Price transparency seems like a no-brainer. Items and services show a clearly posted cost and we choose whether or not to purchase them. But there can be hidden fees, taxes, or add-on’s to just about anything. Thanks to dedicated providers like Longview’s Pacific Surgical Center (PSC), there won’t be any sticker shock when your final bill arrives.
Sometimes extra charges are statewide, like the 20.5% tax on Washington hard liquor sales. Other times they’re a blur like the speed-talking ‘document fees, tax, tag, and title’ they add at the end of every TV or radio commercial for new cars. But for medical procedures, variations are harder for the layperson to predict and calculate.
Beginning January 1, 2019, “hospitals will be required to post their price lists online in an effort to increase price transparency and empower consumers to make informed choices about their care…the list must include all items and services provided by the facility,” say industry experts.
This change is much appreciated by patients, no matter how they’re insured or pay for treatment. This is because, say researchers, “For the most part, consumers remain in the dark about what they will be asked to pay after visiting a primary-care doctor or undergoing an inpatient procedure. In that way, healthcare is unlike every other aspect of the consumer experience in America. It would be unimaginable to leave a broken-down car with a mechanic before getting a cost estimate, for example.”
According to their studies, only 3% of those polled compared health care costs and only 52% were aware of the price before receiving care.
But lists of numbers don’t take several key factors into account. What if you go in for a routine procedure and there are complications? What about emergency treatment? What if an operation isn’t covered but considered elective?
At PSC, skilled doctors work with your primary care physician on the best comprehensive course of treatment. Work is done on an outpatient basis, with no expensive overnight stays. Prices are listed on the website and include fees for the facility, surgeon, and anesthesiologist. Additional charges for hardware and implants, diagnostic tests—many of which can be done on site—and lab work are explained. Patients are presented with an up-front written estimate and financial counselors are available to help.
PSC will work with you on cash payments or bill your insurance or Medicare plan. But sometimes it’s cheaper to skip insurance red tape altogether. If the insurance carrier requires preauthorization, complicated red tape, or hoops to jump through, it may be quicker and less expensive to simply pay cash.
For example, Healthline reports that total knee replacement costs $57,000 in a hospital setting. At PSC, the cash price is only $20,500 which may be less than billing through insurance if you have a high deductible, co-pay, or coinsurance. Even patients on Medicare can expect to pay between $16,500 and $33,000 for hospitalization, surgery, and recovery.
However you pay for the procedure, it can feel overwhelming even with transparency pricing. When you shop around, don’t let cost be the determining feature. Say healthcare advocates, “list-price data…is usually not relevant to patients. That’s because patients don’t purchase individual services from hospitals and usually don’t know exactly what they will need during their hospital stay. In reality, patients receive a complex package of services during an episode of care, such as a knee replacement. Hospital-pricing information should be presented in the same way. In addition, patients covered by insurance rarely pay hospitals’ published list prices. While average list prices can be used by payers to distinguish high-cost from low-cost providers for specific services, patients pay a combination of insurer-negotiated rates, deductibles, and copayments or coinsurance.”
Instead make a list documenting your questions, concerns, insurance details, and price research and call PSC to schedule a consult. Let the staff walk you through the timeline, requirements, and financial expectations. You don’t have to postpone surgery due to cost or confusion. At PSC they’ll do everything possible to address issues, explain the fine print, and translate doctor-speak into plain English.
William Osler once said that “The good physician treats the disease; the great physician treats the patient who has the disease.” Medical stress is a very real thing and can keep us living with pain or reduced mobility. At clinics like PSC, transparency is a way of life and can leave you free to conquer the issue head-on.