Where Do Hospitals Post Their Prices? Part 3: The Medical Mine Field of Billing and Administration

There are thousands of procedures for hospitals to post, which makes their websites and price tools difficult to navigate. Additionally, the price usually varies with the insurance company you have. Finally, the terminology, use of codes for procedures, and abbreviations can make it difficult to know what you’re looking for, and sometimes incomprehensible to understand once you’ve found it.

In order to find the cost of a procedure, you first need to know the exact procedure. “Knee surgery” isn’t enough – you need to know the kind of procedure and how complex it is. Similarly, “X-ray” isn’t sufficient – you need to know what body part is being scanned, how many views you are getting, and potentially the purpose of the scan. It is much easier to find the cost if you know the “current procedural terminology” (CPT) code, which is the number the hospital uses to name procedures in billing. Most procedures you can look up here, though it is still helpful to know the details of the procedure and the medical terminology for it. Your doctor may be able to provide the code as well.

Once you have that code, hospitals vary in how you look up the actual cost. Some have a document on their website that you can download. Some hospitals even used their own estimate tools. Several of the ones I looked at used MyChart, an all-in-one patient tracking tool where if you have an account and your provider uses it, you can track your treatments and appointments as well as look up costs.

Of course, none of the price estimates are a guarantee of the final cost. Often there are additional charges, whether there are complications in a surgery or you get a lab test done, or a specialist or technician needs to get involved. For example, anesthesiologists are often paid separately, as are the radiologist technicians that operate x-ray machines.

The trouble here is two-fold: 1) finding those price estimator tools and price lists is not always easy, and 2) what some hospitals consider a “consumer-friendly format” is definitely not.

In terms of finding the tools, there was rarely any indication as to which documents were intended for consumers’ information, so I was misled several times in trying to look up costs. Some hospitals merely listed the required information in their “resources” section, buried among other pdfs and downloads on their site that cover similar but much harder to sort through explanations such as chargemaster lists,[2] which hospitals are also required to post on their websites but are next to useless for the average consumer. Most of the hospitals also put their “chargemaster” price list in a more visible location than their shoppable services list, or else didn’t have a specific “shoppable services” list at all. If there was no specific shoppable services list, there was usually a price estimate tool, but they varied in terms of effectiveness. It was even more difficult to find the price when chargemaster documents were listed more than once on the page.

Some hospitals did a better job of directing consumers to the correct tools. For example, Legacy Emanuel has a very clear section labeled “Use our price estimator” with a “Launch” button. A few others had a helpful “Get your estimate” button. These made it easier to find the information I was looking for, but even then it wasn’t always the best information. For example, MyChart can be a great tool to determine the cash price, but at most hospitals you have to input your specific insurance policy information to get an accurate estimate for what it would cost with insurance. Only a few hospitals like Bay Area District Hospital and Lake District Hospital made prices for different insurance plans available without going the extra step of inputting your own information.

Given the amount of information there is to sort through in looking for a price, I expected there to be more explanation for consumers on where to go, what information was being presented, and how consumers could use it. However, only one out of the 12 Oregon hospital webpages I looked at had a satisfying, thorough explanation of what information was on the page and what it meant for consumers or other parties looking at it: Samaritan Pacific Communities. Some other hospitals had good explanations and information, but split it up over several pages, making it difficult to find and to follow what they were talking about. A few other hospitals had a basic overview of what it was required to post under the law, but two had minimal or no explanation of what the materials were at all (Bay Area and Harney District).

Finally, the documents posted on the website were not always organized. Looking through a pdf or excel sheet (or pdf of an excel sheet) required an electronic search of the document for keywords, since there didn’t appear to be a rhyme or reason to the order in which the document listed prices or procedures. Hospitals that used MyChart made this a little easier, since it was a search for the CPT code or keyword. One hospital, Legacy Emanuel, used their own tool that was very easy to use, with the option to find your procedure by specialty or department.

These are just some things to look out for when trying to compare hospital prices yourself. Overall, finding the information got easier as I got more comfortable with the terms, website layouts, and what I was looking for, but certain hospitals definitely made it easier than others. If you need to look for a price before going to the hospital, here are some takeaways to make your life easier:

1. Most hospitals have their price information available or linked to on the price transparency page. Find that, and you might have to dig a little further to get the right tool, but at least you’re in the right place.

2. Know the CPT code or exact name of the procedure you are looking for. This will help with your search through the price list.

3. Don’t use the chargemaster. Look for an “estimate” tool first, and if there’s none, the odds are that you want the non-chargemaster list – it may or may not be named as the hospital’s “shoppable services list.”

4. Expect the actual cost of a procedure to be higher than the price you find. Often, technicians and other staff charges are not included in the prices listed. Regardless of the price you find, you should ask your doctor and insurance carrier for more information, and get an estimate directly from the hospital before you get the treatment in order to help prevent surprise billing later.