Hospital price lists fail to shed light on true costs of care

A ride to work on his bike, turned into an eight and a half month fight that could have bankrupted him.

“It turned my life upside down,” said Brian Gerke, who had recently relocated to Cape Coral from New York when he was hit by a car in September 2018.

Gerke was also uninsured at the time, and Lee Health billed him $93,000 for trauma response and surgeries after the accident.

He said none of it made sense, and he didn’t know if he was being charged too much.

The affordable care act required hospitals to make public their charge information in 2010, but the rule was not enforced until years later.

The Centers for Medicare and Medicaid services reminded hospitals of this rule, and asked them to post a machine readable format of their charge master price lists by January 2019.

In Southwest Florida, most hospitals have their charge master price list available online, albeit some are difficult to locate.

WINK News was able to download price information for Lee Health, NCH Healthcare System, Physicians Regional Healthcare System,  Bayfront Health and Fawcett Memorial Hospital.

“The chargemaster rate can be particularly helpful for consumers to use to better understand and compare charges from hospital to hospital or other care settings that offer similar services,” wrote April Washington, a spokesperson for CMS.

At first blush, it seemed impossible to locate charges on Lee Health’s charge master list for Gerke’s medical bill.  For example, his bill summary included “CT Scan”, and the list had dozens of charges for “computerized temography”.

In order to make any use of the pricing spreadsheets, an itemized bill is necessary.

The prices on Lee Health’s current chargemaster were actually slightly higher than Gerke’s itemized bill. A hospital spokesperson explained that prices are adjusted every year after October, and Gerke was billed prior to this adjustment.

Locating the same charge descriptions on his bill between hospital groups was virtually impossible.

For instance, when trying to compare the charge for semi-private room, there was nothing with that description on one hospital list but nearly twenty items on another.

“Some of these charge master (price lists) don’t even list by service. It’s listed by maybe your billing code so it’s really not useful to people,” said Caitlin Donovan of the National Patient Advocate Foundation.

Of the charges on Gerke’s bill that could be located across multiple hospitals, Lee Health had less expensive pricing.

But Donovan said the prices posted online are actually meaningless.

“It means nothing to patients because it also means nothing to the people who are charging it. Most of those prices are just made up and they are a lot higher than your insurers negotiated rate,” said Donovan.

Lee Health agreed.

Mary Briggs, spokeswoman for Lee Health, declined WINK News request for an interview but emailed the following statement:

“Lee Health supports transparency and giving patients access to information they need to make informed decisions about their treatment options. We’ve been posting average charges for common procedures on our website for more than 10 years.

The federal government’s requirement for hospitals to post their Charge Description Masters is admirable in its intent of transparency, but the machine-readable format they require is not consumer-friendly and does not inform people of what they may actually pay for a health care service.

Lee Health has a team of people who provide cost estimates and help people understand their medical bills. We encourage patients to give us a call anytime they have a question about health care costs.”

Gerke’s bill was actually paid at a negotiated rate much lower than the initial $93,000 charge.

He had to move back to New York to get on New York Medicaid to cover the bill, but once he did the price was discounted by $71,000.

Washington explained that the charge master requirement is a step towards transparency, and CMS also encourages hospitals to communicate with patients to understand their bills.

WINK news could not locate a chargemaster list for Lehigh Regional Medical Center and several calls to the media relations phone number at the hospital were not returned.

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Have you ever had medical bill sticker shock?  Email investigations@winknews.com and show us your bill.