A New York Times investigation of hospital pricing data found hospitals are charging patients vastly different amounts for the same basic services: procedures as simple as an X-ray or a pregnancy test. The investigation highlights examples of major health insurers negotiating unfavorable rates for their customers. In many cases, insured patients are getting prices that are higher than they would if they pretended to have no coverage at all.
The New York Times partnered with two University of Maryland-Baltimore County researchers, Morgan Henderson and Morgane Mouslim, to turn files published by hospitals on their Website – as part of the price transparency legislation that went into effect Jan 1, 2021 (AHT, 1/4/21) – into a database that showed how much basic medical care costs at 60 major hospitals.
The data does not yet show any insurer always getting the best or worst prices. Small health plans with seemingly little leverage are sometimes out-negotiating the five insurers that dominate the U.S. market. And a single insurer can have a half-dozen different prices within the same facility, based on which plan was chosen at open enrollment, and whether it was bought as an individual or through work.
According to the New York Times analysis, the disclosures of hospitals pricing data upends the basic math that employers and customers have been using when they try to get a good deal. People carefully weighing two plans — choosing a higher monthly cost or a larger deductible — have no idea that they may also be picking a much worse price when they later need care. Even for simple procedures, the difference can be thousands of dollars, enough to erase any potential savings.