Hospitals often charge uninsured patients more than insurers for same services

Hospitals consistently bill uninsured and other cash-paying patients at their highest rates while giving discounts to insurers, The Wall Street Journal reported July 6.

Hospital billing data was confidential until Jan. 1, when CMS' price disclosure rule took effect. The rule requires hospitals to post a machine-readable file with the negotiated rates for all items and services and display the prices of 300 shoppable services in a consumer-friendly format. 

Now that rates are publicly available, researchers can compare insurance and cash-payment charges. The Journal used data compiled by price transparency startup Turquoise Health for its investigation. The Turquoise dataset comprised 1,550 hospitals that released both insurance and cash-payment rates.

The investigation examined hospitals’ price disclosures for 17 services identified by federal data and experts as those most likely to be sought by uninsured patients in emergency situations.

Below are three of the investigation's notable findings:

  1. Of the 1,550 hospitals, 319 (about 21 percent) bill uninsured patients at their highest rates for the majority of the services included in the study. For 171 of those hospitals, the cash rate was higher than or tied with the rates billed to insurers for all 17 services. This was the case for some hospitals owned by large health systems, such as Sioux Falls, S.D.-based Sanford Health and Yale New Haven (Conn.) Health System.

  2. For the 1,166 hospitals that disclosed rates for Medicare Advantage plans, the average charges for uninsured patients were 3.6 times the average rates billed to the Medicare Advantage plans.

  3. Cash prices often vary widely between hospitals in the same county. In the 270 counties where at least two hospitals have disclosed cash prices, the average difference between the lowest and highest prices for a complex emergency-room visit is $1,852.

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