How Much is That Procedure?

Jaime Rosenthal, a senior at Washington University in St. Louis, called more than 100 hospitals in every state last summer, seeking prices for a hip replacement for a 62-year-old grandmother who was uninsured but had the means to pay herself.

The quotes she received might surprise even hardened health care economists: only about half of the hospitals, including top-ranked orthopedic centers and community hospitals, could provide any sort of price estimate, despite repeated calls. Those that could gave quotes that varied by a factor of more than 10, from $11,100 to $125,798.

One of the many problems with our health care system is that hospitals often have different ideas of what procedures should cost, and for some procedures, “quality” data doesn’t accompany “price” data, so it isn’t clear, for example, if paying for a “Mercedes” hip transplant is better off in the long-term than cheaper options. One good thing about this study was that top-ranked hospitals in the country often offered some the lowest prices for procedures, which: my mama told me, you better shop around, etc.

Photo: Cindy Funk

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8 Comments / Post A Comment

EvanDeSimone (#2,101)

This is why it is so hard to be an informed consumer of healthcare. So little is standardized or comparable.

“Hi there, I’m currently suffering from cardiac arrest on the sidewalk near 1100 19th Street, could you please fax me your price sheet and ambulance rates? Thanks!”

(This is why other countries think our health system is insane, btw)

lemons! (#384)

What if we all asked for a price estimate? Then it’d be a thing hospitals would expect. In conclusion, yes the hospitals need to be more clear about their billing.

blueblazes (#1,798)

@Dont Move to Finland — So… I work at a hospital that offers estimates. We have a hotline and everything. The challenge is that a lot of consumers think that “estimate” is the same as “guaranteed price,” then get upset and consult their lawyers when their real bill arrives. :)

So the nice ladies in our medical billing office could estimate that a hip replacement will cost $11,000, but if anything even slightly out of the ordinary happens (say, the patient has clotting issues, which is a very common side-effect) the price can end up doubling or tripling because of the longer hospital stay and the additional cost of rehab.

The thing about buying healthcare is that our STUPID system in this country (there, I said it!)is not all-inclusive. So you get a separate bill from the surgeon, the anesthesiologist, the hospital/facility for administration and supplies, the rehab facility, the ambulance company… the list can get pretty long. Plus, each of those entities sets its own prices and negotiates different prices based on income and insurance. So when you call the hospital and ask for an estimate, it will by necessity be a REALLY ROUGH estimate.

Even those of us who work here know how crazy-messed-up this is, but we don’t have the power to change it without Washington’s help.

lemons! (#384)

@blueblazes That is really great insight into the system. It’s all so very overwhelming.

acid burn (#113)

I would HOPE that that wouldn’t surprise hardened health care economists, because it doesn’t surprise me as a layperson at all. I have Kaiser, and they completely refuse to provide estimates or even reliably state whether something is covered. I’ve had so many experiences where I ask what something is going to cost me beforehand, they either won’t tell me or (more often) tell me that it’s completely covered under my plan. I say “Okay, I’d like that in writing before I do it,” and they say “No, we can’t do that.” I do the procedure anyway because, well, I have to, then I get a bill for it later.

Jenn@twitter (#2,325)

This doesn’t surprise me at all, sadly. Ten years ago, my boyfriend at the time was very sick, but didn’t want to go to the doctor because he didn’t have insurance. Finally, his landlady drove him to the ER nearby, which happened to be at a private hospital.

They set him up with an IV and wanted to run a full blood panel. But no one could tell us how much it was going to cost. He ended up agreeing to two very basic blood tests (which came back normal) and got another bag of saline to rehydrate him. The nurse also brought him a sandwich to see if he could keep food down. Four hours later, we left without a diagnosis and two weeks later, he got a bill for over $1500. He was able to negotiate it down to about $900 which he paid for over four months.

It was so frustrating, knowing that he needed care, but also knowing that we probably couldn’t afford it. Not being able to have any idea how much we were going to have to pay at the end of the day gave us so much anxiety!

I think this is surprising! I’ve never been in an American hospital and I guess I just assumed there was a price list of some sort posted. At the only hospital I’ve been to here (Mount Saint Joseph in Vancouver) there’s a sign at the front desk with the rates non-Canadian un-insured patients can expect to pay for the emergency room, daily ward, intensive care, ambulance, etc. I guess I just assumed American hospitals would have something similar.

So is it just a surprise every time? That’s a really odd way of doing things.

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