Anyone who's had the pleasure of spending an afternoon trying to decipher a medical bill knows the pricing of healthcare is anything but simple. A new Trump administration regulation that the country's hospitals post prices for every procedure healthcare professionals might perform has shed light on just how expensive medical care in America is, but for the individual consumer the results are anything but illuminating. That's because the hospitals, lacking a unified billing system designed for the non-expert to understand, have spewed forth spreadsheets of gobbledygook likely to leave patients more confused than ever.
Why the price isn't quite right
America's healthcare system consists of a complex web of private insurance companies, government benefits programs (notably Medicare and Medicaid), pharmaceutical companies and providers. With so many cooks in the kitchen, it's little wonder trying to price the cost of, for example, a hip surgery isn't as simple as ordering jalapeno poppers off an Applebee's menu.
Here's an oversimplified (but still complex) breakdown of how you end up with the number you see on a medical bill.
The hospital sets a price based on its "chargemaster." Every medical action taken at a hospital has an associated price, and this data exists on a list called the "chargemaster" (these are the lists hospitals must now make available to the public online). When you have your knee replaced or are treated for pneumonia, every drug administered and medical procedure performed comes with a price tag. One example from New York's Mt. Sinai Hospital chargemaster list is a capillary blood draw (a method of drawing blood from the finger or earlobe instead of a vein) listed as $70. A more expensive procedure is a cardiovascular stress test with an ECG, which costs $1,050.
The hospital price is lowered. Patients rarely see the hospital's chargemaster price because some sort of third party almost always steps in to shoulder some of the financial burden. For about 156 million Americans (or 49% of those with some sort of health insurance), that's an employer-provided plan which covers a portion of the cost based on the individual's plan and how the procedure is covered under it. Even patients lacking any kind of insurance can usually count on a hospital's financial assistance program to shield them from the full chargemaster cost, though the final bill will still likely be more expensive than with insurance.
Even with all of those variables, you may think you can find the cost of a hospital stay beforehand by knowing what procedures you'll have performed on you and then checking with your insurance provider about the coverage for those procedures. The problem is that even with the chargemaster lists now posted to the public, those prices rarely remain static. Not to mention the procedures listed are rarely as understandable and all-encompassing as "cardiovascular stress test with ECG", with most entries resembling "CATH 135X.014 SUPPORT2" and "DEVICE SUTURE CPTR CAPIO SLIM." Even a simple surgery could encompass dozens of the procedures listed, and it's unlikely the hospital will be able to walk you through each one.
The Trump administration has stated its open to any and all suggestions about how to make the price lists more comprehensible to patients, according to reporting by the New York Times. Until the government's crowdsourcing bears fruit (which is even less likely during its shutdown), patients will have to continue on as before—and keep paying the price.