Hospitals should share more information about the prices they charge and negotiate with insurers under a new federal rule, but in South Carolina, many are still not complying.
Under the transparency movement promoted by the Trump administration, the Medicare and Medicaid Service Centers asked all hospitals to post price sheets on their websites by January 1.
The rule is based on another that came into force a year ago. So, hospitals just had to share the gross costs before insurance or any discounts appeared. Many in the healthcare industry said the lists would be almost useless for patients.
Now, hospitals are forced to share the prices they negotiated with insurers.
The federal government, for its part, said it could soon begin to audit medical centers that do not comply.
This poses a dilemma for many organizations, as these rates are negotiated confidentially with insurers.
Most hospitals in South Carolina did not share the files.
Charleston area Roper St. Francis Healthcare, who did not disclose the required new information, urged patients to call the hospital to obtain a personalized price estimate.
“We continue to seek clarity from the federal government on how to fully comply with these rules without violating our agreements with payers and managed care providers that prohibit us from sharing negotiated fees,” a spokesman said in a statement.
O American Hospital Association, one of the largest lobbying groups in the country, has asked the new Biden government to practice leniency while hospitals face COVID-19.
The trading group, which recently lost a lawsuit to prevent the mandate from coming into effect, also said the new rules are not clearly defined, leaving hospitals uncertain about what they have to share.
Policy advocates say that while patients may not be experienced enough to use the information on their own, injecting price transparency into the skewed healthcare market in the United States will stimulate competition.
A spokesman for North Charleston Trident Health said in a statement that the provider has been sharing online price estimates since 2007. The HCAHis hospital system also wants patients to obtain a price range by contacting him directly.
“Trident Health is committed to supporting efforts to provide relevant information to help patients understand what their direct costs for hospital care may be so they can make informed decisions,” said a spokesman.
But the system also did not disclose the new required prices.
Prisma Health, the largest hospital system in South Carolina, did not answer questions about the price transparency rule. The organization has not yet posted the necessary documents.
However, at least a handful of groups in South Carolina hospitals are following the new rule. O South Carolina Medical University, Based on Pickens AnMed Health Cannon, Tidelands Health on the Grand Strand and Beaufort Memorial each hospital posted spreadsheets on their websites, showing a comparison of how much people with different insurance pay for hundreds of common procedures.
And while these prices are not yet a reflection of the part for which the patient is responsible, they do offer a view of how much the costs can vary based on the insurer that is paying for them.
For example, the price BlueCross BlueShield from South Carolina will pay for a state official to get a hip or knee prosthesis at AnMed hospital is almost $ 14,000 less than Aetna agreed to pay. And even the price of simple X-rays can vary by hundreds of dollars, depending on who covers them.
Reach Mary Katherine Wildeman at 843-607-4312. Follow her on Twitter @mkwildeman.