get more information about a local resident from Yelp than you can get about your local hospital from CMS,” Committee Chairman Jason Smith, R-Mo., said during the May hearing.

While agreeing regulators could streamline the process, Henderson, with The Hilltop Institute, said he believes the future is bright for consumers.

“I don’t believe these [tools] are useful for consumers yet, however, I’m optimistic in the five-to-10-year time horizon that it will ultimately,” Henderson said.

In the meantime, he suggested patients ask their doctor for the specific billing code of a test or procedure to help find accurate price estimates. He also suggested patients call their insurance company for price information specific to their plan.

AHA said those struggling to find the cost of a procedure on a hospital’s website could reach out to a hospital’s financial office.

Bailey Williams contributed to this report.