Folks watching the comment section will recall Jerry’s mention of the new requirement that kicked in yesterday, brought to us by President Barack Obama’s great and awesome Affordable Care Act, that hospitals post their standard charges online. KELO-TV’s Don Jorgensen goes shopping for ultrasounds and colonoscopies in Sioux Falls and finds these prices:
A new federal law that went into affect Tuesday requires all hospitals to post an online list of the cost of their standard services.
…At the Sanford USD Medical Center in Sioux Falls, a standard ultrasound costs $136.
At Avera McKennan Hospital, when we searched ultrasound it shows the cost at $176.We also did a search on a colonoscopy, at Sanford the price is listed at almost $3,000, where at Avera a colonoscopy screening is listed at $865 [Don Jorgensen, “Hospital Prices Now Online,” KELO-TV, 2019.01.02].
Avera’s online price list looks a little lazy: while they claim to “fully support… price transparency,” Avera says its list “reflects hospital charges in effect on January 1. As a result, a patient’s bill for hospital services provided at a different date may contain different charges.” Funny: when other businesses publish their prices, those are actually the prices. When I log onto Amazon and see that a set of In-Motion Pro Ergonomic Foldable Crutches is $119.00, I don’t expect to hit Buy Now and get a message that, “Surprise! That was the price a few days ago. The price is now $150. Thanks for shopping!” A hospital, perhaps one of the most technologically advanced businesses in South Dakota, can’t provide daily updates of its price list? Really?
To the extent we can rely on the January 1 price list, Avera also shows some remarkable disparities in pricing from hospital to hospital. Let’s compare prices between Avera McKennan in Sioux Falls and Avera St. Luke’s here in Aberdeen (I’m just grabbing the first 35 matching procedures on each hospital’s list and sorting by price code, because price codes ought to be uniform across the organization, right?):
| FMN | Facility | Charge Code | Description | Charge |
| ASL | St. Luke’s | 01000002 | ROOM ICU | $4,168.00 |
| MCK | McKennan | 01000002 | ROOM ICU | $4,249.00 |
| ASL | St. Luke’s | 01000014 | ROOM SURGICAL UNIT | $1,720.00 |
| MCK | McKennan | 01000014 | ROOM SURGICAL UNIT | $1,948.00 |
| ASL | St. Luke’s | 01000025 | ROOM BHS ADOL UNIT SEMI | $2,277.00 |
| MCK | McKennan | 01000025 | ROOM BHS ADOL UNIT SEMI | $2,475.00 |
| ASL | St. Luke’s | 01000029 | ROOM BHS ACUTE UNIT SEMI | $2,277.00 |
| MCK | McKennan | 01000029 | ROOM BHS ACUTE UNIT SEMI | $2,475.00 |
| ASL | St. Luke’s | 01000030 | ROOM REHAB UNIT | $1,766.00 |
| MCK | McKennan | 01000030 | ROOM REHAB UNIT | $1,171.00 |
| ASL | St. Luke’s | 01000031 | ROOM NICU 174 | $3,341.00 |
| MCK | McKennan | 01000031 | ROOM NICU 174 | $4,427.00 |
| ASL | St. Luke’s | 01000032 | ROOM NURSERY | $1,333.00 |
| MCK | McKennan | 01000032 | ROOM NURSERY | $1,220.00 |
| ASL | St. Luke’s | 01100008 | OBSERVATION 1ST HOUR | $980.00 |
| MCK | McKennan | 01100008 | OBSERVATION 1ST HOUR | $92.00 |
| ASL | St. Luke’s | 01100009 | OBSERVATION EACH ADD HR | $64.00 |
| MCK | McKennan | 01100009 | OBSERVATION EACH ADD HR | $92.00 |
| ASL | St. Luke’s | 02000108 | FETAL NON STRESS | $186.00 |
| MCK | McKennan | 02000108 | FETAL NON STRESS | $566.00 |
| ASL | St. Luke’s | 02000119 | AMNIOCENTESIS DX ANY METH | $185.00 |
| MCK | McKennan | 02000119 | AMNIOCENTESIS DX ANY METH | $933.00 |
| ASL | St. Luke’s | 02000120 | EXTERNAL VERSION | $177.00 |
| MCK | McKennan | 02000120 | EXTERNAL VERSION | $2,178.00 |
