This year, some Americans can do something that was previously impossible: look up the price of care before going to the hospital.
A new federal rule requires hospitals to publish the prices they negotiate with private insurers.
The data is a rich source of new information. We used it to show that some insurers pay two or three times as much as their competitors for basic services – and that paying cash instead of using your coverage can often lead to a lower price.
But most hospitals have not yet published the necessary data. Even if they have, finding it can take time and legwork. You may also need to be a computer programmer to open it.
“Have some coffee and have a drink because it’s going to be a while,” said Touré McCluskey, co-founder of health start-up Redu Health, which collected some of the data files. “Information is available, but it is not customer-friendly.”
To help those who want to try it, we interviewed several researchers who spent months collecting the data. They recommended several simple strategies.
What you need to know to get started
Before looking for pricing, you’ll want to know what type of health insurance you have — both your insurer’s name and details like whether you chose an HMO plan during open enrollment or went with a PPO option.
Insurers often have half a dozen rates within the same hospital. Some are specific to which plan you chose and whether you purchased the insurance through the Obamacare marketplace or a specific employer. Others have to do with which network you chose when you signed up for coverage.
Knowing what type of insurance you have can help you better understand what prices in the data apply to you.
Then do a search on the internet
For most hospitals, the data is placed on a page labeled ‘price transparency’. Many researchers say they look for price files by doing a Google search for that phrase and the name of the hospital.
“That search should lead you to a top result that has something to do with billing price estimates or patient information,” said Morgan Henderson, a health economist at the University of Maryland-Baltimore County who worked with The Upshot to collect the price files. used in our recent articles. “Sometimes what you want is at the very bottom of that page, or you have to follow a few links.”
The page should look something like this from MedStar Hospital Center, the largest hospital in Washington, DC
The hospital’s price transparency site will likely have multiple sections and links, and the labeling of the price files is not always clear. Look for something like a “comprehensive machine-readable file” or “negotiated price list”.
It’s also worth opening files described as “standard charges” or a “charge master.” Here’s how those look at Indiana University Health:
If you open the files, you’ll see that it also has the hospital’s negotiated rates and cash prices.
This is what you are looking for
The government has not created a standard format for hospitals to report their pricing data, and each hospital seems to take a slightly different approach.
Some put their data in Excel or CSV files, which you can open with free software like Google Sheets. But some use JSON files, a data format commonly used by computer programmers and professional data scientists that ordinary people may have trouble opening.
“I’m trained in health economics and policy, and I’m working on a machine with a lot of memory space,” said Morgane Mouslim, also a health economist at the University of Maryland-Baltimore County, who helped The Upshot collect and standardize data files. “If a file is not in Excel, you may need additional software.”
A typical dataset lists prices per procedure for each insurer, such as this one from the University of Pennsylvania hospital:
The five-digit numbers to the far left of this spreadsheet are CPT codes, which hospitals use to describe every service they offer. Most files also have short descriptions for each code, but they can be confusing. For example, code U0003 is translated as “PR COV 19 AMP PRB HIGH THRUPUT” – a jargony way to describe a coronavirus test.
To find out the cost of a specific service you expect to get at a hospital, you will most likely need to call the facility and ask what CPT codes it will charge for your visit.
You may also see other numerical codes, sometimes referred to as procedure codes or income codes, as in the file below from Baptist Medical Center in Little Rock, Ark. You probably don’t need to pay much attention to this and you should focus on the CPT codes. (If the CPT codes are not labeled, you can generally recognize them as the five-digit codes.)
Usually you should see dollar numbers that represent the real prices. But you may come across files stating the price as “variable,” meaning it may be different for two patients with the same insurance who received the same care under different circumstances.
Molly Smith, vice president for public policy at the American Hospital Association, gave the example of a patient coming to the hospital for a flu vaccine versus someone who happens to get one for surgery.
“In the contract, we generally negotiate the price of the primary service, but if it’s a secondary service, maybe 15 percent will be deducted,” she said. “It’s not possible to display that in these files.”
The files must also contain two other prices: the ‘surcharge’ or ‘gross price’, the sticker price for a particular service that hospitals often use as a basis for negotiating discounts. There should also be the “cash” price, which the hospital charges to patients who don’t use insurance. Whether this price is available to patients with insurance varies from hospital to hospital. Some low-income patients may qualify for even higher discounts based on how little they earn.
Once you’ve found the data point you’re looking for, some extra work may be needed to understand it. Most hospitals list prices in dollars, but some show the data as a percentage of the gross amount – meaning patients have to do math to understand their costs.
What if I can’t find anything?
Most hospitals have not posted the necessary data, so that can happen a lot.
For example, on NYU Langone’s price transparency website, you’ll find only standard fees and a patient estimation tool, which uses information about your insurance plan to create a custom estimate of how much you’ll pay for a particular procedure.
Those tools provide limited information. The standard cost can tell you the maximum you could pay for a particular service, and the patient estimator shows the out-of-pocket costs associated with simple services such as mammograms and blood tests. However, when a Times reporter tried to use NYU’s site in late July, it generated error messages for all the services examined.
A representative from NYU Langone declined to comment on why the hospital had not published its full details.
With compliance rates still low, the federal government pledges to step up enforcement. It has sent nearly 170 warning letters to hospitals that violate the rules and plans to increase fines for non-compliance from $109,500 a year to a staggering $2 million.
If you believe that a hospital has not posted the required information, you can file a complaint with the federal government to let it know about the problem.
Third-party sites will soon be able to help
Some health care experts say the large databases will become more useful after third-party data companies clean up and organize the information so patients can search across multiple hospitals and healthcare services.
A data transparency company, Turquoise Health, has already created a free price lookup tool. Others are expected soon.
Do you see anything surprising? Tell us about it.
The Times has looked at data sets from 60 hospitals so far. But there are many more.
If you notice anything surprising in a hospital pricing record – exceptionally high prices, for example, or large variations in what a service costs – we’d love to hear about it. You can email us with what you have found.