|By Steve Twedt, Pittsburgh Post-Gazette|
|McClatchy-Tribune Information Services|
They also may soon become familiar with a new term: chargemaster.
The chargemaster is a hospital's master list of how much it will charge for services, including every treatment, test, scan and aspirin. But, unlike a restaurant that lists meal prices on a menu, the hospital prices are secret and -- almost uniformly -- many times higher than what the service actually cost the hospital to provide.
Most patients are not affected by charges because their insurer pays a pre-determined rate and the patient knows upfront what their deductible and co-payment will be. But those without insurance, or who are out-of-network, have no such protection.
"People need to know there's no rhyme or reason to what goes into your bill," said
As the region awaits details about the
While a 40 percent discount sounds like a bargain at the shopping mall, the same is not true for hospital charges. UPMC declined to provide specific information on its hospital charges, but some examples have come out:
--In February, the
--In January, a
UPMC is not unique among major U.S. health systems, nor are its charges the most eye-opening.
Earlier this month, a
Also this month, researchers at the University of
"Everybody knows that [the chargemaster] has no relation to reality," said
He noted a common rationale is that the charges must make up for the discounted payments negotiated with commercial insurers. "So I guess what the hospitals are saying is, 'We're going to make it up on the backs of the people who cannot afford it very well.'"
The chargemaster and accompanying out-of-network costs carry risks for both UPMC and Highmark. If people opt for a lower premium, narrower network plan such as Highmark's Community Blue, UPMC's health system loses patients. If people are concerned about the potential costs of out-of-network care at UPMC, they may switch insurers.
The other factor at play is secrecy surrounding hospital chargemasters, which means people often do not know how big a hole they're digging financially if they seek care at an out-of-network facility.
"One shouldn't have to wonder or worry about what a hospital will charge for every individual service or supply item," said
"For common procedures, the hospital and physician should tell you what the total cost will be upfront, and they should include a warranty that assures that if you get a complication they could have prevented, you won't have to pay more for them to treat it."
For all the criticism and dissatisfaction with chargemaster systems, changing or getting rid of something so embedded in the pricing structure would not be easy, said
Chargemasters serve as a reference price for
Then there are the administrative and technical obstacles. "My biggest member, HCA, has 165 hospitals nationwide and they have literally thousands of contracts with payers," said
Johns Hopkins and other
He doesn't see
"But when I go to the doctor, it costs 100 percent more," he said. "And the fact that it is hidden from everybody is egregious."
It may not remain hidden for long. One reason the chargemaster has not received greater attention before is that "only an infinitesimally small number [of patients] would ever pay the charges," said
The equation changes, though, if large numbers of Highmark subscribers find themselves out-of-network at UPMC.
"The problem," said
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