| ASL | St. Luke’s | 02000183 | BLOOD ADMINISTRATION | $603.00 |
| MCK | McKennan | 02000183 | BLOOD ADMINISTRATION | $761.00 |
| ASL | St. Luke’s | 02000185 | INF THERAPY MED INITIAL | $325.00 |
| MCK | McKennan | 02000185 | INF THERAPY MED INITIAL | $348.00 |
| ASL | St. Luke’s | 02000186 | SUBQ/IM INJECTION | $105.00 |
| MCK | McKennan | 02000186 | SUBQ/IM INJECTION | $110.00 |
| ASL | St. Luke’s | 02000187 | CHEMOTHERAPY INF INITIAL | $551.00 |
| MCK | McKennan | 02000187 | CHEMOTHERAPY INF INITIAL | $651.00 |
| ASL | St. Luke’s | 02000188 | LEVEL 1 OP VISIT | $94.00 |
| MCK | McKennan | 02000188 | LEVEL 1 OP VISIT | $161.00 |
| ASL | St. Luke’s | 02000193 | INF THERAPY MED ADDL HR | $146.00 |
| MCK | McKennan | 02000193 | INF THERAPY MED ADDL HR | $153.00 |
| ASL | St. Luke’s | 02000204 | IMPLANTED VAD FLUSH | $77.00 |
| MCK | McKennan | 02000204 | IMPLANTED VAD FLUSH | $196.00 |
| ASL | St. Luke’s | 02000207 | LUMBAR PUNCTURE DX | $609.00 |
| MCK | McKennan | 02000207 | LUMBAR PUNCTURE DX | $414.00 |
| ASL | St. Luke’s | 02000211 | CHEMOTHERAPY INF ADDL HR | $105.00 |
| MCK | McKennan | 02000211 | CHEMOTHERAPY INF ADDL HR | $437.00 |
| ASL | St. Luke’s | 02000212 | CHEMOTHERAPY IV PUSH | $325.00 |
| MCK | McKennan | 02000212 | CHEMOTHERAPY IV PUSH | $349.00 |
| ASL | St. Luke’s | 02000213 | CHEMOTHERAPY INTRATHECAL | $1,205.00 |
| MCK | McKennan | 02000213 | CHEMOTHERAPY INTRATHECAL | $606.00 |
| ASL | St. Luke’s | 02000214 | CHEMOTHERAPY INTRAPERITONEAL | $522.00 |
| MCK | McKennan | 02000214 | CHEMOTHERAPY INTRAPERITONEAL | $349.00 |
| ASL | St. Luke’s | 02000215 | IV INJECTION INITIAL | $146.00 |
| MCK | McKennan | 02000215 | IV INJECTION INITIAL | $150.00 |
| ASL | St. Luke’s | 02000219 | INF THERAPY HYD INITIAL | $233.00 |
| MCK | McKennan | 02000219 | INF THERAPY HYD INITIAL | $348.00 |
| ASL | St. Luke’s | 02000220 | INF THERAPY HYD ADDL | $146.00 |
| MCK | McKennan | 02000220 | INF THERAPY HYD ADDL | $153.00 |
| ASL | St. Luke’s | 02000221 | INF THERAPY MED SEQUENTIAL | $146.00 |
| MCK | McKennan | 02000221 | INF THERAPY MED SEQUENTIAL | $153.00 |
| ASL | St. Luke’s | 02000222 | INF THERAPY MED CONCURRENT | $82.00 |
| MCK | McKennan | 02000222 | INF THERAPY MED CONCURRENT | $86.00 |
| ASL | St. Luke’s | 02000223 | IV INJECTION SUBSEQUENT | $135.00 |
| MCK | McKennan | 02000223 | IV INJECTION SUBSEQUENT | $140.00 |
| ASL | St. Luke’s | 02000224 | CHEMOTHERAPY INJ SQ/IM NONHORM | $193.00 |
| MCK | McKennan | 02000224 | CHEMOTHERAPY INJ SQ/IM NONHORM | $200.00 |
| ASL | St. Luke’s | 02000225 | INJECTION CHEMO SQ/IM HORMONAL | $193.00 |
| MCK | McKennan | 02000225 | INJECTION CHEMO SQ/IM HORMONAL | $200.00 |
| ASL | St. Luke’s | 02000226 | CHEMOTHERAPY IV PUSH ADDL | $227.00 |
| MCK | McKennan | 02000226 | CHEMOTHERAPY IV PUSH ADDL | $244.00 |
| ASL | St. Luke’s | 02000227 | CHEMOTHERAPY INF SEQUENTIAL | $407.00 |
| MCK | McKennan | 02000227 | CHEMOTHERAPY INF SEQUENTIAL | $433.00 |
| ASL | St. Luke’s | 02000249 | CIRCUMCISION NEONATE <=28 DAYS | $441.00 |
| MCK | McKennan | 02000249 | CIRCUMCISION NEONATE <=28 DAYS | $161.00 |
Circumcision is $441 in Aberdeen and $161 in Sioux Falls.Intrathecal chemotherapy is $1,205 in Aberdeen and $606 in Sioux Falls.But NICU in Aberdeen is $3,341 while NICU in Sioux Falls is $4,427. And “External Version” is $177 in Aberdeen but $2,178 in Sioux Falls.
Have fun, shoppers, seeing where you can get the better deal for what ails you… but remember: these prices were only good yesterday, so, even with federal law saying hospitals are supposed to be transparent with their pricing, we still don’t really know how much our trip to see the doctor will cost us.
