Question: Why do hospitals charge different prices for the same procedures?
From: Shanna G. of Niwot, CO
Answer: There never seems to be a simple answer to healthcare questions and this one is no exception. Insured patients pay different amounts based on a negotiated rates between the hospitals and the insurance companies. Insurers and hospitals negotiate rates based on the volume of patients with that insurance who are treated at that hospital. The higher the number of patients sent to that hospital, the lower the negotiated rate. The patient is impacted by the deductible and patient financial responsibility. Hospital charges vary based on their proportions of Medicare, Medicaid, commercial, private pay, and charitable care cases. Medicare is starting to publish what it pays to individual hospitals. This may give patients an idea of the actual cost to the hospital as hospitals say Medicare pays slightly less than cost. Also, hospital charges do not include all the physician charges. I have heard from many people that it was very difficult to get a definitive charge for a procedure or that the amounts quoted ranged a great deal. An excellent site to check on the price of a procedure is www.vimo.com. It provides national statistics for a condition or procedure, including the number of patients with the condition, the number of hospitals included in the statistics, the average list price, the average negotiated price, and the average length of stay. The least expensive hospitals per condition are available as are the hospitals where procedures are most commonly performed. You can look up information by hospital name or zip codes.
Ruthann Russo, PhD, JD, MPH, RHIT, is a healthcare expert with more than 20 years of experience working in and advising healthcare organizations.
