Hospital Price Transparency: What You Should Know

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Hospital Price Transparency: What You Should Know

Cost Transparency

The most recent data on healthcare spending in the United States shows that the average American spent $11,582 on healthcare in 2019. We know that wealthier nations typically spend more on individual healthcare than other nations. However, the US rates are more than forty percent higher than the next nation on the list, Switzerland.

Here at Innova Primary Care, we believe that truth and transparency matter within healthcare. One of our core tenants is “mending people, mending standards.” We believe that caring for patients goes hand in hand with caring for the healthcare systems they are a part of. Truth matters in all facets of life, and the care you receive is no different. We do not want our patients to become so burdened by healthcare costs that they do not come in for routine appointments or call us when they need it because of fear of pricing.

Transparency in healthcare matters

Healthcare affordability is a topic close to the hearts of most Americans. Estimates show that close to twenty percent of the gross domestic product (GDP) here in the United States comes from healthcare costs, which are expected to rise in the future. According to the Centers for Medicare and Medicaid Services, healthcare expenditures are expected to reach $6.2 trillion by 2028.

In 2019 all aspects of healthcare spending increased. For example, Medicare spending increased by 799.4 billion dollars. In addition, Medicaid expenditures grew by $613.5 billion, out-of-pocket health expenditures grew by more than $4 billion, and private insurance spending rose by 3.7%.

The cost of healthcare will continue to rise. Now more than ever, it is essential that insurance companies and those who provide care are honest about the fees they charge and how those fees trickle down to consumers. You have the right to know what you are paying for. Unfortunately, and for far too long, consumers have been left in the dark wondering how much they will be charged for services from healthcare providers.

Medical Billing Transparency

Transparency is required

Did you know that as of January 1, 2021, all hospitals must “provide clear, accessible pricing information online about the items and services they provide?”

So, what does this mean? All hospitals within the United States must publish their payer negotiated rates with insurance companies online in a machine-readable format. In essence, hospitals charge a specific rate for every service they provide. Insurance companies then negotiate the price they will pay to cover said service. The coverage you receive from your insurance company will depend on the negotiated rate and your individual plan.

The coverage your receive depends upon the coverage you have from your insurance provider. If they do provide coverage, the rate may be different than if another company covered you.

Confused yet?

It often feels like insurance companies keep their consumers in the dark with esoteric messaging that leaves people in the dark. Rather than doing the hard work of investigating charges, many people with coverage just assume they cannot find answers and pay what their insurance company tells them to pay for services.

Depending on who you choose for your health insurance coverage, your hospital visit may require you to pay more or less for the same service. It isn’t fair. But this is just how insurance works.

Why transparency matters

Until the January 1, 2021 law for hospital transparency went into effect, consumers had no way of knowing what their hospital charged for the services they provide. This left consumers in a world of unknowns, even those with insurance coverage. This law makes it easier for patients to find answers to their questions without the run-around typically associated with such questions.

Price disclosure matters because it allows you, the healthcare consumer, to make informed decisions about the care you receive. Not only this, but research implies price transparency can assist consumers with healthcare costs, something we all need.

Medical Billing Transparency

The truth is, we still have a long way to go

This is the first step in creating transparency across the board. Still, it is one we believe is vital for patients and providers alike. For Innova patients specifically, you may remember speaking with Cindy about our costs and signing a patient agreement.

While we are not a hospital, we decided to go ahead and be at the forefront of the transparency movement with our patients. Information is power for health care consumers. We want this for you. Patients who understand and are aware of charges from our office are empowered. We believe that truth yields power, and as a patient-centered practice, we desire informed patients who know what is expected of them and to them.

Don’t walk your healthcare journey alone

Believe it or not, fees and pricing are not at the forefront of our minds here at Innova Primary Care. Our main objective is to treat those we care for, mind, body, and soul. If insurance and fees were not such an ingrained aspect of medical practice, it would be better for us all. However, we have institutions in place and boundaries we must work within. Our mission is to transform medicine from the inside out. One of the ways we are doing this is by being ahead of the insurance game. We must respect the borders in place, but we always put people first. If you have any questions about your coverage, please reach out. We want to see our patients healthy and thriving and we will work with you to help you understand your coverage. We consider healthcare to be a symbiotic relationship. One where we work together for the good of all involved.

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