A good start, but hospitals seem to be making it harder than it needs to be. Take Rapid City Regional Hospital in Rapid City, see if you can figure this thing out. https://regionalhealth.com/patients-families/about-your-hospital-bill
We, as consumers, need to push the providers into providing the costs of the services they provide with more black and white examples as in a complaint. With this tool, consumers should be able to work to control costs, not to feel frustrated.
In October I was bitten by a dog. I had to get the rabies series and gamma globulin shots, not to mention the wound care. I asked the doctors and nurses who did such a great job or each procedure what was the cost of each procedure. None of them had a clue. What they said was, anyone can refuse treatment based on cost or any other reason, but only one or two people in all of history have survived rabies without the shots. They said the cost of a funeral would be more, especially since I had Medicare. They didn’t figure I was so cheap I would retort, “I’ll skip the funeral, then.” But I was kidding. When it comes right down to it, when the grim reaper is standing nearby and you can save yourself with a few shots in the arm and four in the rear, you let those nurses pump you up, and don’t think about the costs.
….Until you get the bill, and they have miscoded the Medicare claim form for one of the rabies shots and you find you have to pay full cost for that shot, but not the other three. That’s when you start the calls to the medical provider to Medicare and back to the medical provider, pointing out the absurdity of them not covering the second rabies shot, but covering all the other shots. And they all agree something is wrong, but no one takes responsibility for fixing the situation. So far I’ve had two rounds of these calls for a total of six calls and around three hours of my time. I find out I can appeal, but I also find out it’s just a stupid modifier in a claim form that needs to be retracted by the provider, or ignored by Medicare and there is nothing I can do about any of this except call them every month and explain the situation again and tell them they won’t get their money from me until the bill reflects what I should actually pay.
Medicare For All believers need to understand that there is always going to be this issue. You’ll be covered, but it has to be coded right, and it will always be a hassle to get everything figured out. Maybe we should just have completely socialized medicine.
Several years ago, I investigated the costs of a colonoscopy and found two key things.
First, there is a *huge* cost difference between the same services delivered in an “inpatient” setting and an “outpatient” setting. An inpatient colonoscopy would have cost almost three times what an outpatient colonoscopy would have cost.
Second, my insurance plan would cover 100% of the colonoscopy cost if no problems were found – in other words, if the procedure were purely exploratory. However, if the clinical team found any benign polyps and went ahead and snipped them (good medical practice), then the colonoscopy would no longer be covered at 100%, and my deductible and copays would apply. My deductible was $5,000, so a single polyp could cost me thousands of dollars out of pocket.
Coming into more recent times, the acquisition of most medical practices by hospital systems has increased the likelihood that many services delivered in clinic settings – your doctor’s office – will be billed at hospital inpatient rates rather than at outpatient (doctor’s office) rates.
As more people have insurance with higher deductibles, copays, and “stop-loss” thresholds, it behooves all of us to be aware consumers.
Have pity on the doctors and nurses – they have no idea what the charges are for the services they provide. Think of expecting the commercial airline pilot to know the price of your ticket.
Medical and other health care costs are generally determined by a negotiated contract between each health care provider/hospital and each private insurance provider. [States and the federal government sets the price it will pay on behalf of Medicaid and Medicare enrollees, with that price frequently being below the actual cost of the care provided.] Hence, the same procedure can have numerous “prices,” depending upon who is paying the price.
That colonoscopy scam is practiced in Wisconsin, too. That’s one reason why I won’t get one.
True that on emergency’s. But the elective procedures is what this has mostly to do with. As you note, you cannot be loaded in an ambulance and ask the nurse assisting you what it is you have and then go to your search engine to look up the cheapest place to tell the ambulance driver to go to.
If a doc tells you that you need to have your knee replaced, but it is not an emergency, then you can shop. You may also consider Thailand for that orthopedic procedure and make a vacation out of it. It is your deductible and co insurance we are speaking of.
My colonoscopy costs:
Pre-Obamacare – my co-pay out of pocket was $275 (43 benign polyups, three of which were pre-cancerous *my first colonoscopy)
During Obamacare – my co-pay out of pocket was zero. Colonoscopies are covered under preventative procedures. (because of my first colonoscopy results, I get them every two years, now) – Kaiser Healthcare Insurance
Needless to say, Obamacare saves me money.
Porter:
I’m glad costs have reduced for you. Please remember that different insurance plans, different states, different insurers, and different providers may affect each patient’s out-of-pocket costs. In other words, as always, your mileage may vary.
Where are the procedure codes in these lists? You need those to ensure you’re comparing apples-to-apples across health systems.
Kind regards,
David
My mistake. Avera has a CPT column. But Sanford does not.
Curious, David: what’s the difference between the charge codes and CPTs? Is one in-house? Is CPT the more reliable code?
Hi Cory!
That’s correct. Procedure (CPT) codes are standardized for providers submitting claims to insurance or Medicare.
Kind regards,
David